• 보건행정학회지
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• 제29권2호
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• pp.195-205
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• 2019

Background: The food and food service influence the quality of life and the general health condition of older persons living in long-term care (LTC) facilities. Purchasing good food materials is a ground of good food service. In Korea, the residents in LTC facilities should pay for the cost of food materials and ingredients out of their pocket because it is not covered by LTC insurance. This study explored what factors affect the cost of food materials paid by LTC facility residents and which factor affects most. Methods: We used data from the study on out-of-pocket payment on national LTC insurance, which surveyed 1,552 family caregivers of older residents in LTC facilities. We applied conditional multi-level model, of which the first level represents the characteristics of care receivers and caregivers and its second level reflects those of LTC facilities. Results: We found that the facility residents with college-graduated family caregivers paid 11,545 Korean won more than those with less than elementary-graduated ones. However, the income level of family caregivers did not significantly affect the amount of the food material cost of the residents. The residents in privately owned, large, metropolitan-located facilities were likely to pay more than those in other types of facilities. The amount of the food material cost of the residents was mainly decided by the facility level factors rather than the characteristics of care recipients and their family caregivers (intra-class correlation=82%). Conclusion: These findings suggest that it might be effective to design a policy targeting facilities rather than residents in order to manage the cost of food materials of residents in LTC facilities. Setting a standard price for food materials in LTC facilities, like Japan, could be suggested as a feasible policy option. It needs to inform the choice of LTC users by providing comparable food material cost information. The staffing requirement of nutritionist also needs to be reviewed.

• 한국보건간호학회지
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• 제29권3호
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• pp.403-411
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• 2015

Due to lack of an information system regarding the status of using home-visit nursing (HVN), it has barriers of providing improvement of the HVN for management of elderly health care in Korea. The twofold aims of the current review are to expose the existing agendas for HVN and to suggest the political implications for HVN of Korea based on the transition process and revised HVN system of Japan. This review suggests that an information evaluation system has to precede for HVN services in detail. And, the service provided per manpower should be assessed by separating the code of manpower (registered nurse, nurse aide, dental hygienist) as well as securing detailed and precise information on the HVN services. The other suggestion, development of a community-based home health care nursing model in order to provide necessary services for long-term health insurance beneficiaries. In addition, a master plan for health care for elderly should be established at the national level in order to establish an effective home health nursing delivery system.

• 보건행정학회지
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• 제20권2호
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• pp.104-127
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• 2010

To vitalize the link program of Korean long-term care insurance system to community-based services for non-eligible people, we analysed the claim data from the Korean National Health Insurance Corporation (NHIC), and conducted a questionnaire survey to charging employees of elderly service department at local governments. The subjects were all 81,377 people, 57,454 of them were arranged to community-based services. The link program was more necessary among the missed subjects rather than the arranged people due to the need for physical or psychological assistance. By the result of the survey to the local government employees, 59.5% of subjects responded their proportion of link service was over 10% and under 20%, and 54.3% of them responded their job boundary are not clear. Major type of linking was notification the subject list to local government, 91.4%; proportion of periodical notification on the status of their service link were 57.1%, only 7.1% were followed to manage after the link. Difficult factors at the link process were pointed out the overload by other side work, deficiency of resources, rigidity of priority of link, and so on. Considering these results, to vitalize the community-based services to the non-eligible people, it may be essential the active participation of the subjects, construction of parts working in coordination among the institutions including NHIC, local governments, and service providers; development of various services for maintenance or promotion of the non-eligible peoples' health and functional status; and active participation of institutions from the third sector, and so on.

• 성인간호학회지
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• 제26권5호
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• pp.543-552
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• 2014

Purpose: The purpose of this study was to develop integrated evaluation indicators of home care services in the hope that the increasing group of long-term home care patients could receive quality care services. Methods: The development involves a methodological study on a development phase and a verification phase. The main survey at a verification stage was conducted by the staffs at 146 institutions who agreed to participate on this study. Results: The evaluation index for the integrated home visit care consisted of five categories and 57 indicators including Managing Institution (12), Environment and Safety (3), Right and Responsibility (7), Process of Care (31) and Results of Care (4). The criterion-related validity was verified in regard to the participation in the 2010 evaluation of long-term home-care institutions by the National Health Insurance Corporation. Conclusion: The evaluation index of the integrated home visiting care developed in this study is considered suitable to utilize as evaluating indicators in managing and evaluating the way of how institutions integrate and provide home visit care services as well as home nursing care services.

