Supplementary Table 3.

Certification Levels in Long-Term Care Insurance System in Japan

Certification Level	Description
Independent	A person who can perform ADL∗ and IADL† independently and needs neither support nor care
Support required 1	A person who can perform most ADL independently, but needs some support for IADL
Support required 2	A person whose ability to perform IADL is slightly lower than that of persons in the Support required 1 level and needs more support
Care level 1	A person whose ability to perform IADL declined further from that of persons in the Support required category and needs care
Care level 2	A person who needs support for ADL in addition to support for IADL
Care level 3	A person whose abilities to perform ADL and IADL declined significantly and needs constant care
Care level 4	A person whose ability to perform ADL declined further from that of persons in Care level 3 and has difficulty living his or her daily life without care
Care level 5	A person whose ability to perform ADL declined further from that of persons in Care level 4, and it is almost impossible to live his or her daily lives without care

^∗ADL (the Activities of Daily Living) are basic skills required to independently care for oneself, such as eating, bathing, and walking.

^†IADL (the Instrumental Activities of Daily Living) are skills required to live independently in a community, such as cooking, cleaning, and transportation.