2018 Volume 26 Issue 4 Pages 257-264
This study aimed to clarify the challenges of community-based care for elderly residents with mental disorders by analyzing the difficult cases dealt with by care workers and reported at a care conference. Among the difficult cases reported at a community-based care conference among 4 insurers, 10 involving residents with mental disorders were classified based on the name of the diagnosis. Each of the 10 cases was summarized and analyzed by a comprehensive community-based support center (support center) and a home care manager (HCM) to identify the challenges of comprehensive community-based care. There were 6 male and 4 female residents, and their Long-term Care Grades were as follows : Support Grade I : 4 ; II : 1 ; Care Grade I : 2 ; II : 1 ; and III : 1, with 1 who had not applied for the certification. The following mental disorders were observed among them : schizophrenia : 1 ; a depressed tendency : 1 ; anxiety neurosis : 2 ; alcoholism : 4 ; and intellectual disabilities : 2. In the case of schizophrenia, the family refused to use care services. Similarly, in the case of a depressed tendency, the family refused outpatient care services recommended by the HCM. In the case of anxiety neurosis, there was a tendency for a solitary elderly resident, who had moved in the community, relying on his/her relatives and acquaintances, to frequently complain of anxiety-related problems to the HCM. In the case of alcoholism, the HCM attempted to persuade the resident to avoid drinking through cooperation with the family, but the latter refused to cooperate. Lastly, in the case of intellectual disabilities, liaison with welfare supporters for people with disabilities tended to be difficult. The refusal to support elderly residents with mental disorders was associated with the residents’ own obsessions and other reasons, indicating the necessity of assessing the acceptability of community-based care services. The examination of difficult cases encountered in various daily life situations may be useful for care workers to learn about the symptoms and characteristics of mental disorders among elderly community residents. It may also be necessary for support centers to collect information regarding self-help groups in the community, and present it to HCMs. Furthermore, the sharing of information between welfare supporters for people with disabilities and Long-term Care Insurance service providers, with an understanding of the other’s standpoint, and interdepartmental liaison and collaboration in each administrative agency may be indispensable to promote comprehensive community-based care for elderly residents with mental disorders, suggesting the importance of establishing systems to address these challenges on a community-wide basis, rather than individually.
