Purpose: There are two types of around-the-clock in-home care systems. One is single type of home help service and the other is combination type of nursing and home help service. The latter enables nurses to visit not only in the daytime, but also in the early morning, evening and nighttime, and that home helpers work closely with nurses. The current situation and differences between both types of home help were investigated.

Method: Comparison between the characteristics of users of each type of home help service in the Tokyo Metropolitan area was conducted.

Results and discussion: Users of single type of home help service were more independent and living alone compared to those of combination type. The incidence rate of death at home was no different between the both groups. However deaths at home were included int he care plan of home help service in the combination type, but in the single type of home help service deaths at home were caused by suffocation or aspiration unexpectedly.

Conclusion: Around-the-clock nurses’ visits enabled patients in the terminal stage to die at home. Around-the-clock home help service should be provided as the combination type of nursing and home help service in order to be more responsible for patients who need medical care and terminal care int he home as well as to provided as to prevent deterioration of patients.

A burden of family caregivers of those elderly becomes more and more large and importance of social support for them increase more and more. The purpose of this study was to elucidate essential factors for the well-being of care givers in order to plan a more valid social support for caregivers’ well-being and the stability of care giving situation. We asked for 47 caregivers by visiting door-to-door about their care circumstances, life total consciousness, life satisfaction degree, and investigated it statistically. From a factor analysis result of data, 9 factors were extracted as a rule factor of care circumstances, that is, life satisfaction degree (F1), care amount (F2), autonomy (F3), emotional control (F4), spare time activity (F5), care frequency (F6), circumferential support (F7), give-and-take with other those warmly (F8), practical use of service (F9). Considering with these 9 factors in relation to major well-known general ideas, F1 deals with a quality of life, F2 and 6 deal with a care burden, F3, 4 and 9 deal with the dealing behavior, F5, 7 and 8 influence a factor of competence. We proposed a empowerment model providing care giving situation with the mutual participation, and suggested the importance of emotional support, such as circumferential support or give-and-take with other those warmly as well as various kinds of material service from a view of the empowerment point.

The purpose of this study was to examine effective method of care management in the long-term care insurance system through consumer evaluation of services provided by home care management. Subjects were 73 consumers who used home care services more than three months in home care users who agreed to participate the long-term care insurance simulation practice. As consumer evaluation, we developed a questionnaire to measure consumer satisfaction on home care services and conducted a self-report survey by mail. Internal consistency was high (Cronbach’s alpha coefficient of 0.943). The average of consumer satisfaction was 89.2 % ranging from 40 % to 100 %. As factor that consumer satisfaction, consumer’s age, care conference, consumer’s participation to care conference, and consumer’s confirmation of care plan had significant relations. These suggested that consumer and service provider can heighten consumer satisfaction by care management, by deepening mutual understanding and holding needs and objectives in common through care conference and confirmation of care plan.

The purpose of this study is to develop screening sheet to identify high-risk patient situations in need of early intervention of discharge planning in an acute care hospital. At fast, we analyzed discharge planning records of 100 patients was intervened and got hospitalized in the hospital in 1997 from 1995, in order to identify their characteristics and selected discharge screening item with some expects at there work. As a result we chose the screening 17 items.

Next, we analyzed agreement rate of screening item that discharge coordinator and nurse checked 361 patients for one month from May 1998, and developed screening sheet consists of 17 items.

Then we examined possibility of using the screening sheet by same method, checking all 176 patients who got hospitalized in 2 weeks in November 1998 to high risk or no risk by the screening sheet consists of 13 items.

As a result, we identified patients who were applicable to three items among 13 screening items as high-risk patients. Each patients who was judged to need discharge planning using these items was confirmed as appropriate even by comparing with clinical judgment.

Objectives: The purpose of this study was to investigate discharge planning, which was conducted by nursing staff, and to examine about factors, which may have influenced discharge planning process.

Methods: Subjects were nurses who conducted discharge planning at 1998 (n=34) or 1999 (n=42). Data were collected about level of performance, which is needed for discharge planning process, and condition of cooperation. Instrument was questionnaire made by researchers. We compare with the results of 1998 and of 1999.

Results: Level of performance was not significantly different in 1999 from in 1998. Nurses’ behaviors to seek for home care information, other’s opinions and help were different in 1999 from in 1998. Active conference relate with care planning performance level. Nurses’ behaviors to seek for home care information, other’s opinions and help relate with discharge planning process. Support system is an important factor to promote discharge planning.

The purpose of this study was to develop and evaluate the reliability and validity of the Cognitive Appraisal of Disability for Stroke (CADS).

Questionnaire content was based on the work of Lazarus (1984) and 24 items were generated from “A Qualitative Analysis on Problems Recognized by Patients” by Konishi. In pretest, the CADS was significantly correlated with the Cognitive Appraisal of Health Scale (r = .814, p＜0.001), Cronbach’s Alpha was .809 and test-retest reliability coefficient was .976 (p＜0.001).

The CADS was tested in a sample of 105 stroke victims. Five factors were identified through factor analysis using a principal factor method with varimax rotation and the CADS was reduced to 18 items. All factors were good reflections of psychometric components for cognitive appraisal classified by Lazarus, indicating construct validity. Cronbach’s Alpha was .833, indicating internal consistency in re li ability.

