• 간호행정학회지
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• 제21권2호
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• pp.174-183
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• 2015

Purpose: This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). Methods: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. Results: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. Conclusion: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.

• 한국콘텐츠학회논문지
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• 제11권11호
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• pp.231-240
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• 2011

본 연구는 앞으로의 노인장기요양보험 서비스의 확대 시 우선적인으로 방문물리치료 서비스 도입의 기초자료를 제공하는데 그 목적이 있으며 그를 위해 노인장기요양보험 하에서 물리치료 서비스를 제공하고 있는 노인시설 물리치료사들의 제도에 대한 인식조사를 실시하였다. 그 결과 노인장기요양보험에 대한 인지도는 88.1%로 높았으며 필요성에서도 높았지만 40세 이상에서 절대 필요하다는 응답이 60.3%로 더 높았다. 또한 수가는 방문간호를 기준으로 높게 책정해야 한다는 의견이 59.7% 가장 높았다. 방문물리치료서비스 중 가장 중요한 치료접근으로는 일상생활 지도가 40%로 가장 높았고, 서비스 주체로는 방문간호센터처럼 방문재활센터로 해야 한다는 의견이 69.4%를 차지했다. 방문물리치료 시행에 따른 기대효과는 50점 만점에 전체 평균 41.44점으로 나타났으며 특히 40세 이상에서 42.48점으로 나타나 전체적인 기대효과가 높은 것으로 나타났다.

• 대한지역사회영양학회지
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• 제18권2호
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• pp.142-153
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• 2013

The purpose of the study was to examine nutritional management and nutritional care demands of home-visit care service and the nutritional status of serviced elderly. The survey was carried out from $5^{th}$ to $21^{st}$ of January, 2011 among 37 In-Home Service institutions. The number of elderly surveyed by 143 care helpers was 281. Analysis was performed for 203 subjects (male: 44, female: 159). The age distribution was from 50 to 99 years. The grading by long-term care insuranceshowed 18,2% on level 1 and 2, and 81.8% on level 3. For the disease treatment, the proportion of implementing diet treatment turned out to be very low. The proportion of subjects living with their children was 45.3%, and living alone was 29.1%. The proportion of home-visit care among types of In-Home Service was 70%. Subjects who needed additional necessary diet management service turned out to be 40.9%. Diet management was the most necessary services from all levels. MNA (specifiy MNA) scores were significantly (p < 0.001) associated with BMI, mid-arm circumference (MAC), calf circumference (CC), intake problems, and weight loss during the last 3 months. For studied elderly, 45.3% were malnourished, and 46.8% were at the risk of malnutrition by MNA score. Based on the result of this survey, the nutritional care was not systematic on the In-Home Service. Prevention and management of the disease was much better than the treatment to improve the quality of life. We conclude that nutrition management is necessary for the elderly. To improve nutritional status of elderly in home care services, systematic nutrition management should be implemented.

• The Journal of Korean Physical Therapy
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• 제22권5호
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• pp.95-102
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• 2010

Purpose: The purpose of this study was to analyze the necessity of home visit rehabilitation therapy by rehabilitation professionals working at social welfare facilities. Methods: The subjects of this study were 227 rehabilitation professionals (social worker, nurse, physical therapist, occupational therapist, speech-language therapist, special education teacher, and staff of institutions for the disabled who were working at community rehabilitation centers. The data were collected over 65 days (2008. 09. 10~11. 14). The results were analysed statistically by the Chi-square test. Results: The results are as follows: Long-term care service was established in Korea by the Ministry of Health in July, 2008. But there are limits to their being able to provide various rehabilitation services for chronic patients and old people. According to a recent survey, almost all rehabilitation professionals (N=227) stated that home visit rehabilitation therapy is necessary. Conclusion: In Korea, the long-term care service has a nursing service and a service supporting physical activities of daily living, but not physical therapy. So, home visit rehabilitation services should include physical therapy, rehabilitation exercise, and pain management.

• 한국보건간호학회지
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• 제29권2호
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• pp.203-218
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• 2015

Purpose: The purpose of this study is to find and suggest ways to invigorate operation of visiting nursing centers. Methods: SWOT analysis was performed based on the status of use of visiting nursing centers and opinion survey on the centers' nursing experts. Results: SO strategy was drawn to improve service satisfaction, develop standardized manuals, and improve the areas of visiting nursing services, and WO strategy was drawn to establish reliability, strengthen promotion or marketing strategy, strengthen management ability, and reinforce the governmental support of visiting nursing services. ST strategy was drawn to recover the functionality of health management, secure competitive advantage, and simplify the issuance of visiting nursing directions, and WT strategy was drawn to provide customized service, establish the cooperative system of related agencies, and adjust fees. Conclusion: For invigoration of visiting nursing centers, people must recognize the importance of the visiting nursing service and institutional standards should be established so that visiting nursing service, which is currently provided as an option according to Standard Long-Term Care Plan, can be provided on a mandatory basis.

