The effect of the 2018 Japan Floods on cognitive decline among long-term care insurance users in Japan: a retrospective cohort study

BACKGROUND@#The July 2018 Japan Floods caused enormous damage to western Japan. Such disasters can especially impact elderly persons. Research has shown that natural disasters exacerbated a decline in cognitive function, but to date, there have been no studies examining the effects of this disaster on the elderly. The object of this study was to reveal the effect of this disaster in terms of cognitive decline among the elderly.@*METHODS@#Study participants were certified users of the long-term care insurance (LTCI) system in Hiroshima, Okayama, and Ehime prefectures from May 2018 to June 2018. The observation period was from July 2018 to December 2018. Our primary outcome was cognitive decline after the disaster using a dementia symptomatology assessment. In addition to a crude model, a multivariate Cox proportional hazards model was used to assess the cognitive decline of victims, adjusting for age classification, gender, the level of dementia scale before the disaster occurred, residential environment, whether a participant used facilities shut down after the disaster, and population density. After we confirmed that the interaction term between victims and residential environment was statistically significant, we stratified them for the analysis.@*RESULTS@#The total number of participants was 264,614. Victims accounted for 1.10% of the total participants (n = 2,908). For the Cox proportional hazards model, the hazard ratio of the victims was 1.18 (95% confidential interval (CI): 1.05-1.32) in the crude model and 1.12 (95% CI: 1.00-1.26) in the adjusted model. After being stratified by residential environment, the hazard ratio of home victims was 1.20 (95% CI: 1.06-1.36) and the hazard ratio of facility victims was 0.89 (95% CI: 0.67-1.17).@*CONCLUSIONS@#This study showed that elderly living at home during the 2018 Japan Floods were at risk for cognitive decline. Medical providers, care providers, and local governments should establish a system to check on the cognitive function of elderly victims and provide necessary care support.

Association between Timed Up and Go Test and Subsequent Functional Dependency

Determinant Factors in Cost to Feed for Long-Term Care Facilities Residents / 보건행정학회지

BACKGROUND: The food and food service influence the quality of life and the general health condition of older persons living in long-term care (LTC) facilities. Purchasing good food materials is a ground of good food service. In Korea, the residents in LTC facilities should pay for the cost of food materials and ingredients out of their pocket because it is not covered by LTC insurance. This study explored what factors affect the cost of food materials paid by LTC facility residents and which factor affects most. METHODS: We used data from the study on out-of-pocket payment on national LTC insurance, which surveyed 1,552 family caregivers of older residents in LTC facilities. We applied conditional multi-level model, of which the first level represents the characteristics of care receivers and caregivers and its second level reflects those of LTC facilities. RESULTS: We found that the facility residents with college-graduated family caregivers paid 11,545 Korean won more than those with less than elementary-graduated ones. However, the income level of family caregivers did not significantly affect the amount of the food material cost of the residents. The residents in privately owned, large, metropolitan-located facilities were likely to pay more than those in other types of facilities. The amount of the food material cost of the residents was mainly decided by the facility level factors rather than the characteristics of care recipients and their family caregivers (intra-class correlation=82%). CONCLUSION: These findings suggest that it might be effective to design a policy targeting facilities rather than residents in order to manage the cost of food materials of residents in LTC facilities. Setting a standard price for food materials in LTC facilities, like Japan, could be suggested as a feasible policy option. It needs to inform the choice of LTC users by providing comparable food material cost information. The staffing requirement of nutritionist also needs to be reviewed.

The Impact of Weekend Admission and Patient Safety Indicator on 30-Day Mortality among Korean Long-Term Care Insurance Beneficiaries / 보건행정학회지

BACKGROUND: This study investigates the impact of weekend admission with a patient safety indicator (PSI) on 30-day mortality among long-term insurance beneficiaries. METHODS: Data were obtained from the National Health Insurance Service-Senior claim database from 2002 to 2013. To obtain unbiased estimates of odds ratio, we used a nested case-control study design. The cases were individuals who had a 30-day mortality event after their last medical utilization, while controls were selected by incidence density sampling based on age and sex. We examined the interaction between the main independent variables of weekend admission and PSI by categorizing cases into four groups: weekend admission/PSI, weekend admission/non-PSI, weekday admission/PSI, and weekday admission/non-PSI. RESULTS: Of the 83,400 individuals in the database, there were 20,854 cases (25.0%) and 62,546 controls (75.0%). After adjusting for socioeconomic, health status, seasonality, and hospital-level factors, the odds ratios (ORs) of 30-day mortality for weekend admission/PSI (OR, 1.484; 95% confidence interval [CI], 1.371–1.606) and weekday admission/PSI (OR, 1.357; 95% CI, 1.298–1.419) were greater than for patients with weekday admission/non-PSI. CONCLUSION: This study indicated that there is an increased risk of mortality after weekend admission among patients with PSI as compared with patients admitted during the weekday without a PSI. Therefore, our findings suggest that recognizing these different patterns is important to identify at-risk diagnosis to minimize the excess mortality associated with weekend admission in those with PSI.

