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介護サービス利用者数の増加及び介護重度化が介護費用を膨らませた。営利法人が参入できる居宅サービスや地域密着型サービスの給付費も大幅の上昇となっている。しかし，そのような介護保険サービス分野では，参入しやすい特徴があるため競争も激しい。各種サービスの収支差率が低下する傾向にある。大手介護企業の経営面においても，営業利益率は介護売上が大きいほど上位にあることが確認できた。つまり，介護業界でも経済の規模効果が存在する可能性は十分ある。また，介護売上原価率を比較した結果，介護売上上位の企業が原価以外の「販売費及び一般管理費」とのコスト管理は小企業より優れている可能性がある。さらに，臨時正規比率と1人当たり生産額を組み合わせで，臨時正規比率が低いほど1人当たり生産額は高い傾向にある。

Journal of Rehabilitation and Health Sciences. 15, p.25-30

今後急増する高齢者世帯において、要介護高齢者が在宅生活を継続させる条件を検討することを目的とした調査を行った。シルバーハウジング居住者に対するインタビューでは、民間サービスを含む地域の社会資源についての情報提供が必要であることが示された。ケアマネジャーに対するアンケートでは、利用者の在宅生活継続の意欲からそれを目標としたケアマネジメントが始まり、実際に在宅生活を継続させるためには緊急時の判断が可能な身内が近くにいることと、介護保険サービスに留まらない多様なサービスや資源を活用して柔軟に対応する質の高いケアマネジメントが必要であることが示された。, The present study investigated the conditions necessary for elderly people who require long-term care to continue living in households comprised solely of elderly members, the number of which is anticipated to rise sharply in the coming years. Interviews conducted on residents of public housing for the elderly revealed a need for information regarding local social resources, including privately run services. A survey of care managers revealed that care management aiming to enable continuing home care was initiated based on the users' motivation to do so. The survey also revealed the following two factors to be necessary for continued home-living: the nearby presence of a relative capable of making emergency decisions; and high quality, flexible care management that utilizes various resources and services that are not limited to those covered by long-term care insurance.

三原市を事例として，住宅改修前後における介護保険サービスの利用がどのように変化し，住宅改修が介護保険サービスにどう影響するのかを明らかにする。 分析の結果，次のことが明らかになった。（1）支給額上限の「20 万円」を受ける者が最も多く，三原市の住宅事情が要因である。（2）住宅改修の前後で介護保険サービスを利用している人が最も多く，住宅改修が介護保険サービスの利用開始の契機となっている。（3）要支援者で住宅改修をした人には介護保険サービスを利用していない人が多く，要支援者の介護保険の利用方法に課題がある。（4）高齢者の在宅生活を支えるためには，介護保険以外の住宅改修の助成制度の創設が必要である。, We found the following as an example in Mihara City of how the long-term care insurance service was put to use before and after house adaptation and what kind of influence house adaptation had on the use of the long-term care insurance service. As a result of analysis, we determined the following: 1. Many people received 200,000 yen, the upper limit of the allowance. One factor was the housing situation in Mihara City. 2. For many people, house adaptation was the occasion where they started using long-term care insurance service. 3. There were many people requiring support who did not use long-term care insurance service for house adaptation. One factor was that the long-term care insurance system was diffi cult to use. 4. Because elderly people continue living at home, it is necessary to fi nd a system to further house adaptation other than the long-term care insurance service., 報告

三原市を事例として，住宅改修前後における介護保険サービスの利用がどのように変化し，住宅改修が介護保険サービスにどう影響するのかを明らかにする。 分析の結果，次のことが明らかになった。（1）支給額上限の「20 万円」を受ける者が最も多く，三原市の住宅事情が要因である。（2）住宅改修の前後で介護保険サービスを利用している人が最も多く，住宅改修が介護保険サービスの利用開始の契機となっている。（3）要支援者で住宅改修をした人には介護保険サービスを利用していない人が多く，要支援者の介護保険の利用方法に課題がある。（4）高齢者の在宅生活を支えるためには，介護保険以外の住宅改修の助成制度の創設が必要である。|We found the following as an example in Mihara City of how the long-term care insurance service was put to use before and after house adaptation and what kind of influence house adaptation had on the use of the long-term care insurance service. As a result of analysis, we determined the following: 1. Many people received 200,000 yen, the upper limit of the allowance. One factor was the housing situation in Mihara City. 2. For many people, house adaptation was the occasion where they started using long-term care insurance service. 3. There were many people requiring support who did not use long-term care insurance service for house adaptation. One factor was that the long-term care insurance system was diffi cult to use. 4. Because elderly people continue living at home, it is necessary to fi nd a system to further house adaptation other than the long-term care insurance service., 報告

