• 한국사회정책
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• v.25 no.1
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• pp.125-159
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• 2018

The purpose of this study is to analyze the factors affecting service use intention of long-term care among the disabled. This study conducts a longitudinal study using the modified Andersen model by the disabled age groups of the 50-64 group and the 65 over group. This study examined random effects panel logit analysis for the 50-64 group and the 65 over group by age variations. The results have shown that there are different factors Influencing factors for each specific age group of the disabled(50-64, 65 over). The results were as follows: there are differences of factors between the 50-64 group and the 65 over group. This study found that predisposing factors of the service use intention of long-term care were significantly related to age, residential area, education status, existence of spouses. Enabling factors of the service use intention of long-term care were significantly related to long-term care service recognition, saving, personal salary income level, housing status. Need factors of the service use intention of long-term care were significantly related to chronic diseases, psychological health, IADL. So, there are a need for a policy considerations such as service for the mid-old age disabled by age groups. Finally, implications and future research directions were discussed based on the finding of the study.

• 한국노년학
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• v.30 no.4
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• pp.1027-1044
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• 2010

This study is to examine the effective system for providing services for long-term care elders, despite the expansion of formal care, informal care still is needed. Thus, this study's purpose is to classify the informal-formal resources linkages types of long-term care elders and looks into service satisfaction by these types and discover effective informal-formal resources linkages models. For that, this study is to divide informal-formal resources linkages types by the degree of providing services of informal and formal caregivers and discover the informal-formal resources linkages types using cluster analysis and explores the effectiveness of service satisfaction using multiple regression. The study's results is to suggest four models, such as family care, complementary, separation, formal service and complementary type was founded to be the most effective and then based on the result, we discuss as follows. First, we must strive to combine informal resources into formal service systemto the system for providing of service is made up the complementary type. Second, the system for providing services of long-term care elders is required integrated care system to alining of medical and long-term care services. Third, we have to consider a measure to improve of formal service type, for the satisfaction of formal service appears low relatively. Based on research findings, this study propose that the informal-formal resources linkages models are subdivided into the dimension of quantity and quality of care for improving the effectiveness of long-term care services.

• Health Policy and Management
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• v.27 no.2
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• pp.139-148
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• 2017

Background: The purpose of this study is to investigate family caregivers' opinions about out-of-pocket payment for long-term care (LTC) facilities, and find the differences in the opinions for family caregivers of all different levels of income. Methods: We used the data of the study on out-of-pocket payment in national long-term care insurance, including 1,552 family caregivers with the elderly in long-term care facilities. Results: The average out-of-pocket payment per month was 511,635 Korean won and distributed from 230,750 to 1,365,570 Korean won. The amount of out-of-pocket payment might be affected by not co-payment but the cost of non-covered service. There were differences in them for family caregivers of all different levels of income. Opinions were surveyed about 5 issues. By levels of income, there were differences in their opinions about 3 issues, the financial burden on LTC, the necessity of reducing out-of-pocket payments, and to be willing to pay more for a high quality service. But there were not different opinions about the interruption of LTC service and staying with LTC facilities. Conclusion: These findings suggest that the range of out-of-pocket payment for LTC facility is wide and it can be a burden to lower income group. It should be to prepare the policies to ease the financial burden and support the appropriate LTC use.

• Journal of Korean Academy of Nursing Administration
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• v.14 no.3
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• pp.229-240
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• 2008

Purpose: To develop the patient classification system based on the resource utilization for reimbursement of long-term care hospitals in Korea. Method: Health Insurance Review & Assessment Service (HIRA) conducted a survey in July 2006 that included 2,899 patients from 35 long-term care hospitals. To calculate resource utilization, we measured care time of direct care staff (physicians, nursing personnel, physical and occupational therapists, social workers). The survey of patient characteristics included ADL, cognitive and behavioral status, diseases and treatments. Major category criteria was developed by modified delphi method from 9 experts. Each category was divided into 2-3 groups by ADL using tree regression. Relative resource use was expressed as a case mix index (CMI) calculated as a proportion of mean resource use. Result: This patient classification system composed of 6 major categories (ultra high medical care, high medical care, medium medical care, behavioral problem, impaired cognition and reduced physical function) and 11 subgroups by ADL score. The differences of CMI between groups were statistically significant (p<.0001). Homogeneity of groups was examined by total coefficient of variation (CV) of CMI. The range of CV was 29.68-40.77%. Conclusions: This patient classification system is feasible for reimbursement of long-term care hospitals.

• Health Policy and Management
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• v.24 no.3
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• pp.283-290
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• 2014

Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use groups home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part models and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting for all covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing services under the public long-term care insurance are necessary in Korea.

• The Korean Journal of Health Service Management
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• v.10 no.3
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• pp.159-171
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• 2016

Objectives : This study was performed to investigate the characteristics and ADL(Activities of Daily Living) associated factors of elderly inpatients in long-term care hospitals. Methods : Data were collected from the nationwide data of 'Survey of Patients (2013-2014)' administerd by the Ministry of Health & Welfare. The data included in this study consisted of 27,606 cases of elderly inpatients in long-term care hospitals. Results : The survey scores for the elderly inpatients were as follows: 57.6% 'Needed much and total help' with ADL, followed by 26.6% who 'Needed much help', and 15.8% who 'needed minimal supervision' in long-term care hospitals. The ADL score was high in the following categories: women, old age, referred visit, health insurance type, not-recovered & death, transferred, corporate hospitals, small hospital size, low number of physicians per 100 beds, and high number of nursing staff per 100 beds. The inpatients with 'diseases of the nervous system', 'diseases of the circulatory system' and 'diseases of the genitourinary system' were more likely to have high ADL scores. Conclusions : The results of this study suggest that long-term care hospitals should provide active and proper care for patients with high ADL scores and improve medical personnel training as well provide more medical care.