The Effects of Welfare Center's Cognitive Improvement Program on the Community Elderly Provided by Nursing Student Volunteers and Social Welfare / 의료커뮤니케이션

PURPOSE: This study was conducted to investigate effects of welfare center's cognitive improvement program on the community elderly provided by nursing student volunteers and social welfare.METHODS: A quasi-experimental with non-equivalent control group pretest-posttest design was implemented. The participants were the community elderly with or without mild cognitive impairments (experimental group: 17, control group: 15). The experimental group participated in the cognitive improvement program for four months based on the demonstration program of the special grade of dementia in long-term care insurance for the elderly.RESULTS: After the intervention, the satisfaction with perceived social support (F=9.30, p=.005) was improved statistically between the experimental group and the control group, but there was no significant difference in MMSE-K, IADL, depression, EQ-VAS, and EQ-5D variables.CONCLUSION: These results indicated that a multidisciplinary approach or a variety of manpower is needed, in order to prevent the dementia of the elderly. However, in order to provide a systematic cognitive-based intervention, it was once again recognized that the training of relevant experts and the quality planning on them were very important.

Locomotive syndrome in Japan

The present aging rate in Japan of some 28% will continue to increase along with the advancing age of elderly persons. Therefore, the demand for care will also increase. Approximately 25% of the need for nursing-care defined by the Japanese long-term care insurance system is associated with disorders or deterioration of locomotive organs. Therefore, the prevention and treatment of diseases in the locomotor system and maintenance of motor function are important for extended healthy life span and to decrease the demand for long-term care. Based on this background, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, which is defined as reduced mobility due to impaired locomotive organs. Changes in locomotion must be noticed early to ensure the timely implementation of appropriate checks and measures of locomotion can uncover risk of acquiring LS. The acquisition of an exercise habit, appropriate nutrition, being active and evaluating and treating locomotion-related diseases are important to delay or avoid LS. The JOA recommends locomotion training consisting of four exercises to prevent and improve LS. Countermeasures against LS should become a meaningful precedent not only for Japan, but for other countries with rapidly aging populations.

Demand and willing to pay for oral hygiene service in long-term care insurance of elderly / 대한구강보건학회지

OBJECTIVES: This study was conducted to identify the demand and willingness to pay for oral hygiene services among elderly people with long-term care insurance. METHODS: Our study was a cross-sectional analysis. Subjects comprised 126 elderly individuals from long-term home-care centers. A total of 28 centers were selected through convenience sampling from among 78 centers in ○○. For analysis, semi-structured questionnaires that required about 20–30 minutes to complete were used. Analysis was performed using SPSS 23.0 software. RESULTS: The overall demand for oral hygiene services was 44.4%, and willingness to pay was 31.0%. Thirty-three people (58.9%) of elderly those who have demand for an oral hygiene service were willing to pay for the service, and 64 people (91.4%) who did not have a demand were not willing to pay for it. Among those with partial dependence on brushing, 65.6% had demand for oral hygiene services and 50.0% were willing to pay costs. Among basic livelihood beneficiaries, 69.6% were willing to pay for oral hygiene services; general subjects and relievers were less willing to pay. CONCLUSIONS: The overall demand for oral hygiene services among elderly people was 44.4%, and the willingness to pay was as low as 31.0%.

