The Changes of Quality and Structural Provision of Domiciliary Care Coinciding with the Statute Long Term Care Insurance Policy-A Study of the Task and Responsibilities of Care Managers-

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With the implementation of the Long Term Care Insurance Policy, care management was structured based mainly on the needs of those in need of such services. The existence and positioning of the Care-Managers have proven to play a critical role of such care management. According to research held last year, it was found that Care-Managers need to acquire new care management skills to fulfill their requirements. Research was conducted toward the Care-Managers within Kanagawa Prefecture to gather basic data regarding care management from which 408 valid answers were gathered- question＆answer written research, research concerning the content of the working hours and verbal (interview) research.The question＆answer written research made apparent the status of Care-Managers, the content of care management and burden. By recording the specific content of work conducted during each Manager's working hours for one month, the level of work actually conducted can be revealed and analysed, highlighti … More ng problems and providing possible solutions for improvement. Further, verbal research was conducted to understand personal working conditions.The result showed that : The initial qualifications held are ; "Health Nurse/Nurse"-40%, "Certificated Care-Worker"- 24.9% "Certificated Social Worker"-8.1%. The organization to which the Care-Managers belong to are ; "Foundation for Social Welfare. " -36.4%, "Foundation for Medical Services"-23.3%, "Private Corporations"-23.3%. The average number of clients held ranged from 40 to 59.The highest number of Care-Managers that raised "significance of care management? as the reason for their acquisition of their position was "Certified Social Workers". The highest age-group that acquired such position was over 50 years old. In regard to the actual content of care management, there is a lack of mutual understanding in regard to the "Terms of the Long Term Care Insurance Policy", "Role of the Care-Managers" and the actual "Contract". Those that do not use any structured measurements for Assessment - 24%. Those that acknowledge the client's "Informal Care Network" - 26%. Those that fully understand the client's "Financial Status" - 35%. Within the actual working hours, the hours spent on the phone to provide care, to acquire information and to record such results at the office took much time making the actual time spent visiting the clients much less than initially anticipated. The subjective burden of care managers measured by the Tao's Burnout Scale were identified 4 factors, emotional exhaustion, personal accomplishment, depersonalization and task accomplishment." Less