2007 Volume 65 Issue 2 Pages 55-66
The long-term care (LTC) insurance system for the elderly in Japan was launched in 2000 and has quickly expanded during the subsequent five years in the number of service users and the volume of service use. Such growth has been accompanied by significant reforms to the LTC insurance system. In October of 2005, in response to out-of-pocket meal expenses, LTC facilities were introduced into the nutrition care and management (NCM) system. This has dramatically changed the work of the administrative dietician from food servicing to providing nutrition care on an individual basis. In order to deepen our understanding of NCM under the revised LTC insurance system and to be better prepared to address future issues as they arise, we examined the results of the Ministry of Health, Labor and Welfare-funded study, “Research on Nutrition and Food Services Management for the Elderly” (2004-2006; lead researcher, Sugiyama, M.) and “Research on NCM for the elderly” (1996-1999; lead researcher, Matsuda, A.; co-researchers, Koyama, H, and Sugiyama, M.). NCM can be characterized by the introduction of the PDCA cycle as a fundamental principle of management and the managerial procedure of continuous quality improvement (CQI). These are based on the continuous evaluation of outcomes. This program seeks to improve the total function based on assessing the process and system and establishes collaboration activities that go beyond the territory of each department. “Quality” in this program refers to the satisfaction of patient needs and expectations. In a word, CQI is a permanent, continuous program dedicated to pursuing higher quality in LTC. The administrative dietician should be collecting evidence based on the nutrition care process in order to further improve the quality of NCM.