Health care perspectives on community care

The Ministry of Health and Welfare announced a plan for community care in March 2018. Community care is a concept of social services that includes residential, welfare, and health care services, as well as direct care. It is a policy to actively prepare for an aged society. Various services must be developed for comprehensive community care. It is especially necessary to ensure that adequate resources are provided for home care and visiting care. To achieve this goal, the benefit policies of health insurance and long-term care insurance must be changed. Community service providers and infrastructure must be expanded, and a diverse professional workforce should be trained. Doctors need training and experience as team leaders, as they will be able to work with nurses, nutritionists, and social workers. It will be particularly important to operate clinics as group practices rather than as solo practices. Change is also needed in community hospitals, which must receive orientations regarding early patient discharge plans and community-centered collaboration. Hospitals should serve as health care safety nets, including short-term stays and same-day care. Regional governance is important for community care. Doctors must work with a variety of institutions, including community health centers, welfare centers, and elderly facilities. Medical professionals should prepare for and lead future social changes.

Elderly Welfare System and Role of Dental Hygienists in Korea and Japan / 치위생과학회지

In accordance with the aged society, oral health care for the elderly is considered important to maintain general health. Although the role of dental hygienists is essential for proper health management of the oral cavity, research on the care system for the elderly people's oral health and on the role of dental hygienists in the field of elderly welfare is still insufficient. Hence, the aim of this study is to investigate the status of Korean elderly welfare system and dental hygienists by comparing them with those in Japan, a precedent of aged society. First, we compared and investigated the Japanese long-term insurance system, which provides an institutional basis for a long-term care system for the elderly in Korea. Second, the elderly welfare law and care system, focusing on oral care, were examined. Lastly, in elderly care, we analyzed the distinctions between Korea and Japan regarding dental hygienists' role and scope of work. Taken together, as a precedent of aged society, Japan has shown well-specialized and systematic welfare for the elderly compared with Korea. With the development of the welfare system for the elderly in Japan, the role and the workscope of dental hygienists have been expanded to improve quality of life of elderly people, as a key professional for elderly oral care. Therefore, we should perceive the need for improvement of long-term care insurance and the expansion of dental hygienists' work in Korea. In conclusion, these results could be used as basic data for improving the elderly welfare system and developing dental hygienists in Korea.

Correlation Between Walking Ability and Monthly Care Costs in Elderly Patients After Surgical Treatments for Hip Fractures

OBJECTIVE: To validate the relationship between residual walking ability and monthly care cost as well as long-term care insurance (LTCI) certification level in elderly patients after surgical treatment for hip fractures in Japan. METHODS: Elderly patients aged >75 years who underwent surgical treatment for hip fractures in our hospital were included. The preand post-surgical (6-month) walking ability and LTCI certification and the presence or absence of dementia was determined from medical records and questionnaires. Walking ability was classified into 6 levels used in our daily medical practice. Based on these data, we correlated the relationship between walking ability and the LTCI certification level. Further, based on the official statistics pertaining to the average monthly costs per person at each LTCI certification level, we evaluated the relationship between walking ability and monthly care cost. RESULTS: A total of 105 cases (mean age, 80.2 years; 16 men; 39 patients with dementia) were included. The correlation between walking ability and average monthly cost per person as well as LTCI certification level at 6 months postoperatively (r=0.58) was demonstrated. The correlation was found in both groups with and without dementia. CONCLUSION: The ability to walk reduced the cost of care in elderly patients who experienced hip fracture, regardless of the presence of dementia.

Factors Affecting Family Caregivers' Burden and Depression in Home-based Long-Term Care Service under the Long-Term Care Insurance System

PURPOSE: This study tried to identify changes in family burden after the introduction of the long-term care insurance and to examine the factors influencing subjective and objective caring burden and depression of family caregivers of elders receiving home-based long-term care. METHODS: Data were collected from 203 family caregivers of elders from August 1 to 31, 2015 using questionnaires. They were analyzed in descriptive statistics, t test, ANOVA test, and multiple regression analysis. RESULTS: The mean score of depression was 7.24, which suggested mild depression level. The subjective family burden was 2.71 and the objective burden 3.04. The factors affecting depression included subjective burden (t=5.08, p < .001), objective burden (t=2.80, p=.006), time of elderly care per day (t=−3.61, p < .001), caregiving duration (t=3.33, p=.001), age (t=3.13, p=.002), family relationship (t=2.48, p=.014), and economic status (t=1.99, p=.047). CONCLUSION: The family burden was most important influencing factor on caregiver's depression. Therefore, services and supports to alleviate caregivers' burden in the home-based care should be added to long-term care.

