• 한국사회정책
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• 제25권3호
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• pp.103-130
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• 2018

본 연구에서는 노인 돌봄을 돌봄 논의와 지원정책에 통합해야 함을 전제로 노인장기요양보험제도를 돌봄정의의 관점에서 분석하였다. 돌봄 정의는 돌봄에 대한 책임과 권리를 모든 사회구성원이 동등하게 분담하는 이상을 의미하며, 돌봄 정의의 실현을 위해 탈상품화, 탈가족화, 탈젠더화, 노인의 참여와 권한의 네 가지 차원이 설정되었다. 노인장기요양보험제도를 네 가지 차원에서 분석한 결과 시장 위주의 상품화와 젠더화 된 돌봄 서비스를 통해 노인을 배제한 돌봄의 탈가족화를 추구함으로써 돌봄 정의가 실현되지 못하고 있는 것으로 나타났다. 노인장기요양보험제도에서 나타난 노인 돌봄의 상품화, 가족화, 젠더화, 노인 배제를 극복하기 위한 방안으로 돌봄 서비스 비용의 적정화와 공공화를 통한 돌봄 노동의 사회적 위상 제고, 생애주기적 차원에서 아동, 성인, 노인을 통합적으로 포괄하는 돌봄 방식의 재조직화, 노인과 돌봄 관계 당사자들이 돌봄의 조직화와 결정 과정에 참여하고 결정권과 선택권을 행사할 수 있는 제도적 변화를 제시하였다.

• 대한간호학회지
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• 제33권2호
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• pp.275-283
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• 2003

Purpose: This study was to classify elderly in long-term care hospitals for using Resource Utilization Group(RUG-III) and to consider feasibility of payment method based on RUG-III classification system in Korea. Method: This study designed by measuring resident characteristics using the Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. The data were collected from 382 elderly over sixty-year old, inpatient in the five long-term care hospitals. Staff time was converted into standard time based on the average wage of nurse and aids. Result: The subjects were classified into 4 groups. The group of Clinically Complex was the largest(46.3%), Reduced Physical Function(27.2%), Behavior Problem(17.0%), and Impaired Cognition(9.4%). The average resource use for one resident in terms of care time(nurses, aids) was 183.7 minutes a day. Relative resource use was expressed as a case mix index(CMI) calculated as a proportion of mean resource use. The CMI of Clinically Complex group was the largest(1.10), and then Reduced Physical Function(0.93), Behavior Problem(0.93), and Impaired Cognition(0.83) followed. The difference of the resource use showed statistical significance between major groups(p<0.0001). Conclusion: The results of this study showed that the RUG-III classification system differentiates resources provided to elderly in long-term care hospitals in Korea.

• 한국노년학
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• 제31권4호
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• pp.999-1014
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• 2011

본 연구의 목적은 생태체계이론을 적용하여 노인장기요양보험제도라는 거시체계가 가족관계라는 미시체계에 미치는 영향을 살펴보는 것이다. 이를 위해 『한국복지패널(KWPS: Korean Welfare Panel Study)』 2차년도(2007년)와 4차년도(2009년) 데이터를 활용하여 노인장기요양보험제도의 이용자 및 그 가구원(실험집단)과 비이용자 및 그 가구원(통제집단)으로 구분한 후, 노인장기요양보험제도 이용 전후의 가족관계의 변화를 살펴보았다. 이중차이모델(difference-in-difference model) 분석결과, 생태체계이론은 노인장기요양보험제도와 가족관계를 설명하는 이론이라고 할 수 있다. 주목할만하며 새로운 발견은 우리나라의 노인장기요양보험제도가 소득 효과(income effect)가 아닌 독립효과(independent effect)를 갖는다는 것이다. 이러한 결과는 무엇보다도 점점 더 가족의 의미가 퇴색되어 가족관계가 약화되고 있기 때문이다. 또한 한국의 노인장기요양보험제도가 사회보험으로서의 특징을 온전히 갖추지 못하였기 때문으로 추정된다. 노인장기요양보험은 제도의 포괄성, 급여대상의 보편성, 급여의 적절성, 서비스 접근성 측면에서의 제도개선이 필요하며, 가족친화적 사회복지제도로의 변모가 절실히 요청된다.

• 간호행정학회지
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• 제14권3호
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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.

• 산경연구논집
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• 제9권10호
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• pp.39-50
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• 2018

