CARE MANAGERS' PERCEIVED PROBLEMS REGARDING CASE MANAGEMENT OF DIFFICULT CASES AND THEIR CORRELATES

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  • YOSHIE Satoru
    Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo
  • SAITO Tami
    Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo
  • TAKAHASHI Miyako
    Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo
  • KAI Ichiro
    Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo

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Other Title
  • 介護支援専門員がケースへの対応に関して抱く困難感とその関連要因　12種類のケース類型を用いて
  • カイゴ シエン センモンイン ガ ケース エ ノ タイオウ ニ カンシテ イダク コンナンカン ト ソノ カンレン ヨウイン 12シュルイ ノ ケース ルイケイ オ モチイテ

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Abstract

Objective In Japan, a National Long-Term Care Insurance that provides care for older and infirm people was started in 2000 and the role of care manager (CM) was established to coordinate care plans. As a new profession, CMs have experienced difficulties. This study aimed to clarify CMs' perceived problems regarding case management of difficult cases.<br/>Subjects and methods A nationwide mail survey was conducted with CMs in 500 public and privately run home care management organizations who were randomly sampled in 10 prefectures. A total of 556 CMs in 268 organizations returned the questionnaire, which asked questions about the demographics of CMs, their training background, employment experience, caseloads, hours worked, whether full-time or part-time, social support, and training given in the previous year. Questions about 12 different types of difficult cases, devised from a previous study by the authors were further developed in this research's preliminary interviews. The difficult cases identified included: clients with dementia, clients living alone, conflict laden families, over-demanding clients and/or family members, individuals with economic difficulties, reluctance to accept formal services, absence of a responsible family member, clients with medical needs, clients and/or family members with mental or psychological disorders, subjects of mistreatment and abuse, and those having disagreement with service providers. Bivariate analysis was conducted on the variables.<br/>Results More than 40% of the CMs felt difficulties in all of the 12 case types. Among those who have taken charge of these cases within the previous year, around 80% of the CMs felt difficulties in nearly all cases. From the bivariate analysis, CMs with a registered nursing background reported less difficulty in dealing with clients with medical needs (P<.001) and clients and/or family members with mental or psychological disorders (P<.01). Paradoxically, CMs with longer experience in the job felt greater difficulty with a majority of the 12 case types. This result might be explained by the fact they are given charge of more difficult cases.<br/>Discussion These results suggest that registered nurses have a background suitable for dealing with medical and psychological cases, while those with other backgrounds may need further training and support in these areas. Furthermore, there is a need to provide more intensive training and support to CMs with longer experience in the job who are providing care management to more difficult cases.

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