The Experience of Paid Family-Care Workers of People with Dementia in South Korea

PURPOSE: The South Korean government introduced the universal long-term care insurance program in 2008 that created a new employment category of “paid family-care worker” to assist the elderly with chronic illnesses including dementia. The aim of this study was to understand the lived experience of paid family-care workers of people with dementia in South Korea. METHODS: The study was a qualitative research design underpinned by interpretive description principles involving eight paid family-care workers. The participants were recruited by attaching the advertisement flyer in a notice board of an educational facility for paid family-care workers. RESULTS: Paid family-care workers struggled to manage the behavioral and psychological symptoms of their care recipients. Their workloads created physical, emotional, social, and financial burdens. However, the care-giving activities were encouraged through their sense of responsibility, filial piety, and personal religious beliefs. Financial subsidies from the government and help received from others were also identified as encouragements. The education course provided to them assisted them to improve their dementia-care capabilities. CONCLUSION: Understanding paid family-care workers' lived experience in dementia care in South Korea assists with the identification of their educational needs and level of support they require to improve dementia care in the home care environment. A number of suggestions are made to increase paid family-care workers' knowledge, clinical skills, and job satisfaction to reduce their burdens and work-related incidents, such as challenging behaviors from those being cared for.

Urinary tract infection: a cohort of older people with urinary incontinence / Infección del tracto urinario: cohorte de ancianos con incontinencia urinaria / Infecção do trato urinário: uma coorte de idosos com incontinência urinária

ABSTRACT Objective: To evaluate epidemiological aspects of urinary tract infection in older patients with urinary incontinence living in long-term care institutions in Belo Horizonte. Method: Concurrent cohort held from April 1st to October 1st, 2015. The study was conducted in two long-term care institutions in the city of Belo Horizonte, Minas Gerais, with 84 incontinent older people. Results: Cumulative incidence of urinary tract infection was 19% (95% CI: 7.83-23.19) and the incidence density was 3.6 cases/100 people-month of follow-up period. The variables Bacteriuria and Institution presented statistical association with the occurrence of urinary tract infection. Conclusion: It is observed that the incidence of urinary tract infection in the study was smaller than in other similar international and national studies, however this is an important world health problem for the older population, with impact on mortality of these individuals.

RESUMEN Objetivo: Analizar los aspectos epidemiológicos de infección del tracto urinario en ancianos con incontinencia urinaria, en residencias para ancianos de Belo Horizonte, Brasil. Método: Se realizó una cohorte del 1º de abril al 1º de octubre de 2015. Se realizó el estudio en dos residencias para ancianos de la ciudad de Belo Horizonte, del cual participaron 84 ancianos con incontinencia urinaria. Resultados: La incidencia acumulada de infección en el tracto urinario fue del 19% (IC 95%: 7,83-23,19) y la densidad de la incidencia fue de 3,6 casos/100 personas-mes por seguimiento. Las variables Bacteriuria y la residencia presentaron asociación estadística en la aparición de este tipo de infección. Conclusión: A pesar de que la incidencia de infección del tracto urinario en este estudio fue menor que en otros estudios nacionales e internacionales de mismo tema, es un grave problema de salud para los ancianos por todo el mundo, puesto que implica la mortalidad de ellos.

RESUMO Objetivo: Avaliar aspectos epidemiológicos da infecção do trato urinário em pacientes idosos com incontinência urinária, residentes em instituições de longa permanência, de Belo Horizonte. Método: Coorte concorrente realizada no período de 01 de abril a 01 de outubro de 2015. O estudo foi realizado em duas instituições de longa permanência, na cidade de Belo Horizonte, MG, com 84 idosos incontinentes. Resultados: A incidência acumulada de infecção do trato urinário foi de 19% (IC 95%: 7,83-23,19) e a densidade de incidência foi de 3,6 casos/100 pessoas-mês de seguimento. As variáveis Bacteriúria e Instituição apresentaram associação estatística com a ocorrência de infecção do trato urinário. Conclusão: Observa-se que a incidência de infecção do trato urinário no estudo foi menor que em outros estudos nacionais e internacionais semelhantes, no entanto trata-se de um importante problema de saúde mundial para os idosos, com impacto na mortalidade desses indivíduos.

