Estimation of the required care level of the disabled elderly using Minimum Data Set-Home Care

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In long-term care insurance, the required care level of the disabled elderly is calculated from the results of the basic investigation. However, this calculation involves complex mathematical processes, and the estimation of the required care level at small facilities is difficult. We, therefore, developed a tree model that allows simple estimation of the required care level from the state of noticeable disabilities in daily activities. The model was prepared separately for dementia and physical disabilities. From the patients being cared for at Higashiyama Sanatorium for the Elderly who had undergone primary rating, a total of 240 individuals consisting of 20 each in each of the 6 required care levels for both dementia and physical disabilities were selected, and the results of their primary rating were reviewed. "Putting on and taking off the jacket", in which the required care level increases relatively consistently as the investigation items progress from those for "independent" to … More those for "totally assisted", was selected as the first selection item. In each tree model, the state of "putting on and taking off the jacket" was matched for various required care levels as follows. Dementia model: "independent"→assistance needed, "observation needed" and "independent" in "standing up"→required care level 1,"observation needed" and "not independent" in "standing up"→required care level 2, "partly assisted" required care level 3,"totally assisted" and "not totally assisted" in "eating"→required care level 4,and "totally assisted" and "totally assisted" in "eating"→required care level 5. Physical disability model: "independent" or "observation needed" and "independent" in "care after urination" and "independent" in "walking"→assistance needed, "independent" or "observation needed" and "independent" in "care after urination" and "dependent" in "walking"→required care level 1,"independent" or "observation needed" and "dependent" in "care after urination"→required care level 2; required care levels 3-5 were the same as in the dementia model. The accuracy rate, i.e. the frequency of complete matching between the estimation of the required care level using this tree and that of the primary rating, was 70% in those with dementia and 64.2% in those with physical disabilities. The near accuracy rate, i.e. the frequency of matching between the two estimations within one rank higher or lower was 98.3% in those with dementia and 96.7%. in those with physical disabilities. From these results, this tree model is considered to be useful for clinical rating. Less