• 한국직업건강간호학회지
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• 제16권2호
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• pp.188-196
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• 2007

Purpose: The objective of this study was to evaluate long-term care needs using RAI MDS-HC and MI-CHOICE among the disabled workers. Methods: Data were obtained from 45 personal care recipients with the disability of mental and nervous system, and analyzed using SAS 9.1 by applying t-test, ${\chi}^2$ test, or fisher's exact test. Results: Only 'bed mobility' and 'indoor ambulation' items of ADL and problem activity were statistically significant factors by the level of personal care benefit. By MICHOICE grouping, 20.0 percent of subjects belonged to nursing home group, 51.5 percent were home care service, 28.9 percent were intermittent personal care. Conclusion: Personal care services in industrial accident compensation insurance have been categorized with two groups according to level of disability. But our results could contribute to provide personal care service according to the long term care needs.

• 응용통계연구
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• 제27권5호
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• pp.667-679
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• 2014

우리나라 노인장기요양보험에서는 수급자가 월 한도액 범위 내에서 필요한 서비스를 비용-효율적으로 이용할 수 있도록 지원하고자 표준장기요양이용계획서를 작성하여 제공하고 있다. 본 연구는 표준장기요양이용계획서의 객관성 확보와 업무 효율성 제고를 위하여 의사결정나무기법을 이용해 수급자의 건강 및 기능 상태에 맞는 최적의 급여계획을 도출하는 표준급여모형을 개발하였다. 타당도 높은 모형 개발을 위하여 국민건강보험공단의 전국 220개 장기요양운영센터로부터 장기요양인정조사와 표준장기요양이용계획서 작성 경험이 풍부한 직원(본 연구에서는 '훈련된 조사자'라고 함)을 추천받아 자료수집의 내용과 방법에 대해 교육을 실시하였고, 이들이 수급자의 건강 및 기능 상태를 평가하고 작성한 수급자 개인별 맞춤형 급여계획을 자료 분석에 활용하였다. 표준급여모형은 1단계로 시설 또는 재가 급여 권고 여부를 결정하는 모형을, 2단계로 재가급여를 권고했을 경우의 재가급여 세부 종류별 권고 여부를 결정하는 모형을 개발하였다. 본 연구에서 개발된 표준급여모형은 전산프로그램화 되어 국민건강보험공단 직원이 수급자에게 제공할 표준장기요양이용계획을 수립하는 과정에 실제로 활용되고 있어 표준장기요양이용계획서의 객관성 확보와 업무 효율화가 기대된다.

• 한국사회복지학
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• 제63권4호
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• pp.301-326
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• 2011

이 연구는 우리나라 노인장기요양보험의 제도성과를 평가하는데 그 목적이 있다. 정확한 제도성과를 추정하기 위하여 준실험적 방법인 성향점수매칭과 이중차이 결합모형을 이용해 타당성을 저해할 수 있는 요인들을 제거하였다. 노인장기요양보험제도가 사회적 성과변수인 대상노인과 부양가족의 삶의 질과 가족관계 만족도에 미치는 영향을 분석하기 위해 한국복지패널 3-4차 조사자료를 이용하여 성향점수추정을 통해 실험집단과 비교집단을 매칭한 후, 정책시행 이전과 이후 실험집단과 비교집단 간의 성과의 차이를 추정하기 위해 패널고정효과모형을 이용한 이중차이분석을 실시하였다. 그 결과, 노인장기요양보험제도의 대상노인과 부양가족의 삶의 질은 통계적으로 유의미하지 않았고, 가족관계 만족도는 제도시행 이전에 비해 제도시행 이후 향상된 것을 확인할 수 있었다. 이러한 결과는 노인장기요양보험이 실시되고 제도가 충분히 성숙된 시점에 이루어진 평가가 아니라는 한계점을 가지지만, 노인장기요양보험제도의 최종 목표인 대상노인과 부양가족의 삶의 질 향상이라는 정책의 목표실현과 향후 제도개선에 있어서 중요한 함의를 가진다.

