The purpose of this study was to examine the necessity and method of an evaluation system on the housing modification services proposed by the Long-Term Care lnsurance system. By investigating the suitability of house adaptation and user's satisfaction from the viewpoint of ADL independence， we examined the relation between subjective satisfaction and objective suitability on the housing modification．

First， we mailed questionnaire to 140 persons in 2 cities in Tokyo who installed handrails using the Long-Term Care lnsurance in fiscal year 2002． Second， we visited 16 users’ houses and examined the factors relevant to the evaluation of housing modifications through observation and interviews of the users and their familieg．． Both surveys were done in January-February， 2003． With 90 effective responses of the questionnaire． we statistically analyzed the related factors of satisfaction with whole housing modifications and satisfaction with handrail installation． Then， with visit investigation data， we determined the relation between user's satisfaction and suitability of house modifications．

Consequently， the following points were revealed． （1）Half of the modification cases were not adequate for ADL independence． （2）Use's satisfaction was very high． （3）There was no significant relationship between user's satisfaction and the suitability modifications．

As a result, we found two types of models that explain user's satisfaction with housing adaptation． These models shows that the evaluation of housing modification is not necessarily measured only by user's satisfaction．

The purpose of the study is to identify the factors related to burnout among visiting nurses. We used MBI scale in order to measure the burnout. The possible contributing factors for burnout are demographics, worksite environments, attitudes toward their professional works, communication skills with their service users, worksite administrators' understanding for their workshop participation, and job training.

The research design is a cross-sectional mailed survey with self-administered questionnaire. The sample was 574 visiting nurses in 284 visiting nurse stations in Osaka Prefecture. The response rate was 39.9%. In the current study, we newly developed measures for worksite environments and communication skills in accordance with literature reviews. The expert review confirmed the face validity of the measures, and the reliability analyses (Cronbach's alpha) confirmed the reliability (internal consistency) for the measures. In addition, we analyzed the structure of sub-scales in each measure by using principal component analyses with Varimax rotation.

The measures for worksite environments and communication skills were confirmed the structure of sub-scales. In MBI scale, we identified five sub-scales rather than three sub-scales that were identified by the previous studies. The five were "tress," "personal accomplishment," "'de-personalization." "professional work accomplishment," and "psychological exhaustion."

The regression analyses revealed that their appropriate communication skills and positive attitudes toward their professional works were strongly related to "personal accomplishment," and "professional work accomplishment" in the MBI scale. On the other hands, the regression analyses revealed that their feelings of heavy duties on their jobs and inappropriate relationships in their worksite were strongly related to ''stress" and "psychological exhaustion." The results imply that the preventive strategy for visiting nurses' burnout is to newly develop educational and administrative systerns. In the systems, visiting nurses are able to improve their communication skills to reduce their feelings of job burden, and to obtain their supportive feelings from their colleague and supervisors.

Purpose：The purpose of this study was to clarify what nurses observed in patients with dysphagia, how they assessed them, and whether practiced dysphagia rehabilitation or not.

Method：ln order to select dysphagia patients 178 samples. Japanese care insurance rank 2 or more, from two visiting nurse services in Shiga Prefecture, were investigated. One hundred and fifty one patients out of 178 were collected, 100 of them dysphagia patients. The subjects were 31 nurses in charge of those 100 patients. The variables for nurses were whether they could assess that their patients had dysphagia, and whether they practiced dysphagia rehabilitation and oral care for them or not. For the 100 samples, we also investigated Japanese care insurance rank, circumstances at meal time, degree of speech disorder and communication impairment, Fujishima’s questionnaire（15 questions）, and pulse circulation and blood oxygen.

Result：The rate of nurses who could not asses their patients as having dysphagia （non-assessment group）was a larger population than nurses who could（assessrnent group）. The rate of not practicing dysphagia rehabilitation in the non-assessment group was significantly bigger compared with the assessment group.

Thus, it was considered that nurses are required to increase both their ability to assess patients’ dysphagia and their skills to take care of them.

The purpose of this study is to examine actual cases of home remodeling with the·‘Home Remodeling Allowance’·after the enforcement of the·‘Long-Term Care Insurance’ and to study the current status of such remodeling, serviceability to the users and changes to the caregiver’s burden in terms of taking care or the insured. The study is also aimed at understanding the effect of home remodeling.

The result: 1) Shortening of care-giving time by home renovation may be possible where the care-giving hours are short. 2) In cases where care-giving hours are less than 2 hours, home remodeling may reduce the physical burden on the caregiver and make care-giving work easier. However, no effect was seen on the psychological/mental aspect or on the attitude towards care-giving. 3) In cases where care-giving time is less than 2 hours, the number of things care-receivers can do without assistance increased to some extent after home remodeling. 4) Regarding the effect on care-receivers’ zest for life, there was no major gap between the caregivers’·and care-receivers’ evaluation.

The purpose of this study was to examine related factors to care managers’ burnout. The survey was conducted among care managers attending training programs about care management held under a certain prefecture in December 2002. Care managers’ burnout was measured by Maslac Burnout Inventory (MBI), composed of 3 factors ; Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Of 250 respondents, a sample of 226 care managers who satisfied all the item of MBI took part in the study.

The results were as follows

1. Emotional Exhaustion was significantly higher in care managers under 36 years of age, compared to those 36 and over, those without a nurse’s license compared to those with it, and those working overtime beyond 20 hours per month compared to under 20.

2. Depersonalization was significantly higher in care managers making a care plan of 40 cases and over, compared to those making under 40.

3. Considering the effect of meeting and training programs for care management, Depersonalization of the subjects getting a negative impression for them was significantly higher than that of those impressed positively. Personal Accomplishment of the subjects who felt training programs effective in their job was significantly higher than that of those who did not.

Objective : The purpose of this study was to determine to what extent the patients’ family, the nursing staff and the medical staff agreed on the evaluation of the daily life of the terminally ill patient who were cared for by their family, nurses and physicians at home, and to identify the state of the patients.

Methods : Data was collected by survey methodology. The questionnaire with the T. Noguchi’s tool was conducted to their family, the nursing and the medical staff who had jointly provided care for those patients. A total of 13 cases were analyzed.

Results : The findings are as follow : The degree of agreement among their family, the nursing and the medical staff was 76.9%. A half of the cases about which their family, nurses and physicians agreed to a high degree also were evaluated good state at the terminal stage. Of the 13 items of the tool, eleven maintained the state till terminal stage. Especially, sleep, pain, emotional stability, cleanliness, and right to choose were maintained.

Conclusion : What have turned out to be important are two. The first, the family should be included in the assessment and care planning in order to facilitate common understanding of the care goal among their family, the nursing and the medical staff. The second, their family, the nursing and the medical staff who collaborated in caring for the terminally ill homebound patients should first evaluate the quality of the care they provided separately and then minimize whatever differences among their family and two staffs in order to maximize the patient’s overall quality of terminal life. And health care providers were needed that they provide aggressive care for the domain where it is difficult to maintain the state. The view point of the evaluation for the daily life of the terminally ill patients was that the emphasis should be given on the ability of patients, not on the inability of them.