We conducted strategy of "A" Visiting Nursing Station where there were cumulative deficits by comparison of client satisfaction and cost with other stations. Client satisfaction survey was carried out for the quality of visiting nursing care. Subjects were 242 clients of 8 visiting nursing stations who participated in the survey. The questionnaire consisted of visiting nursing care items for clients and satisfaction for client outcomes items. Managers filled in the cost survey sheet asking on financial management including revenue, expense, profit, unit price, number of home visits and number of clients. The study period was one month in September 1999 and one month in September 2000 before and after the introduction of the long-term care insurance program. We used t-test to compare "A" Visiting Nursing Station and other stations. As a result, the clients in "A" Visiting Nursing Station were more independent but more demented, and tended to show lower satisfaction in "information and guidance." Although the unit price for a home visit was high, the number of clients and the number of home visits were less than a half compared with other stations. Thus, it resulted in lower revenues. Base on these results, action plans for management were made that are stimulating staff awareness aiming at increasing the number of clients and improvement of client satisfaction on information and guidance, marketing activities for related facilities, and seminars for dementia care and technical guidance.

Examples of Occupational Therapy (OT) intervention for the elderly over the age of 65 in need of home health care have been selected from various literatures. In each example, goals and outcomes of OT interventions were analyzed and classified based on ICIDH and the guidelines issued by the Japanese OT Association. It was found that the ideal support for elderly people in need of nursing care who wish to remain in their homes is to intervene at the earliest possible stage. People with disabilities were the primary consumers of this OT care. It was suggested that the interventions include counseling and physical exercise instruction, including coordination training. In comparing those in institutional care (hospitals, nursing homes) and those living at home receiving home ADL, it was found that people who were institutionalized needed family support and those living at home needed consistent IADL support. It was also suggested that OT models based on levels of dementia should be discussed in the future.

The purpose of this study was to investigate the subjective quality of life (QOL) of amyotrophic lateral scleros is (ALS) patients at home and to clarify what kind of factors were related to this QOL. We questionnaired 61 ALS patients at home from August to November in 1999.

As a result, the mean score for the subjective QOL of ALS patients was 28.8 (SD = 11.8). QOL score of ALS pati ents who had bodily pain or numbness, or who needed to be given care at night tended to be lower than that of the patients who didn't have these factors. While the attributes of care givers were not related to this QOL. The amount of hours of visiting nursing of social support resources tended to be related to the subjective QOL of ALS patients, that is, the longer , the higher.

These results suggest that it is possible to raise the subjective QOL of ALS patients by considering the way of giving better care to ALS patients and securing visiting nursing.

　The purpose of the researches is to make clear the contents of care practices where quality improvement are required or care managers in the future , by investigating how care management is actually practiced, how much care managers recognize the importance of their job, etc. Questionnaires were sent out to 571 care managers registered with the WAM NET who practice care management to user in Osaka.

　The result shows the need of improvement especially in the quality of the process concerning "Needs analysis and Care Conference by Service Providers" and "Monitoring and Evaluation", among other care management processes, consequently showing the need of training programs for the purpose of improving the quality in the area such as needs assessment, care service planning, management of the care conferences by service providers, method of monitoring and evaluation, development of social resources, and so on.

　Internet based hearing aids fitting system is established in the term of the Tele-medicine. The system is designed with integration of the hearing threshold test for nude ear, the speech discrimination test for the ear warring the hearing aids and the environmental sound test for virtual reality. And also the trouble shooting support system is included.

　This system is good for the hearing impaired persons who could not visit the ear clinic or the office of the hearing aid dispensers.

　Standardization of the sound pressure level is required for the adequate fitting and we have to improve the system on this point. And also the user interfacing system should be redesigned for senior clients.

A mail survey was conducted in September 2000 to clarify the actual state of oral health care for patients with ALS. The subjects were members of a patient's association, and a total of 170 members answered the questionnaire for a response rate of 62.7%.

Of total subjects, those who were taken care of for oral health only by relatives without professional help accounted for 40 percent. Those whose oral health care was taken less than once a day accounted for 15 percent. Those who received oral health care in such an insufficient way as being wiped with gauze or rinsed with antiseptic accounted for 20 percent. Although 57 percent of subjects were living under mechanical ventilation, those who had received the guidance to prevent aspiration pneumonia accounted for only eight percent. A half of patients who did not need help in daily living, and a quarter of those being bed-ridden had not received dental treatment after the onset of ALS. Thus the oral hygiene instruction for patients with ALS in early stage seems insufficient. In order to prevent aspiration pneumonia by improving oral health in patients with ALS, it is necessary for doctors and nurses to cooperate with dentists and dental hygienists.