• 보건행정학회지
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• 제22권1호
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• pp.145-162
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• 2012

The purpose of this study is to understand magnitude and its related factors of user's cost-sharing for non-covered services in long-term care facilities. We corrected data for 1,016 subjects, based on the long-term care benefits cost specification. Eighteen subjects were excluded from the data analysis due to missing data on family care-givers characteristics. Finally, 998 subjects were included in the study. The average cost of non-covered services per month was 209,093 won and distributed from 0 to 1,011,490 won. There was a significant difference by the characteristics of family care-givers and long-term care facilities. The monthly average cost for meal materials per person was 199,181 won(0~558,000), average cost of additional charge caused by using private bed was 232,992 won (50,000~600,000), and costs for haircut and cosmetics were 8,599 won. For the rest, there were various programs costs(93,328 won), diaper and its disposal cost(109,628 won), purchase cost for daily necessaries(24,435 won) and etc. The related factors for the magnitude of non-covered services expenditures were education level of family care-givers, occupancy rate and location of LTC facilities, and the costs of using private bed, haircut and cosmetics, and various programs among non-covered services. These findings suggest that present level range of LTC facilities users' cost-sharing is wide and it is urgent to prepare the standard guideline for cost and level in non-covered services.

• 보건행정학회지
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• 제23권1호
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• pp.90-100
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• 2013

Background: This study examined the relationships of dementia, stroke, and combined multimorbidity with long-term care utilizations among older people in South Korea. Methods: A nationally representative sample of 10,130 older adults who used long-term care services in 2010 were analyzed. We used the 5% sample of aged 65 years or older linked with National Health Insurance Corporation registry data of long-term care insurance system. The sample was categorized into three groups: dementia only (47.6%), stroke only (36.3%), and both dementia and stroke (16.1%). We estimated the use of institutional care, home care, and total expenditure of long-term care services, adjusting for the severity of each function (such as daily life, behavior or cognitive change, nursing care needs, and rehabilitation care needs) and sociodemographic characteristics. Results: Having dementia symptoms was positively associated with the use of institutional care services, on the other hand, having stroke symptoms was positively related with the use of home care. The total long-term care cost was higher in the group of having both dementia and stroke. Conclusion: Older persons with dementia symptoms and stroke symptoms have different patterns of long-term care utilization, and the multimorbidity increased the overall expenditure of long-term care utilization. These findings imply a need for differentiated management strategy targeting physically and cognitively impaired older persons, and special concerning for persons with multimorbidity conditions for long-term care insurance program in Korea.

• 보건의료산업학회지
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• 제10권4호
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• pp.61-73
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• 2016

Objectives : The aim of this study was to investigate the satisfaction determinants of rehabilitation care group inpatients in rehabilitation long-term care hospitals. Methods : A survey was conducted with 262 patients from 6 rehabilitation long-term care hospitals located in Busan Kyungnam. Data were collected from June 2016 to July 2016 with a structured questionnaire and analyzed with SPSS 23.0. Results : The significant factors affecting the overall satisfaction score were disease group and 5 quality indices of medical services(Medical service quality, Rehabilitation services quality, Hospital reputation, External physical environment, and Internal physical environment). Additionally, the significant factors affecting intention to revisit were age, disease group, length of hospital stay and the 5 quality indices of medical services. Conclusions : The results of this study indicate that rehabilitation long-term care hospitals should try to improve the overall satisfaction of inpatients, especially focusing on the internal physical environment and the quality of the rehabilitation services and medical services, which will lead to a high level of intention for patients to revisit.

• 한국사회복지학
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• 제58권1호
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• pp.31-58
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• 2006

일본은 1990년 이후 사회복지제도를 개혁하는 과정에서 이용자본위의 서비스지원, 자기결정에 따른 서비스이용, 자립생활을 지원하는 서비스 등을 새로운 개혁이념으로 제시하면서, 이를 실천하는 제도적 장치의 하나로써 서비스에 대안 이용지원제도를 제시하였으며, 개호보험제도의 개호지원전문원이 당해 역할을 담당하게 되었다. 따라서 개호지원전문원의 도입은 사회복지서비스의 이용과정의 따른 패러다임의 변화를 가져왔다. 즉, 조치제도에 따른 서비스이용의 타율성과 서비스의 이용과정의 복잡성을 고려할 때, 개호지원전문원이라는 단일창구를 통한 서비스의 종합적 상담 지원 그리고 시장기능에 따라서 움직이는 개호지원전문원의 역할을 고려할 때, 요원조고령자의 서비스 선택폭은 크게 확대 강화되었다. 한편, 개호지원전문원제도는 구조적 취약점도 지니고 있다. 즉, 개호지원사업자(소)를 중심으로 한 개호지원기능 개호지원사업자와 서비스사업자간의 병행 운영, 개호지원전문원의 업무내용과 범위의 모호, 개호지원전문원의 겸무허용에 따른 업무과다, 처리역량을 벗어난 사례담당에 따른 어려움, 사회적 지원제도의 부족, 역할과 신분을 초과하는 의무와 처벌 등이 이에 해당된다. 한편, 일본의 개호보험제도와 비슷한 노인수발보장제도와 평가관리원의 도입을 추진하고 있는 한국의 입장에서 보면 이와 같은 개호지원전문원제도의 구조와 특징은 많은 시사점을 줄 수 있을 것으로 본다.

