A research on the reconstruction of community care management system

社区照护管理制度重构研究本研究的目的是调查目前在肺期照护保险制度下社区所提供的照护服务，并提出符合社区需要的照护服务。本研究基于以下两个研究：1.对岐阜州A市老年人个人长期护理需求认证考试所获得的信息进行统计处理。2.个别护理管理者决策个案研究。结果1：从“需要支持”到护理二级的护理需求程度相对较低的老年人，主要参加家访、长期护理和家访/日间服务。更严重依赖护理服务的人往往会被送进机构。在CARE le…的人们的偏好更多的VELIV和V在机构和居家护理服务之间有明显的分裂，以III级护理为临界点，发现导致机构化的因素是与大小便失禁和痴呆症(因身体和/或精神功能障碍而制度化)和IADL(因日常生活不便而制度化)有关的问题，在选择机构护理服务的原因上呈现两极分化的趋势。结果2：在家中接受护理服务的护理水平较高的人是非痴呆的肢体残疾人或需要医疗护理但情况稳定的人，所谓卧床不起的人。研究发现，当大小便失禁、痴呆症或行为障碍等问题出现时，人们会因为在家庭护理服务下生活困难而改变他们的生活地点。从护理管理者的角度来看，当需要提供夜间护理和/或持续监测，或者患者变得无法与他人保持正常关系时，制度化是最受欢迎的。对卧床不起的人的护理服务可以以某种固定的模式提供，即使他们必须长时间或频繁地护理，因此，当情况允许护理提供者按计划工作时，家庭护理服务可以继续。较少

A research on the reconstruction of community care management systemObject of this research is to investigate the care services currently provided in communities under the Lung-term Care Insurance System, and propose the desirable care services that meet the needs of the community. The research was based on the following two studies :1.Statistical processing of information gathered through examinations for long-term care requirement certification of individual elderly persons in city A of Gifu Prefecture. Permission was obtained from city A for the use of the information for the purpose of statistical study.2.Case study on the decision made by individual care managers.Result 1: Elderly People with relatively low degree of needs for care, ranging from "support required" to care level II, are enrolled mostly for home-visit long-term care and home-visit/day services. People who are more heavily dependent on care services tend to be admitted to institutions. Preference of people at care le … More vels IV and V is clearly split between institutionalization and home care services, and care level III is regarded as the critical point, It was found that factors that lead to institutionalization are problems related to incontinence and dementia (institutionalization due to disorder in physical and/or mental functions) and IADL (institutionalization due to inconvenience in daily life), showing a trend of polarization in the reasons for selecting care services at institutions.Result 2: People of higher care levels who receive care services at their homes are physically disabled persons without dementia or persons who need medical care but in stable conditions, the so-called bed-ridden people.It was found that people change their places of life due to difficulty to live under home care services, when such troubles arise as incontinence, dementia or behavior disorder. From the view point of care manager, institutionalization is preferred strongly when it becomes necessary to provide nighttime care and/or constant monitor, or the patient becomes unable to maintain normal relationship with others. Care services for bed-ridden people may be provided in somewhat fixed pattern, even if they must be attended for a long period of time or frequently, and therefore home care services can be continued when the situation allows the care provider to work as planned. Less