• 한국노년학
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• v.28 no.4
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• pp.1249-1264
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• 2008

Guilt feelings are dysfunctional feelings that the primary caregiver of the frail elder are apt to have and those feelings increase a burden of caring, while there is lack of empirical study on the effect of guilt feelings on caring behaviors. In light of this, this study lays its purpose on examining the effect of the primary caregivers' guilt feelings on their burden of caring and request behaviors for help with caring, paying attention to their guilt feelings in our society where Confucian values toward supporting the elderly have remained. The questionnaire survey was conducted for 220 primary caregivers caring frail elders over 60 years of age by visiting. As a tool for measuring guilt feelings, a self-designed measure for caregivers was used (${\alpha}=.949$), and factors of guilt feelings were classified into four namely, the factors of lack of self-control, lack of resources, burnout, and the normative factor As a result, the following findings were derived. First, it was revealed that the guilt feelings of caregivers as family members have a positive correlation with a feeling of burden of caring and the feeling of burden have even effects on the four factors of guilt feelings. Second, when primary caregivers request help with caring, they feel guilty toward cohabiting family members and neighbors, and also they show no guilt feelings when using day-care services for the elderly. Especially, guilt feeling factors affecting primary caregivers were found to be the normative factor to cohabiting family members, the factor of lack of resources to neighbors, and the factor of burnout to using day-care services for the elderly. This result tells that the dysfunctional feelings of primary caregivers namely guilt feelings arising when asking help with caring not only increase their burden of caring but also can cause difficulties in sharing the role of the caregiver. Accordingly for the mental health of caregivers, we should develop programs with which we could understand and cope with their guilt feelings.

• The Journal of the Korea Contents Association
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• v.17 no.4
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• pp.585-595
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• 2017

The purpose of this study is to analyze the difference of medical care between medical assistance and health insurance patients to evaluate the increase of medical care costs due to the moral hazard of medical care patients and to provide a basis for rational medical care policy decision. For this purpose, we compared health insurance benefit data for Seoul citizens by gender, age, and type of medical institutions. The results of the analysis are as follows. First, all of the hospitalized and outpatient use of the advanced general Hospitals, medical assistance patients were less than those of the health insurance patients, so that the medical assistance patients could not use the high cost medical services. Second, in general hospitals, patients with health insurance are often hospitalized. On the other hand, medical assistance patients use a lot of outpatient services because they are less burdened. Third, in hospitals and clinics, medical benefits patients often use inpatient and outpatient services. Therefore, medical assistance patients are likely to use unnecessary medical care of outpatient and hospitalization clinics and hospitals, outpatient of general hospitals. But, in hospitalization and outpatient use in advanced general hospitals and medical assistance patients can not use due to excessive medical burden. Therefore, the policy to reduce the burden of medical expenses for patients with severe illness will continue, and the medical care patients using clinics and hospitals should be careful not to use unnecessary medical services.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.6
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• pp.2161-2168
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• 2010

The administration data of the national health insurance and health insurance bills were utilized in this study. The data of 485,953 patients who were at the age of 30 and up and used the out-patient departments of every medical institution located in some regions involving two southern and northern provinces once or more during a 184-day period from July to December, 2008. As a result of analyzing their Continuity of Ambulatory Care and factors affecting it, the following findings were given: The continuity of ambulatory care among the adult patients with hypertension in our country turned out to be on a high level(MMCI $0.96{\pm}0.13$, MFPC $0.96{\pm}0.12$). Given examining the outpatient medical-cure continuity level according to index, the averagely medical-cure continuity level was calculated to be high level with MMCI, $0.96{\pm}0.13$, and MFPC $0.96{\pm}0.12$. Thus, the tendency of visiting only one medical provider was high. The findings of the study illustrated that the average continuity of ambulatory care among the adult patients with hypertension in our country was on a high level, and it seemed that special care should be provided to patients with a low-level continuity of ambulatory care, such as women and elderly people aged 64 and over. The findings of the study are expected to serve as one of the barometers for the health care of patients with hypertension and for the performance of national hypertension management plans.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.5
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• pp.285-293
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• 2017

This study examined the causal relationship among job stress, fatigue, and job satisfaction, which affect the turnover intention of elderly nursing home care workers. Data were collected from Sep.15 to Sep. 30, 2014. Structured self-administered questionnaires were delivered and collected without the respondents' personal information. The subjects were 232 female care workers working in nursing homes in D city. The data were analyzed using the SPSSWIN 21.0 and AMOS 21.0 programs. Covariance structure analysis was performed to estimate the causal relationship between the variables affecting the turnover intention of care workers. The results of the analysis were as follows. The variables included in this study were fatigue, which comprised 4.9% of job stress. Job satisfaction explained 54.6% of job stress and fatigue. The turnover intention was 46.2% due to job stress, fatigue, and job satisfaction. In other words, job stress, fatigue, and job satisfaction had a direct or indirect effect on the turnover intention of care workers. In conclusion, job stress, fatigue, and job satisfaction affect the turnover intention. Therefore, a policy to improve the work environment and working conditions is needed to reduce the turnover intention of care workers, and fulfill their duties in a stable life time workplace.

• Korea Journal of Hospital Management
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• v.25 no.2
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• pp.45-56
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• 2020

Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW -11,900±10,544, whereas it was KRW -196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.