• 한국보건간호학회지
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• 제24권2호
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• pp.211-225
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• 2010

Purpose: This comparative study analyzed information systems including manpower, contents of service, clients, and costs among four nations. Methods: A literature review of relevant publications from Korea, United States, Japan, and Germany supported the use of several plans to activate home nursing care services under the long-term care insurance system in Korea. Results: Korean home nursing care services require quality improvements. The results indicated that a rule is necessary that rations simple visiting service and home nursing care services under the long-term care insurance system, that an integrated management system for elderly care is required, and that the revised delivery of services needs to establish and reflect on various factors to estimate the value in a home visiting nursing care cost system. Conclusion: The data should be valuable in establishment of home nursing care services under the long-term insurance system in Korea.

• 대한간호학회지
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• 제34권1호
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• pp.191-201
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• 2004

Purpose: This study aimed to evaluate economic viability of public health center visiting nurse services for the low-income elderly with long-term care needs. Method: The sample consisted of 252 community dwelling elderly who enrolled in public health center visiting nurse services for three months or more. Data was collected on physical (ADL and IADL) and cognitive impairments of the elderly, contents and frequency of visiting nurse services, cost per visit, and costs of alternative services for long-term care. Result: The mean score of ADL and IADL levels of the elderly was 2.80.4904, which indicated these patients were mostly independent. Eighty four percent of the elderly subjects were cognitively intact. Among visiting nurse services supplied, providing assessment was 34%, followed by education and counseling 26%, medication 22%, and referral. The mean cost per visit was 17,824.1 won, which transformed into a total cost per person per year of 161,130.2 won. Comparing the cost of a visiting nurse service with those of other long-term care alternatives, the visiting nurse service was the least costly alternative, followed by an outpatient clinic, hospital based home care, and nursing home. Conclusion: Overall, the results of the study provide evidence of the economic viability of visiting nurse services for the low-income elderly among long-term care alternatives.

• 한국의료질향상학회지
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• 제7권1호
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• pp.18-31
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• 2000

Background : This study is to identify the inappropriate hospital services for elderly inpatients over 65 years in general hospital with acute care functioning. Consequently elderly inpatient care and the management of long-term care facilities are key issues for current government health policy. Method : The survey was conducted for two months for all inpatients over 65 in 7 general hospitals, 6 work sampling days randomly selected. In each survey day, the subjective judgement by medical staff on the degree of acute care needs and by nursing unit manager on hospital services of each inpatients was also conducted. Result : The total number of cases collected are 2,541 elderly inpatients, according to subjective judgements by medical staff on inpatient condition. However 46.8% of cases are turned out to be non-acute care group. The frequency of medical services provided to non-acute group are 2~3 vital sign checks per day 78.2%, IV injection 40.1%, antibiotics medication 20.2%. Conclusion : Lots of elderly patients' who are staving in acute hospitals, at present need to be transferred to long-term care facilities. However, there was been shortage of long-term care facilities. It is expected to identify the need of elderly inpatients and therefore, to provide cost-effective, appropriate and good quality health services to elderly inpatients depending on their needs.

• 한국보건간호학회지
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• 제24권1호
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• pp.5-18
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• 2010

Purpose: The purpose of this study is to understand nurses' perception of visiting nursing services of long-term care insurance. Method: The descriptive survey study involved 188 nurses selected by the convenient sampling of visiting nurses who participated in professional education sessions. Results: Of the 188 participants, 149 (79.3%) were aware of long-term care insurance. Awareness of aspects of long-term care services was 78.7% for facility service, 77.7% for ordinary visiting care service, 85.1% for visiting nursing service and 77.7% for visiting bathing service. Concerning visiting nursing service provision, the majority of the study subjects considered nurse-aid not to be the appropriate route for delivery of services including nasogastric tube exchange, tracheostomy tube management and stitch removal. Conclusion: Continuous evaluation and research on the standards and requirements of the nursing workforce is needed to secure and maintain the high quality of visiting nursing services. Exhaustive studies concerning task division and workforce separation according to nursing services type and level of difficulty should be done to develop the appropriate job description for visiting nursing service staff.

• 보건행정학회지
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• 제19권2호
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• pp.36-50
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• 2009

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

• 한국농촌건축학회논문집
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• 제18권3호
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• pp.9-16
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• 2016

This study aimed to clarify the multifunctional services and space composition in the process of developing a multifunctional long-term care program in small elderly care facilities in Japan. We collected data about multifunctional long-term care at small facilities from the Community Life Support Center (CLC), a Japanese non-profit corporation, and conducted an interview survey of the members of the CLC's secretariat in 2014. Furthermore, we selected 3 Japanese pioneering care facilities (known as takurosho), and conducted interview surveys and data collection to clarify in detail the space composition and process of development of multifunctional long-term care at small facilities. Four distinct results were found. First, the facilities had gradually increased non-institutional services, including visitation, overnight stays, and long-term stays, to fit the needs of users and their families. Secondly, in the 1990s, they could offer both non-institutional and institutional services at the same facility, but after the long-term care insurance system began in 2000, non-institutional long-term stay services were not allowed. Third, the facilities had built extensions or extra rooms in response to increases in multifunctional services and users. These rooms had common characteristics, with sitting rooms at the center of the facility. Lastly, the maximum number of service users at each of the 3 facilities was limited to 15, to maintain a small scale. However, as the size of facilities was increased through building extensions or remodeling, the overall amount of area available to users increased.