Purpose - This study is to propose discriminative management strategies to long-term care facilities based on the empirical analysis after reviewing the effects of social support, perceived by long-term care facility employees, to service orientation. Research design, data, and Methodology - The research model designed social support, job stress, organizational commitment, and service orientation. The survey collected data from 453 customers in a long-term care facility in jeju. The SPSS 18.0 package was used for analysis. Results - First, social support for long-term care facility employees has a negative(-) effect to job stress. Test results, social support factors except appraisal support had a negative impact on job stress. Second, social support has a positive(+) effect to organizational commitment. Test results, informational support, tangible support and appraisal support had significant effects on organizational commitment. However, emotional support had a positive impact on affective commitment and normative commitment. Third, social support has a positive(+) effect to service orientation. Test results had a positive impact. Fourth, job stress has a negative(-) effect to organizational commitment. In the test results, employee's continuance commitment and normative commitment had significant negative effects in job stress. However, affective commitment had no significant impact. Fifth, job stress has a negative(-) effect to service orientation. Test results showed a negative impact. Conclusions - The study implies the following. First, that there should be a change in the social perception of long-term care facilities. 'Long-Term Care Insurance for The Elderly' was enacted to emphasize this responsibility for the elderly problems as a new system. Enactment of this Act was expected to improve the quality of life of the people by stabilizing the elderly life and reducing the burden of families. Therefore, long-term care facility system should be as efficient as possible for making plans for systematic and organizational support. Second, the efforts of facility managers to minimize job stress of employees is necessary. Accordingly, performing spontaneous work is required for a comfortable working environment and management. Third, the systematic education and training to employees for service oriented behavior of the facility will be required in the long term.

• 보건행정학회지
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• 제17권2호
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• pp.52-67
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• 2007

Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include socio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.

• 보건행정학회지
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• 제22권3호
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• pp.383-402
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• 2012

The purpose of this study is to investigate the factors affecting family caregiver financial burden of out-of pocket expenses for the nursing home service under Long-term Care Insurance System. We conducted a national cross-sectional descriptive survey from July to September 2010 to collect data based on the long-term care benefits cost specification. Total 1,016 family caregivers completed questionnaires. 185 subjects of total were excluded from the data analysis due to being answered by user(18 cases), or caregivers not to pay for services expenditures(122 cases), having a missing data on family caregivers characteristics(45 cases). Finally, 831 subjects were included in the study. The average financial burden was 3.18(${\pm}0.71$). We divided subjects into two groups by level of burden, high-burden group and low-burden group. In the result of the multiple logistic regression analysis, family caregiver financial burden was significantly higher in family caregivers with ages 40 to 49 compared to less than 40, lower educational level, unsatisfaction for long-term care service, high percentage(more than 50%) of cost-sharing and high total out-of pocket expenses(more than 300,000 won) for long-term care services. Also, Family caregivers who are spouse felt higher financial burden compared to son. This study is meaningful as the first attempt to measure family caregiver financial burden for long-term care service and to identify factors affecting the financial burden. Family caregivers felt financial burden of out-of pocket expenses for the nursing home service. The policy makers, the insurer, and the providers need to pay attention to ease family caregiver financial burden.

• 한국농촌간호학회지
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• 제16권2호
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• pp.60-68
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• 2021

Purpose: This case report was attempted to present the process of the end of life nursing care provided by the visiting nurse. Methods: The subject was a person who was decided the long-term care Grade 1 and received a visiting nursing service, and the service was terminated on the death, and then was selected as a case with the consent of his family. The data were collected through long-term care benefit provision records and interviews with the visiting nurse. The nursing process was presented by applying the Omaha System. Results: The subject had digestion-hydration problems and respiration problems in the physiological domain, and the problems of role change, caretaking/parenting, spirituality, and grief in the psychosocial domain were identified. Depending on the problem, the end of life nursing care was provided to the subject and family members through activities on physical symptoms/signs, dietary management, end-life care, and coping skills. Conclusion: We expect that if the visiting nurse provides anticipatory guidance on the death process, the subject will be able to prepare for death comfortably with the family at home instead of vague fear of death.

• 성인간호학회지
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• 제26권6호
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• pp.642-652
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• 2014

Purpose: The purpose of this study was to compare the role-expectations of gerontological nurse practitioners and performance of gerontological nursing by nurses in long term care hospitals and general hospitals. Methods: Subjects were 200 nurses; 100 nurses from long term care hospitals where as 100 nurses from general hospitals. The subjects completed a questionnaire on general characteristics, role-expectations of gerontological nurse practitioners, and performance of gerontological nursing by nurses. Data were collected from February to March 2013 and analyzed using SPSS/WIN 18.0 version program in order to perform descriptive statistics, independent t-test, and one-way ANOVA. Results: Results indicated that there were significant differences in the role-expectations of gerontological nurse practitioners and performance of gerontological nursing between nurses from long term care hospitals and those from general hospitals. Conclusion: Nurses in general hospitals showed significantly higher role expectations than nurses in long term care hospitals. Therefore it is necessary to spread the knowledge on the roles of gerontological nurse practitioners and the nurse practitioners system to nurses in long term care hospitals.

• 간호행정학회지
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• 제18권1호
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• pp.106-117
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• 2012

Purpose: This study was designed to develop quality outcome indicators for nursing homes and community-based home care that would contribute to an appropriate evaluation and improvement of quality of long term care in Korea. Methods: The preliminary quality indicators of long term care were developed from a literature review and clinical expert panel. A content validity testing was done using a panel of experts who were selected from academic and clinical field of long-term care. The final quality indicators were confirmed after application in four nursing homes and four home care agencies to test clinical validity. Results: The preliminary quality indicators consisted of 3 domains and 19 indicators. The final quality indicators were composed of 4 domains and 17 indicators. Conclusion: This study demonstrated the feasibility of outcome quality indicators in long term care. These quality indicators can be effectively used to evaluate the quality of nursing home and home care and to improve the quality of care in the Korean long-term care system.