小規模多機能型居宅介護施設の利用圏における広域化の全国的実態

抄録

 The purpose of this study is to inspect whether Small-Scale Multi-Care facility provide the community based service to users or not through the research into the aspect of real utility area. The following facts have been clarified through the research into ninety three municipal governments and all of Small-Scale Multi-Care facilities in fourteen cities in Japan.
 The real utility area of almost facilities have extended beyond the planned service area and the distance between user home and facility is long. As a result of it, the concept which Small-Scale Multi-Care facility provide the community based care service to users has been emasculated.
 The many causes of the expansion phenomenon of utility area is found as following through the analysis of opinions by persons in charge of the department for old people welfare in municipal governments and manager in Small-Scale Multi-Care facilities. The strongest direct cause is the owner's mind of management to hope to get many users as possible for keeping business. The second direct cause is user's mind or their family's mind to select facility being based on various factors except distance, also their mind to wish to avoid the backbiting by their neighbors. From these facts, we can find the coincidence between demand by users and supply by the facility owners.
 In the background, there is indifference by municipal governments and the facility owners to the significance of the community based care service. Also there is indifference to the significance of setting the planned service area for supply it. Beside them, the disordered utility and the expansion phenomenon of utility area is promoted with the nonexistence of the information service organization.
 As mentioned above, the expansion phenomenon of utility areas come from the circumstances of management system, administration, facility owners, users and their communities The correlation between the number of Small-Scale Multi-Care facility in a city and their utility areas is not clear against our expectation. In the previous paper wrote by us, we explained the structure with many causes in the expansion phenomenon of the utility areas. The structure has been verified also in this research.
 In this time, we have found new causes of the expansion phenomenon of utility area. That is the long stay use at Small-Scale Multi-Care facility. The mean of the long stay use is staying at Small-Scale Multi-Care facility over thirty nights against the regulation. The long term stay appear as the result from the coincidence between user's mind and owner's mind. The user desire the care facility which can supply the long term care and accept the long term stay although it lead to long term distance use. On the other hand, the owner wish to accept many users as possible to fill out regular user number although it lead to the long distance use. As the background of this phenomenon, the long term care facilities like the nursing home for old people are not sufficient. So if we expect Small-Scale Multi-Care facility regain the role as the community based care service facility, it is necessary to discuss each role and necessity of care facility.