Studies on Care Management Involving End-stage Care for the Elderly

护理管理的方法，重点是终末期护理的老年人，讨论在本报告。这个问题是从日本养老院提供临终关怀的现状中浮出水面的。通过这项研究可以清楚地看到，对医疗服务的需求，特别是对生命末期护理的需求，往往会增加，因此，设施居民往往被转到从事医疗护理的人那里。基于以上事实，我们得到了以下三点发现：老年人机构认为应该改善的临终关怀问题，不一定是老人家属希望改善的问题。因此，他们之间出现了一定的差距，这进一步导致了护理服务的恶化。住院医生的家属希望听到医疗机构的工作人员对病人生命结束时的情况作出详尽的解释。解释的次数越多，家庭对临终关怀服务的满意度越高。为了给住院病人提供高质量的临终关怀，住院病人或他的家人，或两者都必须清楚地表明他们想要得到的护理的意图，并且这些意图充分包括在机构的护理计划中。结合这三个发现，我的研究也清楚地表明，除了改善终末期护理的问题外，近年来还有越来越多的问题需要解决。其中之一是大多数医疗机构长期缺乏护理人员。由于人手不足，住院医生无法得到充分的照顾。日本通过实行老年护理保险制度，引进了护理管理制度。为了开发更高质量的终末期护理，通过我的研究，我清楚地认识到，必须立即建立一个由护理管理者主导的护理管理系统，其中应纳入以下三个方面：家属的意愿；设施面临的挑战；还有社会资源。作为我研究的一部分，本报告还讨论了如何改善养老院的终末期护理。少

Methods of care management, with a focus on end-stage care for the elderly, are discussed in this report. The issue has surfaced from the current situation of providing end-stage care at nursing homes for the elderly in Japan.Through this research it became clear that the need for medical services, particularly for care at the end of life, tends to increase, and thus facility residents are often turned over to people engaged in medical care.Based on the above facts, the following three findings were obtained :1. The issues of end-stage care that the facilities for the elderly think they should improve are not necessarily the ones that the families of the residents want to see improved. Therefore certain disparities appear between them, which causes further deterioration in providing care services.2. Families of the residents want to hear from facility personnel a thorough explanation of the conditions at the end of a resident's life. The more frequently that explanations are given, the … More more satisfied the families are in their feelings about end-stage care services.3. In order to provide quality end-stage care to the residents at the facility, it is necessary that either the resident, or his family, or both, clearly show their intentions regarding the care they want to be provided, and that those intentions are sufficiently included in the facility's care plans.Together with these three findings, it also became clear through my research that there have been mounting problems in recent years that need to be solved in addition to the issue of improving end-stage care. One of them is the chronic shortage of care-givers at most facilities. Due to the shortage of staff, sufficient care-giving can not be practiced for residents.A care management program has been introduced to Japan by implementing the elderly care insurance system. In order to develop end-stage care of higher quality, it became clear through my studies that it is critical to immediately create a Care Management System with care managers taking a lead in the project, in which the following three aspects should be incorporated: the family's wishes; the facility's challenges; and social resources.As a part of my studies, ways to improve end-stage care at nursing homes is also discussed in this report. Less