Tsutsui Takako, Muramatsu Naoko, Higashino Sadanori
National Institute of Public Health, Ministry of Health, Labour and Welfare, Saitama, Japan.
School of Public Health, University of Illinois at Chicago.
Gerontologist. 2014 Oct;54(5):797-807. doi: 10.1093/geront/gnt093. Epub 2013 Sep 5.
Japan introduced a nationwide long-term care insurance (LTCI) system in 2000, making long-term care (LTC) a right for older adults regardless of income and family availability. To shed light on its implications for family caregiving, we investigated perceived filial obligation norms among coresident primary family caregivers before and after the policy change.
Descriptive and multiple regression analyses were conducted to examine changes in perceived filial obligation norms and its subdimensions (financial, physical, and emotional support), using 2-wave panel survey data of coresident primary family caregivers (N = 611) in 1 city. The baseline survey was conducted in 1999, and a follow-up survey 2 years later.
On average, perceived filial obligation norms declined (p < .05). Daughters-in-law had the most significant declines (global and physical: p < .01, emotional: p < .05) among family caregivers. In particular, physical support, which Japan's LTC reform targeted, declined significantly among daughters and daughters-in-law (p < .01). Multiple regression analysis indicated that daughters-in-law had significantly lower perceived filial obligation norms after the policy introduction than sons and daughters (p < .01 and p < .05, respectively), controlling for the baseline filial obligation and situational factors.
Our research indicates declining roles of daughters-in-law in elder care during Japan's LTCI system implementation period. Further international efforts are needed to design and implement longitudinal studies that help promote understanding of the interplay among national LTC policies, social changes, and caregiving norms and behaviors.
日本于2000年引入了全国性的长期护理保险(LTCI)系统,使长期护理(LTC)成为老年人的一项权利,无论其收入和家庭状况如何。为了阐明该系统对家庭护理的影响,我们调查了政策变化前后同住的主要家庭照顾者所感知的孝道义务规范。
使用某城市同住的主要家庭照顾者(N = 611)的两波面板调查数据,进行描述性和多元回归分析,以检验所感知的孝道义务规范及其子维度(经济、身体和情感支持)的变化。基线调查于1999年进行,两年后进行随访调查。
平均而言,所感知的孝道义务规范有所下降(p < .05)。在家庭照顾者中,儿媳的下降最为显著(总体和身体方面:p < .01,情感方面:p < .05)。特别是,日本长期护理改革所针对的身体支持方面,女儿和儿媳的下降尤为显著(p < .01)。多元回归分析表明,在引入政策后,儿媳所感知的孝道义务规范显著低于儿子和女儿(分别为p < .01和p < .05),同时控制了基线孝道义务和情境因素。
我们的研究表明,在日本长期护理保险系统实施期间,儿媳在老年人护理中的作用在下降。需要进一步开展国际合作,设计并实施纵向研究,以促进对国家长期护理政策、社会变革以及护理规范和行为之间相互作用的理解。