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-

随着长期护理保险政策的实施，护理管理的结构主要基于那些需要这种服务的人的需求。护理管理者的存在和定位已被证明在这种护理管理中发挥着关键作用。根据去年进行的研究，发现护理经理需要掌握新的护理管理技能来满足他们的要求。本研究以神奈川县护理管理人为研究对象，收集护理管理的基本资料，共收集有效问卷408份--问答书面研究、有关工作时间内容的研究及口头(访谈)研究。问答书面研究了解护理管理人的状况、护理管理内容及负担。通过记录每个经理在一个月的工作时间内进行的具体工作内容，可以揭示和分析实际进行的工作水平，Highlight ti…更多的NG问题，并提供可能的改进解决方案。在此基础上，通过口头调查了解个人的工作情况，结果表明：获得的初始资格为：“健康护士/护士”--40%，“执业护理员”--24.9%--“执业社会工作者”--8.1%。护理经理所属的组织：“社会福利基金会”--36.4%，“医疗服务基金会”--23.3%，“私营企业”--23.3%。平均持有的客户数量从40到59人不等。最高数量的护理经理提出了“护理管理的重要性？因为他们获得这一职位的原因是“注册社会工作者”。获得这一职位的最高年龄段是50岁以上。关于护理管理的实际内容，在“长期护理保险单的条款”、“护理管理人的作用”和实际的“合同”方面缺乏相互了解。那些没有使用任何结构化测量进行评估的人-24%。那些承认客户的“非正式护理网络”的人--26%。完全了解客户“财务状况”的受访者比例为35%。在实际工作时间内，在办公室花在电话上提供护理、获取信息和记录这些结果的时间要长得多，这使得探望客户的实际时间比最初预期的要少得多。采用陶氏职业倦怠量表测量护理管理者的主观负担，确定了4个因素：情绪衰竭、个人成就感、去人格化和任务成就感.较少

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