New Proposal of Private Insurance Program for Dementia Patients: Design of Sustainable Private Insurance Program in Korea

The purpose of this study is to examine interventions and supporting systems by dementia stage, take a look at dementia insurance policies in Korea and the United States, and present Korean private insurance programs for dementia patients. According to the study, our suggestions of a design of private insurance products for Korean dementia patients are as follows. First, the products should support people aged 80 and older. Second, new products should include the mild stage dementia in the insurance coverage. Third, non-pharmacological treatments, such as the cognitive stimulation, the cognitive training, and exercises need to be covered through the new private insurance. Fourth, the private insurance should be contained home health care services in its coverage. These suggestions can reduce the dependence of the public insurance, help people choose appropriate treatments for themselves, and give people a good opportunity to improve the effect of dementia treatment and to increase the satisfaction of patients and their families.

A Panel Study on the Determinants of the Regional Variation in the Rate of Certification in Long-Term Care Insurance / 보건행정학회지

BACKGROUND: There have been deviations in the regional rate of certification in Korean long-term care insurance (LTCI). This study aimed to explore the determinants of the rate of certification in LTCI. METHODS: The panel data of the year 2010–2014 of the 227 National Health Insurance Service (NHIS) regional office were used. Making use of 26 explanatory variables (socio-demographic factors, access to the long-term care services, etc.), we estimated the random effects model using STATA SE ver. 13.0 program (Stata Corp., College Station, TX, USA) and tried to find out the determinants of the regional rate of certification. RESULTS: Estimation results showed that the most important determinants of the regional rate of certification in LTCI are the long-term care infrastructure such as capacity or number of the homecare service institution, sanatorium, or convalescent hospital. The number of the elderly who lives alone and the dimentia patients were positively related to the regional rate of certification in LTCI. CONCLUSION: The estimation results implied that the regional variation in the rate of certification in LTCI has nothing to do with the NHIS regional offices or their employees. To alleviate the deviation in the regional rate of certification in LTCI, we suggested the analysis of the deviation in the survey checklist. We also proposed to found the regional comprehensive support center to prevent the geriatric illness and to improve the residents' health, etc.

Perspectives and Challenges for Geriatric Medicine / 대한내과학회지

Korean society is aging rapidly. Overall, 13.1% of the Korean population was elderly (age ≥ 65 years) in 2015, and this rate is expected to reach 40.1% in 2060. To prepare for this change, the Korean government has developed a long-term care insurance service and supports regional medical centers for the aged. It has established laws about life-sustaining treatment and directives to improve end-of-life care. Although the long-term care insurance currently provides ‘ in-home service’ and ‘ aged care facilities,’ it does not cover rehabilitation hospitals, which can prevent elderly individuals from accessing certain medical services. With the changing demographics, medical care requires change. Conventional medical care must be upgraded to provide suitable care for an aged society. It is important to support the activities of daily living, rather than simply prolonging life. This will require providing homeand community-oriented medical care to improve quality of life. It will also be necessary to train more geriatricians who understand the characteristics of elderly patients, provide comprehensive geriatric assessments, and lead other physicians in team-based medicine. Internists are already engaging in multidisciplinary collaboration and end-of-life care, which are critical qualities of leading geriatricians. Further discussion and consensus is needed regarding the training of geriatric medicine specialists in Korea.

Differences in Family Caregivers' Opinions about Out-of-Pocket Payment for Long-Term Care Facilities by Income Levels / 보건행정학회지

BACKGROUND: The purpose of this study is to investigate family caregivers' opinions about out-of-pocket payment for long-term care (LTC) facilities, and find the differences in the opinions for family caregivers of all different levels of income. METHODS: We used the data of the study on out-of-pocket payment in national long-term care insurance, including 1,552 family caregivers with the elderly in long-term care facilities. RESULTS: The average out-of-pocket payment per month was 511,635 Korean won and distributed from 230,750 to 1,365,570 Korean won. The amount of out-of-pocket payment might be affected by not co-payment but the cost of non-covered service. There were differences in them for family caregivers of all different levels of income. Opinions were surveyed about 5 issues. By levels of income, there were differences in their opinions about 3 issues, the financial burden on LTC, the necessity of reducing out-of-pocket payments, and to be willing to pay more for a high quality service. But there were not different opinions about the interruption of LTC service and staying with LTC facilities. CONCLUSION: These findings suggest that the range of out-of-pocket payment for LTC facility is wide and it can be a burden to lower income group. It should be to prepare the policies to ease the financial burden and support the appropriate LTC use.