目的：Ａ町の65歳以上の在宅高齢者936人を対象にして，生活活動状況と介護保険サービス利用状況との関連を明らかにする 結果： 1）対象の内訳は単独世帯24％，高齢者世帯37％，「その他の世帯」38％であり，特に女性に単独世帯の割合が高かった． 2）性・年齢と生活活動状況との関連をみると，男性では「一人で外出」「買い物」において70－74歳と75－79歳の間で有意差があり，女性では，「一人で外出」「買い物」「金銭管理」「入浴」において80－84歳と85－89歳の間で有意差がみられた． 3）世帯と生活活動状況との関連をみると，単独世帯の生活活動得点が他の世帯と比べて有意に高くなっていた． 4）生活活動状況を介護保険サービス利用状況別で比較すると，サービスを利用している（利用あり）が，生活活動得点が低く，介護保険の認定を受けているがサービスを利用していないもの（認定のみ），サービスを利用していないもの（利用なし）それぞれと比べると統計的に差がみられた．しかし認定のみと利用なしの間では差がみられなかった．この傾向は世帯別でみると単独世帯で強くみられた． 以上の結果からＡ町では，介護サービス認定を早めに受けようとしている傾向があることが示唆された．, Objective: The purpose of this article is to clarify the relation between daily living activities and how the nursing care insurance service is used. Subjects: The subjects were 936 elderly people aged 65 years and older living at home in A. Town. Results:（1）The breakdown of the subjects was as follows: the households in which the subjects lived alone accounted for 24%, those in which elderly people lived 37%, and the households other than these accounted for 38%. The proportion of the women who lived alone was noticeably high.（2）Regarding the relation between sex, age group and their living activities, there were significant differences（going out alone and shopping alone）among 70-74 years old and 75-79 years old in men . There were significant differences（going out alone, shopping alone, the money management, and bathing）among 80-84 years old and 85-89 years old in the women.（3）Regarding the relation between the households and their living activities, the scores of the households in which the subjects lived alone were significantly higher than those of other households.（4）When living activities were compared in how the nursing care insurance was used, those who were using it scored less in living activities, which showed a statistical difference when compared with "only the designation," which means those people who were not using the service although they were designated as in need of nursing care insurance service, or "not using the service," which means those people who were not using the nursing care insurance service. However, no difference was observed between "only the designation" and "not using the service." When looked at in terms of the households, these tendencies were more conspicuously observed in the households in which the elderly people lived alone. Conclusion: All of these results suggest that in A. Town elderly people tend to have their nursing care insurance service designated earlier than usual.