Thus, the CADS was found to have both reliability and validity as a scale for measuring the psychometric components of cognitive appraisal of disability for stroke.

The purpose of this study is to consider the ideal way of family support by clarifying the factors which relate to Well-being of wives who are helping aged husbands at home and also analizing these factors through the time passage of caring at home.

The study method executed a semi-structural interview to 21 persons who had approved the investigation by home visit. The analysis objects in this paper are 17 wives who looked after their husbands. The way of analysis was classifying the interview records into wives’ Well-being categories and located them in the time passage of caring.

The results were as follows:

1) The six factors which related to wives’ Well-being were extracted. They were: (a) marital relationship, (b) wives’ social participation, (c) the relations of family and relatives, (d) caring techniques, (e) wives’ physical health, and (f) adaptation to living environment.

2) The intimacy of marital relationship and the husbands’ stabilized condition improved wives’ Well-being. On the other hand, communication gap between a wife and husband hurted wives’ Well-being.

3) Wives’ social participation was a factor to improve their Well-being.

4) The relations of family and the relatives were observed both directions of which wives’ Well-being was improved or hurted.

5) The six factors which related to wives’ Well-being changed in the time passage of caring.

Therefore, the idea of the family support along the time passage of caring was suggested.

The present study was investigated the conditions surrounding elderly abuse in Taiwan and attempts to identify possible measures for preventing elderly abuse by comparing the Taiwanese situation with that of Japan. We sent a questionnaire to all public health nurses working at health centers in 12 districts in Taipei. An identical questionnaire was used in Saitama prefecture in 1995.

The results were as follows:

1) In Taipei, most of the elderly experiencing abuse were independent and living alone, and in the usual case, it was their son, rather than their daughters-in-law who had responsibility for providing care.

2) As it was found in Saitama prefecture, elderly abuse involved a family relationship such as a parent-child or a daughter-in-law/mother-in-law relationship. In addition, it was not always the case in Taipei that the degree of physical dependence influenced the occurrence of abuse.

3) The quality and quantity of services available in Taipei, including services provided in close cooperation with other healthcare providers is currently insufficient.

In light of the conditions surrounding elderly abuse in Taiwan, the present results suggest the importance of monitoring family relationships and providing ready access to needed social services.

This study identified the factor structure of user satisfaction with day service for the elderly and examined the determinants of the overall user satisfaction. The study design is a cross-sectional survey with interviewing the day service users. The sample came from service users in Mie prefecture agreed to participate in this study. The questionnaire was completed by 132 individuals. That is an average response rate of 82.5%. The factor analysis with varimax rotation identified four sub-scales of user satisfaction: Staff Attitude, Facility Comfort, Service Accessibility, Day Service Fee. The internal reliability of the sub-scales was moderate (0.72 to 0.56). The overall user satisfaction is composed of general satisfaction, amicable recommendation, and intended reuse. The internal reliability was also moderate (0.60). Results of the multiple regression analysis showed that the determinants of overall user satisfaction were Staff Attitude, Facility Comfort, Service Accessibility in sub-scales of the user satisfaction and that they were also age and family arrangement in demographic variables. The results are interpreted as providing the practical implications of service evaluation in day services. The main implication is that not only facility comfort but also staff attitude and service accessibility are crucial in order to improve overall user satisfaction of day service.

The purpose of this study was to evaluate care the quality of visiting nursing station that obtained high score in client’s satisfaction for received visiting nursing and to identify characteristic of agency’s client has high score satisfaction. Subjects were 154 clients who received home care and 3 managers in each visiting nursing stations. Method was to mail questionnaire that consists of items related to improvement of client conditions and collect it. We asked manager of agencies to fil self-evaluation sheet. The results were that the highest agency had high score client's satisfaction about nursing action and clients need solution than two agencies. Self-evaluation of the agency was higher evaluation about nursing education of basic philosophy and taking measure suited to the occasion, nursing assessment, nursing practice about self-support care in response client’s need.

From the above, it is important for nurses to evaluate satisfaction degree of client family and at the same time effort to improve organizational system of agency side, care method, staff education.

Objectives: Objectives of this study was to examine psychological effects of using hoists quantitatively in comparison between using and not using hoists in home care by applying rating scale method.

Methods: (1) Subjects: Subjects were 16 hoists-users (8 hoists-users were persons to need care, 8 hoists-users were caregiver).

(2) Questionnaire form: Hoists-users were asked to choose a suitable grade in ten scales containing 5 grades for each.

(3) Methods: In order to find how the hoists-users feel while not using a hoists which is usually used in every day activities, the hoists-users who need care were taken care without hoists, at first. In reality if there is a care giver, the care giver took care of the same activities without hoists. If a hoists-user uses a hoists dependently, the investigator took care without hoists. After this, the all hoists-users were asked to assess psychological differences in comparison between using and not using hoists.

Results: (1) There was a tendency of positive feelings to use hoists in 16 conditions out of 20.

(2) There was a tendency of negative feelings, those are fear, to use hoists in 1 care giver and 2 persons to need care.

(3) There was another tendency of negative feelings, those are unwillingness, to use hoists in 1 caregiver.

In conclusion, the psychological effects of using hoists were evidenced quantitatively.