Hospice & Palliative Care Policy in Korea / 한국호스피스완화의료학회지

Globally, efforts are being made to develop and strengthen a palliative care policy to support a comprehensive healthcare system. Korea has implemented a hospice and palliative care (HPC) policy as part of a cancer policy under the 10 year plan to conquer cancer and a comprehensive measure for national cancer management. A legal ground for the HPC policy was laid by the Cancer Control Act passed in 2003. Currently in the process is legislation of a law on the decision for life-sustaining treatment for HPC and terminally-ill patients. The relevant law has expanded the policy-affected disease group from terminal cancer to cancer, human immunodeficiency virus/acquired immune deficiency syndrome, chronic obstructive pulmonary disease and chronic liver disease/liver cirrhosis. Since 2015, the National Health Insurance (NHI) scheme reimburses for HPC with a combination of the daily fixed sum and the fee for service systems. By the provision type, the HPC is classified into hospitalization, consultation, and home-based treatment. Also in place is the system that designates, evaluates and supports facilities specializing in HPC, and such facilities are funded by the NHI fund and government subsidy. Also needed along with the legal system are consensus reached by people affected by the policy and more realistic fee levels for HPC. The public and private domains should also cooperate to set HPC standards, train professional caregivers, control quality and establish an evaluation system. A stable funding system should be prepared by utilizing the long-term care insurance fund and hospice care fund.

Envejecimiento y cuidados a largo plazo en Chile: desafíos en el contexto de la OCDE / Aging and long-term care in Chile: challenges in the OECD context / Envelhecimento e assistência a longo prazo no Chile: desafios no contexto da OCDE

RESUMEN Chile se encuentra en pleno proceso de transición demográfica y su población envejece rápidamente. Esta situación presenta múltiples desafíos de política pública, incluidos los del área de la salud pública. En concreto, la relación entre el envejecimiento y la pérdida de la autonomía exige diseñar con urgencia una política de cuidados a largo plazo en el país. El objetivo de este documento es describir el escenario actual de los cuidados a largo plazo en Chile usando la experiencia de los países de la Organización para la Cooperación y el Desarrollo Económico, para poner de manifiesto la necesidad de avanzar en el diseño y el financiamiento de una política coordinada en el país, que permita afrontar con antelación los desafíos del envejecimiento en las próximas décadas.

ABSTRACT Chile is fully in the process of demographic transition, with a rapidly aging population. This situation poses multiple public policy challenges, including those in the public health sector. Specifically, the association between aging and the loss of autonomy calls for the rapid design of a long-term care policy in the country. The purpose of this article is to describe Chile's current situation with respect to long-term care in aging, using the experience of the countries of the Organisation for Economic Co-operation and Development to draw attention to the need to move forward with the design and financing of a coordinated policy in the country that will permit early action to meet the challenges of aging in the coming decades.

RESUMO O Chile está em pleno processo de transição demográfica e a população do país está envelhecendo rapidamente. Esta situação apresenta vários desafios de políticas públicas, inclusive em saúde pública. Especificamente, a relação entre o envelhecimento e a perda de autonomia requer o planejamento com urgência de uma política de assistência a longo prazo no país. O objetivo deste documento é descrever o cenário atual de assistência a longo prazo diante do envelhecimento no Chile com base na experiência dos países da Organização para a Cooperação e Desenvolvimento Econômico a fim de evidenciar a necessidade de avançar no planejamento e financiamento de uma política coordenada que permita enfrentar com antecedência os desafios do envelhecimento no país nas próximas décadas.

Regional Comparison of Home Visiting Care Service Satisfaction among Elder Beneficiaries of the Long Term Care Insurance

PURPOSE: This study aims at comparing levels of service satisfaction with and needs for visiting nurse(VN) services among their beneficiaries in order to make a plan for extending VN services. METHODS: The number of the subjects of this study is 270 in total. They were selected in random sampling in which 30 VN service recipients were randomly selected from each of 7 regions based on their grades and region types. RESULTS: The highest total score for satisfaction with the VN services was 46.30, which the rural residents gave to their received VN services, then the metropolitan residents gave 44.57, and the small and middle size cities' residents 43.64. On the other hand, the highest total score for needs for VN services was 33.03, which the small and middle size cities' residents gave to their received VN services, then the rural residents gave 31.68, and the metropolitan residents 30.88. CONCLUSION: As the small and middle size cities' residents showed low satisfaction with and high needs for local VN services, policies need to be made to promote service providers' expertise and accessibility.