• 한국노년학
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• 제29권3호
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• pp.917-933
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• 2009

본 연구는 새롭게 도입된 노인장기요양보험제도 체계 내에서 공적보호서비스(시설보호서비스와 재가보호서비스)를 이용하게 되는 요인과 두 서비스유형간의 선택을 결정하게 되는 요인을 밝히고자 한다. Andersen의 행동모델에 기반하여 노인장기요양서비스 이용형태를 결정하는 소인요인과 자원요인, 욕구요인의 영향을 검증하는 연구모형을 구성하였으며, 노인장기요양보험 2차 시범사업의 서비스 이용권리가 있는 요양 1~3등급의 노인 5,497명의 서비스 이용자료와 개인적 특성 자료를 활용하여 다항 로지스틱 회귀분석을 실시하였다. 주요 분석결과는 다음과 같다. 첫째, 서비스 이용의 본인부담금을 나타내는 소득수준에 따라 서비스 이용형태에 차이가 나타났다. 국민기초생활보호대상자, 일반소득계층, 차상위계층의 순으로 서비스 이용이 높았으며, 재가보호서비스에 비해 시설보호서비스의 이용이 높게 나타났다. 둘째, 군지역에 비해 대도시와 중소도시가 시설보호서비스 또는 재가보호서비스를 이용할 확률이 높으며, 특히 중소도시의 경우 재가보호서비스보다는 시설보호서비스 이용이 높은 것으로 나타났다. 셋째, 요양 1~2등급이 3등급에 비해 시설보호서비스 또는 재가보호서비스 이용이 높으나, 등급에 따른 서비스 이용 유형간 차이는 나타나지 않았다. 넷째, 일상생활수행능력(ADL), 수단적 일상생활수행능력(IADL), 인지기능과 문제행동의 기능이 나쁠수록 시설보호서비스 이용이 높으며, 재가보호보다는 시설보호를 이용하는 것으로 나타났다. 그러나 간호처치영역은 기능상태가 나쁠수록 서비스 이용이 적고, 재활영역의 기능상태는 통계적 유의미성을 나타내지 못하였다. 이와같은 연구결과를 통해 현 노인장기요양보험제도의 본인부담금의 조정과 지역별 균형적인 서비스인프라 구축의 필요성을 제기하며, 또한 요양등급판정체계의 재검증의 필요성을 제기하는 바이다.

• 대한간호학회지
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• 제39권3호
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• pp.409-421
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• 2009

Purpose: In this research multi-level analysis was done to identify factors related to quality of services. Patient characteristics and organizational factors were considered. Methods: The data were collected from the Health Insurance Review and Assessment Service(HIRA) data base. The sample was selected from 17,234 patients who had been admitted between January 2007 and May 2008 to one of 253 long-term care hospitals located in Seoul, six other metropolitan cities or nine provinces The data were analyzed with SAS 9.1 using multi-level analysis. Results: The results indicated that individual level variables related to quality of service were age, cognitive ability, patient classification, and initial quality scores. The organizational level variables related to quality of service were ownership, number of beds, and turnover rate. The explanatory power of variables related to organizational level variances in quality of service was 23.72%. Conclusion: The results of this study indicate that differences in the quality of services were related to organizational factors. It is necessary to consider not only individual factors but also higher-level organizational factors such as nurse' welfare and facility standards if quality of service in long term care hospitals is to be improved.

• The Journal of Korean Physical Therapy
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• 제34권2호
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• pp.80-89
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• 2022

Purpose: In Japan, the long-term care insurance and health insurance acts have stipulated the visiting rehabilitation system to provide support at the national level. The prior case of Japan would provide guidelines for seeking a suitable policy direction in South Korea. This study aims to examine the historical transition process of the visiting rehabilitation system in Japan, and the issues that emerged in the process of the institutionalization of this system. Methods: To examine the historical transition process of the system, the regulations announced by the government and their reports were reviewed. The relevant issues were qualitatively analyzed based on the opinions of scholars, therapists, and interested organizations that were reported in published papers on the topic. Result: The visiting rehabilitation system has been implemented in the following chronological order: The Health and Medical Service Act for the aged (1982-2006), the Health Insurance Act (1988-), and the Long-term Care Insurance Act (2000-). Currently, visiting rehabilitation is provided through hospitals, clinics, visiting nursing stations, etc. The following issues came to the fore in the process of the institutionalization of the system: (1) the complexity of the system, (2) the necessity of changing perceptions into a life model approach, (3) insufficient service provision by therapists, (4) the lack of human resources and an education system, (5) the lack of awareness of care managers and doctors about visiting rehabilitation, and (6) the necessity of quality enhancement through a team approach. Conclusion: It is deemed worthwhile to refer to the visiting rehabilitation system in Japan and the issues that emerged in the process of institutionalizing the system while seeking a policy direction for a similar system in South Korea.