We investigated factors related to the stress associated with the role of ethical coordination for nursing managers of home-visit nursing stations. The survey comprised 393 nurse managers and was conducted from November to December 2019. The stress-related factors were examined using multiple regression analysis. The results showed that the following factors were involved in the stress associated with the role of ethical coordination: the presence or absence of ethical education in basic nursing education, the level of knowledge regarding the guidelines and guiding principles, recognition of the necessity for ethical coordination, and the presence or absence of supporters. These results suggest that ethical coordinators need to acquire skills that facilitate using their knowledge to develop ethical conversations as well as supporters who understand the quandaries faced by the coordinators and who can draw out the coordinators’abilities.

This study aimed to clarify the effects of nutritional support by comparing the condition of users of Community Comprehensive Support Centers before versus after the nutritional guidance. Subjects were 25 users of Community Comprehensive Support Centers who provided informed consent to participate in the study. Subjects were assessed before and after the nutritional guidance based on anthropometric data MNA^®-SF, simple frailty index score, healthrelated QOL (SF-8), and the amount of food intake. After the nutritional guidance, MNA^®-SF, simple frailty index score, GH of SF-8, PCS, subjective sense of health, self-efficacy, protein adequacy, and fish intake improved-cantly. The nutritional intervention by registered dietitians brought about improvements not only in nutritionrelated items but also in psychological aspects.

Objectives : To clarify how the general public feels about death from senility and the differences in characteristics between those who view senility as a reasonable cause of death and those who do not.

Methods : An Internet-based survey was conducted among the general public.

Results : All 1,003 participants responded to all questions. More than 80% of the respondents felt that dying of senility was a peaceful death, about 7% felt that they did not receive adequate medical care. More than 70% felt that dying of senility was a valid cause of death. Multivariate analysis showed the higher the score on the “avoidance of death” scale, the less likely dying of senility would be seen as a valid the cause of death. (odds ratio : 0.94, 95% confidence interval : 0.91–0.96).

Conclusion : The majority of the general public was positive about death from senility. In addition, it was suggested that the view of life and death may have influenced their thoughts about senility.

Patients' families' views on polypharmacy in home medical care were investigated using a questionnaire, In cases where consent to either drug increase or decrease was obtained (70% of the respondents), the rate of the patients' hospital visit was low, the medical treatment implementation rate was high, and the degree of dissatisfaction regarding the number of prescribed drugs was low，However, in total, 20% of the patients' families did not want drugs increased, and the intention rate of dying at nonhospitals was high, In particular, for patients who were taking neuropsychiatric drugs, their families tended to feel that the number of regular drugs was too high, On the other hand, a small number of patients' families (10% of respondents) were satisfied with the current prescription ; the home care rate was high, the intention rate of dying at nonhospitals was low, and many patients were prescribed kampo herbal medicines and similar treatments. When the hospital-visit rate was high, the medical treatment implementation rate was low, and the number of neuropsychiatric drugs was large, the patients' families tended not to consent to either drug increase or decrease, Therefore, when reviewing prescriptions, families' views should also be considered.

Ultrasonography is being increasingly used in home care nursing. However, nurses have few opportunities to learning this technique. Although nurses do perform ultrasonography, there are no studies that echo education for home care nurses or compare the levels of difficulty in the different echo techniques. Therefore, we investigated the practice of ultrasonography of home care nurses who utilize ultrasound. IVC observation was performed for 84% of the subjects, and bladder echo was performed for all the subjects. The median difficulty of IVC and bladder ultrasound was 4 (3 - 5) vs. 2 (1 - 3) (p<0.05). The median time required for bladder ultrasound was 4 (3 - 5) vs. 2 (1 - 3) (p<0.05). The need for home care was 4.5 (3.8 - 5) vs. 5 (4.3 - 5) (p = 0.13), with no statistically significant difference. Since bladder ultrasound is simple and quick procedure, learning this technique should be prioritized.

The purpose of this study was investigated the characteristics of the “gap” in medical staff perceptions of the types of discharge support needed during hospitalization and after discharge for patients. Participants were 76 patients who were included in our Transitional care program from April 1, 2018, to March 31, 2019. Of the support items that were initially deemed unnecessary at the time of hospitalization, the frequencies of support items considered necessary at discharge were analyzed. The most common support item with “gap” was “medical management /long-term care education” (65.8%), followed by “support for coordination with other providers” (27.3%), “support for using long -term care services” (27.1%), “drug education” (22.6%), and “nutrition education” (15.9%). Since the causes of “gap” differ for each item, measures should be taken to address this gap, in consideration of the support types and the occupation of staff participating in TC programs.

To the best of our knowledge, it remains unclear whether the activities of daily living (ADL) for very old individuals who receive home-visit rehabilitation can be improved by personalizing the housing environment. Our center experienced a case in which a woman in her 90s developed right hemiplegia after a left corona radiata infarction. We conducted a home survey while she was hospitalized in our center's convalescent rehabilitation ward. She was subsequently discharged for in-home care by her family members once home renovations were complete. However, she required more assistance at home than at the hospital because of a slight difference in the positioning of handrails. Consequently, from the start of home-visit rehabilitation, adjustments involving repeated personalized instructions for movement and practice were tailored to the environment and given to the patient. Here, we report a case of a woman in her 90s who achieved her goals because she could improve her ADL and increase the number of independent activities.

We report on a cervical spinal cord injury that caused multiple disabilities in a visually impaired elderly patient living alone. Despite the patient's lack of sufficient improvement in activities of daily living (ADL) after undergoing rehabilitation, the patient wanted to be discharged and sent home. A comprehensive approach was applied by coordinating the medical staff and home-care staff, which covered adjusting the patient's home environment and ensuring his access to care services such as periodic or on-call nursing care. This approach allowed him to be discharged and sent home. He has been continuously living alone for three years since he was discharged from the hospital. Some Functional Independence Measure (FIM) scores have unfortunately declined over time, but there has been no need to change his care plan drastically. He has been actively participating in social interactions and has also been enjoying living alone at home. This report shows that it is meaningful to discharge and send an elderly patient back home using the comprehensive approach discussed. The case study also highlights the necessity to consider the feasibility of home discharge even for patients with multiple disabilities that make performing ADLs difficult.

In the summer of 2018, we accepted Thai students majoring in public health for practical training in a home care clinic. After the practical training, we held a group discussion in which we mutually learned about community medicine and home healthcare in Thailand and Japan. While home healthcare in Japan provides advanced medical care through interprofessional collaboration, community medicine in Thailand includes treatment from doctors in regional center hospitals and primary care through volunteers in rural areas. Through the discussions, we were able to take an objective view of medical care in both countries. From the perspective of Japan, which is facing community healthcare issues due to being a super-aged society, we were able to send a message about the challenges that Thailand will face in the future and the opportunities to seek solutions in terms of home healthcare.