A qualitative inquiry on the effective support for the use of social services by the older adults with dementia and their family

摘要本研究旨在探讨失智长者及其家人使用社会服务的过程，并探讨有效的社会服务支持。我们通过各种社会服务机构如家庭护理站招募研究参与者。在获得参与研究的同意后，我们对家庭成员及其护理经理进行了定性访谈。我们采访了16对家庭/护理经理。社会服务使用障碍分为4组：1)护理经理问题，2)老年人问题，3)家庭问题，4)服务系统/其他问题。障碍的细节及其在每种情况下如何产生影响，以及家庭成员如何处理这些障碍，根据社会服务的类型而有所不同。造成这种差异的因素有很多。首先，一些家庭很难找到护理经理并与之联系。第二，老年人的意愿是服务使用的重要因素，但它对实际服务使用的影响程度取决于老年人与主要家庭照顾者之间的亲属关系类型。还有人建议，老年人和家人都必须接受老年人的衰老，才能继续使用这项服务。一些家庭提到了服务使用的经济负担。在协助老年人及其家庭使用社会服务方面，护理管理人员采取了多种方法。一般来说，服务的使用量是逐渐增加的，这样老年人和家人就可以逐渐习惯这项服务。许多非护士护理管理人员讨论了他们在估计老年人未来身体状况方面的困难，而其他非护士护理管理人员则没有这样的困难。

The purpose of this study was to elucidate the process of social service use by the older adults with dementia and their family and to conceptualize effective support for them. We have recruited study participants through various social service agencies such as home care nursing stations. Upon acquiring consent to participate the study, we have conducted qualitative interviews to the family members and their care managers.We have interviewed 16 pairs of family/care managers. The barriers of social service use were categorized into 4 groups : 1) issues around care manager, 2) issues around the older adult, 3) issues around the family, and 4) issues around the service systems/others. The details of the barriers and how they take effect in each case as well as how the family members dealt with the barriers were different according to the types of social services. There are multiple factors that relate to the differences. First, some families have difficulty in finding and connecting to the care manager. Second, the willingness of the older adult is a significant factor of service use but how much it influences the actual service use depends upon the type of kin relationship between the older adult and the primary family caregiver. It was also suggested that both older adult and the family must accept aging of the older adult before they can move on to use the service. Some families refer to the financial burden of service use.There was a variety of approach by the side of the care managers in assisting older adults and their family in using social services. Typically the service use is gradually increased in the amount so that the older adult and the family can gradually get used to the service. Multiple non-nurse care managers discussed their difficulty in estimating future physical condition of the older adults, while other non-nurse care managers do not have such a difficulty.