• Korean Journal of Social Welfare Studies
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• v.44 no.3
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• pp.31-56
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• 2013

The purpose of this study was to investigate the changes that family caregivers have experienced since using the Korean Long-Term Care Insurance(LTCI) system. In-depth interviews were conducted to determine how the services offered within the LTCI program had affected family caregiving and what changes they had incurred. Results from the qualitative content analysis show that the LTCI program significantly reduced the caregiving burden among family caregivers although burdens that family caregiver perceived varied greatly depending on the types of service that the family selected, and assigned family caregivers different identities and diverse roles(i.e., service user, family caregiver, certified care provider) depending on the service they use. The phenomenon of 'certified family care provider', which was not an intention of LTCI, demonstrates the practical need of elderly persons who require both care and the comfort of family and economic status of the family. Despite the positive impact of the LTCI policy on the family caregivers' burden and family relationship, the current LTCI system should be modified in order to better meet the needs of beneficiaries and their family caregivers.

• The Journal of Korean society of community based occupational therapy
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• v.8 no.3
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• pp.1-12
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• 2018

Objective : This study conducted a preliminary study to develop a occupational therapy model focused on improving living functions within the community care system. Methods : From June to July, 2018, the literature on community care was researched, focusing on cases of Japan's Management Tool for Daily Life Performance (MTDLP), Sweden, United Kingdom, Germany and domestic S Elderly Care Centers and I Health Centers. Based on this information, a group of experts developed a occupational therapy model within the community care system. Results : Assessment tools such as occupation-based health promotional table, interest checklist, occupational goals for improving living functions, sheet for evaluation of living functions, survey of daily life time (weekday and weekend), and sheet for transition of living functions were developed to conduct evaluation for occupational therapy. The improving living functions program, analysis of activities based on ICF model, lifestyle redesign program, cognitive exercise therapy, the Lee Silverman Voice Treatment (LSVT), hospice, and home modification were also organized interventions already in place by occupational therapists. Conclusion : This study showed specific measures and models for the implementation of occupational therapy within community care systems. Occupational therapy is positioned as a specialized area that is essential to the client, and we look forward to the use of this model.

• 한국노년학
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• v.31 no.2
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• pp.195-209
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• 2011

This study examined the prevalence of and factors associated with unmet care need among community-dwelling middle-aged and older people in Korea. Data were from the 2006 Korean Longitudinal Study on Ageing (KLoSA), a national survey of 10,254 non-institutionalized adults aged 45 or older. Having unmet care needs was defined as needing personal assistance with activities of daily living (ADL) or instrumental activities of daily living (IADL) but having no available helper. Weighted logistic regressions were fitted to examine factors associated with unmet care needs. Overall, 7.3%, 14.5%, and 41.8% of subjects among the middle-aged, younger old, and older old, respectively, reported care needs of these, 34%, 33%,and 24% had unmet needs. Factors associated with unmet needs differed among the three groups: Education and income level were negatively associated with unmet needs among the middle-aged, but living alone was the only factor positively associated with unmet needs in both the younger and older old. The prevalence of and factors associated with unmet care needs differ by life-stage. Needed are home- and community-based care and services to meet the need for personal assistance among the elderly living alone in a community.

• Transactions on Control, Automation and Systems Engineering
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• v.4 no.1
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• pp.49-55
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• 2002

A decrease in the birthrate and aging are progressing in Japan and several countries. In that society, it is important that physically weak persons such as elderly persons are able to take care of themselves. We have been developing exoskeletal robots for human (especially for physically weak persons) motion support. In this study, the controller controls the angular position and impedance of the exoskeltal robot system using multiple fuzzy-neuro controllers based on biological signals that reflect the human subject's intention. Skin surface electromyogram (EMG) signals and the generated wrist force by the human subject during the elbow motion have been used as input information of the controller. Since the activation level of working muscles tends to vary in accordance with the flexion angle of elbow, multiple fuzzy-neuro controllers are applied in the proposed method. The multiple fuzzy-neuro controllers are moderately switched in accordance with the elbow flexion angle. Because of the adaptation ability of the fuzzy-neuro controllers, the exoskeletal robot is flexible enough to deal with biological signal such as EMG. The experimental results show the effectiveness of the proposed controller.

• Journal of the Korean housing association
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• v.19 no.4
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• pp.79-87
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• 2008

Snoezelen, multi-sensory stimulation, provides stimulation through the visual, aural, tactile, olfactory, gustatory and proprioceptive senses. Its aim is to be a relaxing, feeling of safety, novelty and stimulation with no expectations for performance. Agitated behavior of people with dementia causes significant problems and distress for cares. The objective of this research study was to test the effects of Snoezelen room on physical and verbal agitated behaviors of people with dementia. Four patients participated five sessions in Snoezelen room of 'F' dementia care facility in Sweden. Assessment instrument was basically used Cohen-Mansfield Agitation Inventory-Short Form to be rated by caregivers on a 5-point frequency scale. Pre-trial and post-trial assessments were carried out during $27^{th}$ Aug.-$27^{th}$ Sept. 2007. Result shows that Snoezelen room has some short-term positive effect on agitated behavior even though there was a considerable variation individuals responded. This result adds to the increasing evidence that Snoezelen could be a therapeutic environment for the elderly with dementia. Further research study, with larger number of participation, and a control group is required to establish more scientific evidence of Snoezelen effects on health outcome.