• 한국산학기술학회논문지
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• 제15권3호
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• pp.1489-1495
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• 2014

고령화시대를 맞아서 한국은 2008년부터 노인장기요양보험을 실시하면서 노인부양부담을 가족으로부터 국가의 책임으로 인식하기 시작하였다. 데이케어센터(주간보호센터)는 사회적 보살핌을 제공하는 시설 중의 하나로 입소생활시설과는 다른 주간이용시설인데 설립초기 자원부족 및 서비스 질 향상 등의 문제가 지적되어 왔다. 본 논문에서는 데이케어센터를 지역을 중심으로 접근하면서 그 발전방향을 논의하였다. 또한 전문가심층면접분석을 통해서 데이케어센터의 차후 비전을 제시하였다. 심층분석 결과로는 데이케어센터에서 제공하는 건강케어 프로그램은 지역사회의 문제 및 특성을 반영하여야 하고, 사용자 중심이어야 하며 지역통합적 방식을 취해야 함이 제시되었다.

• 가정간호학회지
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• 제28권2호
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• pp.111-123
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• 2021

Purpose: This study aimed to present the management strategies necessary to improve the operational efficiency of visiting nurse centers and evaluate their effectiveness. Methods: The subjects of this study were visiting nurse centers registered as long-term care centers. Based on value chain analysis, cost information analysis, and data envelope analysis, the study was carried out according to the Magerison's management consulting procedure, for six months. This procedure comprised eight sub-steps of approach and application. Results: The following management strategies were agreed upon: establishment of a cooperative network with other visiting care centers, creation of high satisfaction of external customers by providing practical training to care workers, and making rehabilitation and exercise services as the core nursing activities to be focused on. Conclusion: The management consulting process and analysis method applied in this study can referred to as a useful methodological framework for revitalizing visiting nursing centers in the future.

• 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.

• 보건행정학회지
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• 제26권1호
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• pp.39-50
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• 2016

Background: This study examined patient and hospital factors related to long-stay admissions in long-term care hospitals (LTCHs) among older people in Korea. Methods: We analyzed health insurance claims data, entitlement data, and institutional administrative data from the National Health Insurance Service databases between 2010 and 2012. At the patient level, we compared characteristics of patients staying in LTCHs for over 180 days (the long-stay group) with those staying in LTCHs for less than 90 days during a calendar year. At the hospital level, we examined the general characteristics and staffing levels of the top 10% of hospitals with the highest proportion of patients whose length of stay (LOS) was 180+ days (the hospitals with long-stay patients) and compared them with the top 10% of hospitals with the highest proportions of patients whose LOS was less than 90 days (hospitals with shorter-stay patients). Results: The long-stay group accounted for about 40% of all LTCH patients. People in the group were more likely to be women, aged 80+, living alone, and experiencing more than two health conditions. Compared to the hospitals with shorter-stay patients, those with long-stay patients were more likely to be occupied by patients with behavior problems and/or impaired cognition, owned by corporate or local governments, have more beds and a longer period of operation, and deliver services with lower staffing levels. Conclusion: This study found long-stay older people in LTCHs and those in LTCHs with high proportions of long-stay older patients had several distinct characteristics compared to their counterparts designated in this study. Patient and hospital characteristics need to be considered in policies aiming to resolve long-stay admissions problems in LTCHs.

• 보건행정학회지
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• 제24권4호
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• pp.349-356
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• 2014

Background: This study aimed to explore factors associated with the non-use of beneficiaries of long-term care insurance services for the elderly in Jeollanam-do Province by analyzing a dataset obtained from National Health Insurance Service. Methods: The study sample consists of 1,663 individuals who were evaluated as eligible for long-term care insurance services in Jeollanam-do Province during the period of July 1, 2008 through June 30, 2009. As a dependent variable, the non-use of the service was defined as one when a beneficiary had used it once or more times during one year after he or she was evaluated as eligible and as zero otherwise. A proportion analysis was conducted to describe characteristics of study sample. Chi-square tests were used to compare general characteristics between beneficiaries who had used the services and those who had not used them. Multiple logistic regressions were performed by three models including additional sets of explanatory variables such as socio-demographic characteristics, health conditions, and economic status. Results: Main results are summarized as follows. The proportion of beneficiaries who had not used the service was 14.5% of all beneficiaries. According to the results from the model using all explanatory variables, the factors associated with the non-use of the services were residence location, dwelling place, type of desired service, level of care needs, and instrumental activities of daily life limitations. Conclusion: In particular, regarding the type of desired service, the cash benefit showed a high likelihood of the non-use of the service; it had an odds ratio (OR) of 50.212 (95% confidence interval [CI], 24.00-105.04) compared with home service. In case of dwelling place, a hospital showed also a high likelihood of the non-use with an OR of 20.71 (95% CI, 10.12-42.44) compared with home.