• The Korean Journal of Health Service Management
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• v.5 no.1
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• pp.147-158
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• 2011

This study compares the degree of satisfaction and the causes of selecting facilities for stroke patients in the senior specialized hospitals and other senior care facilities. The research results are followed. First, The patients who held the level of senior long-term care used senior specialized hospitals, while the patients who had the level of 2 or 3 degree used senior care facilities. The patients helped by cooperative care service used senior care facilities, and the patients helped by private service or family service used senior specialized hospitals. Second, The patients in senior specialized hospitals had affirmative attitude for their service system, while the patients in senior care facilities preferred their various service systems. In the satisfaction of the facilities, the patients in senior care facilities felt more satisfaction to staff, environment, service, and other factors than the patients in hospitals did. Third, in the result of logistic analysis, the patients had an affirmative attitude in case that they had spouse, experience of senior specialized hospitals or senior care facilities, without senior long-term care insurance. They also valued the service standard and the staff quality. As this study points out, the overall preference is higher in the senior care facilities. So, the stroke patients recognized the new role between the hospitals and the facilities after the establishment of long-term senior medicare system. This research had some limitation for the research areas and numbers. So the data analysis for the types of facility and the responses may not be generalized. However, the standard of choosing facility and satisfaction will be a guideline for establishing a new future role between hospitals and facilities. This result will be used as a basic data for the renovation of long-term senior medicare insurance.

• Journal of the Korean Society of Food Culture
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• v.12 no.3
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• pp.331-339
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• 1997

With increases in senior citizens and changes in family structure, the need for long-term care system for elderly is increasing, however, the capacity and environment of Korean facilities are very limited. Health and nutritional status of long-term care residents are worse than free-living elderly. In this study, general food service management and health care practices in long-term care systems were investigated. Questionnaire were sent to the directors of all 162 long-term care facilities in Korea and 81 returned the complete answers. The results showed 1) There are slow but steady increase in long-term care systems in Korea, however, the capacity is far from adequate. Less than 10,000 elderly were resided in the facilities. Most of the systems were free-nursing homes and supported by the goverment. Staffing structure revealed that most of the facilities had a director, a secretary, nurses, but only 21% of the systerm hired a dietitian. It showed the shortage of nurses, physical therapists, and dietitians. Therefore, food purchasing, menu planning, food delivery, and the other food service management processes are handled by non-professionals, such as director, secretary, or cooks. Modified fool frequency questionnaire were used to get the frequencies of each food items used in menu and a menu-analysis was made on the one-day menu provided by the facilities. The results showed relatively satisfactory in nutrients content and food frequencies., however, this was about what was used in menu, not what was eaten by the residents. Therefore this results did not tell that the food intake status of individuals. In most facilities general health checkup was done on a regular basis, and had residents with various chronic degenerative diseases, such as hypertension, neuralgia, stroke, arthritis, diabetes. But the items checked on health checkup included weight, height, blood and urine tests, X-ray test, which suggested that the checkup lists should be revised to accomodate the health problem of the aged today.

• Korean Journal of Social Welfare
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• v.66 no.2
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• pp.5-29
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• 2014

The purpose of this study is to interpret how the long-term care evaluation system implements in the actual service settings with institutional isomorphism and decoupling based on new-institutional theory. This study conducted in-depth interview with employees engaged in 7 long term care service facilities. Directed qualitative content analysis was used to analyze the data. As a result, unlike the intention of the long-term care evaluation system to improve the efficiency of the organization by market competition, it found that organizations forcibly adapted a evaluation system to rely on government's resources and it results in isomorphism phenomena which is similar between organizations. This results confirmed that the evaluation system has implemented in the direction of enhancing the government's role to standardize and institutionalize the long-term care service rather than improving the efficiency of the organization by market competition. This study also partially found the phenomenon of decoupling between organizational formal structure accompanied by isomorphism and real behaviors. These results suggest that it is required to improve government's evaluation indicators on the issue of inefficiency caused by dual structure of organizations. In addition, this study proposes that government's evaluation index which is reflected the characteristics of care service is necessary for operating.

• The Korean Journal of Health Service Management
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• v.12 no.4
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• pp.155-172
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• 2018

Objectives: The purpose of this study was to investigate the influence of fall-related knowledge and fall prevention self-efficacy of care-givers working in long-term care hospitals on fall prevention behaviors and fall management behaviors for older adults with dementia. Methods: Participants were 125 care-givers working in long-term care hospitals. Data were collected with structured questionnaires from August 7 to 14, 2018. Data were analyzed by t-test, ANOVA, $Scheff{\dot{e}}$ test, Pearson's correlation coefficients, and multiple regression analysis using SPSS 18.0. Results: Fall prevention self-efficacy influence fall prevention behaviors(${\beta}=.55$, p<.001), while fall-related knowledge impacted fall management behaviors(${\beta}=.43$, p<.001). Conclusions: The results suggest that an education program for fall prevention of older adults with dementia in long-term care hospitals should focus on improving the fall-related knowledge and fall prevention self-efficacy of care-givers to increase both the fall prevention behaviors and fall management behaviors of care-givers.