目的：Ａ町の65歳以上の在宅高齢者936人を対象にして，生活活動状況と介護保険サービス利用状況との関連を明らかにする 結果： 1）対象の内訳は単独世帯24％，高齢者世帯37％，「その他の世帯」38％であり，特に女性に単独世帯の割合が高かった． 2）性・年齢と生活活動状況との関連をみると，男性では「一人で外出」「買い物」において70－74歳と75－79歳の間で有意差があり，女性では，「一人で外出」「買い物」「金銭管理」「入浴」において80－84歳と85－89歳の間で有意差がみられた． 3）世帯と生活活動状況との関連をみると，単独世帯の生活活動得点が他の世帯と比べて有意に高くなっていた． 4）生活活動状況を介護保険サービス利用状況別で比較すると，サービスを利用している（利用あり）が，生活活動得点が低く，介護保険の認定を受けているがサービスを利用していないもの（認定のみ），サービスを利用していないもの（利用なし）それぞれと比べると統計的に差がみられた．しかし認定のみと利用なしの間では差がみられなかった．この傾向は世帯別でみると単独世帯で強くみられた． 以上の結果からＡ町では，介護サービス認定を早めに受けようとしている傾向があることが示唆された．, Objective: The purpose of this article is to clarify the relation between daily living activities and how the nursing care insurance service is used. Subjects: The subjects were 936 elderly people aged 65 years and older living at home in A. Town. Results:（1）The breakdown of the subjects was as follows: the households in which the subjects lived alone accounted for 24%, those in which elderly people lived 37%, and the households other than these accounted for 38%. The proportion of the women who lived alone was noticeably high.（2）Regarding the relation between sex, age group and their living activities, there were significant differences（going out alone and shopping alone）among 70-74 years old and 75-79 years old in men . There were significant differences（going out alone, shopping alone, the money management, and bathing）among 80-84 years old and 85-89 years old in the women.（3）Regarding the relation between the households and their living activities, the scores of the households in which the subjects lived alone were significantly higher than those of other households.（4）When living activities were compared in how the nursing care insurance was used, those who were using it scored less in living activities, which showed a statistical difference when compared with "only the designation," which means those people who were not using the service although they were designated as in need of nursing care insurance service, or "not using the service," which means those people who were not using the nursing care insurance service. However, no difference was observed between "only the designation" and "not using the service." When looked at in terms of the households, these tendencies were more conspicuously observed in the households in which the elderly people lived alone. Conclusion: All of these results suggest that in A. Town elderly people tend to have their nursing care insurance service designated earlier than usual., 保健学研究. 2007, 20(1), p. 49-57

今回、山梨県内の居宅介護支援事業所を対象に、サービス担当者会議の開催状況を主とした各サービス事業所との連携について調査した。その結果、介護保険施行後１年半を経過する現在、以下のような実状と今後の課題が明らかになった。 各居宅介護支援事業所において、ケアマネージャーは非常に多忙な状況にありながら、他のサービス事業所との連携を９割以上が実施していた。またサービス担当者会議の開催率は８割を越えていた。 サービス担当者会議開催に際しての困難として、日程の調整が最も多かった。また連携そのものがボランティア的要素が強く、サービス担当者会議についても報酬が得られないこと、会議を有効に進める上での方法論等の問題もあることがわかった。 そして課題として以下の６点があげられた。 各居宅介護支援事業所の努力として １）所在する市町村の動向把握に努め、行政ルートを活用して各サービス事業所との連携強化に役立てる。 ２）連携の効率をあげるために、業務整理の一環として、サービス事業所との日常の連絡方法の見直しを行う。 ３）日頃のサービス事業所との連携の中で、サービス担当者会議の対象者選定及び会議の必要性の共通理解を得るよう努める。 行政からの支援として、 １）各支援事業所とサービス事業所の連携に役立つ具体的な支援を強化する。 ２）サービス担当者会議の目的の再認識、会議進行に関わるノーハウを学ぶ研修の場を設ける。 ３）サービス担当者会議に参加するサービス担当者の報酬に結びつく策を検討する。, A survey was conducted to ascertain the state of collaboration among various service agencies, with a special emphasis on service provider meetings, by interviewing home care support agencies in Yamanashi Prefecture. One and a half years have passed since the implementation of the Home Care Insurance legislation, and the results of this survey clarified the actual situation and future tasks: Care managers in all home care support agencies were very busy, but more than 90% of the agencies were collaborating with other agencies. In addition, the rate of hosting service provider meetings was above 80%.Scheduling was the most common problem associated with hosting service provider meetings. In addition, the nature of collaboration among these agencies displayed a strong sense of volunteerism, and there were problems with methodology since no financial incentive is provided for attending service provider meetings and service providers are not trained to effectively advance the agenda of meetings.These problems could be addressed in a number of ways. Each home care support agency could :1) ascertain trends in local agencies, and strengthen collaboration among various service agencies by making effective usage of bureaucratic resources. 2) reevaluate ways in which daily contacts are made with service agencies to improve collaboration, as part of workplace reorganization. 3) select one member to attend service provider meetings, and reiterate the necessity of these meetings when collaborating with other service agencies.Bureaucratic agencies could: 1) strengthen supports that are truly useful for facilitating collaboration between various support and service agencies. 2) remind each agency of the objectives and benefits of service provider meetings, and provide opportunities for learning methods of advancing meetings. 3) investigate methods to financially reward service providers who participate in service provider meetings.

原著論文, Original Papers