Assisted Living 9,, ( ) ( ) 1. 6) 2. 5. 3. 1) 4. 2) 1) 6. : 2) 1) 3) 2) 4) 3) 5) 4) (1998) 21 2025 80 73.,. 1980..?,,.,.,, 130
,,.,.,,,. (managed care),,,.,.,,,.,,,,.,.,,,,,.,..,. 131
1. 2010 - -,,,,,..., / / (,, ) / / 132
WHO(1984)., (Activity of Daily Living, ADL), ADL(Instrumental ADL, IADL),,. Lawton(, 1996)(quality of life, QOL) 4. Behavioral competence( ),, 4 (ADL, IADL ),, ( ), ( ) QOL. Perceived quality of life( ).,,,,, QOL. Objective environment( ) (, ) (, ) QOL. Psychological well-being( ) QOL.. 65 86%, 99.7% (, 1998). 3. 1) : (,, 1, 15, 200-300m,, ) 2) : IADL(,, ) 3) : ADL(,,, /, ) 60 56%, 133
, 1999). 10%, 34% ( 1. 60 1997 65 8.3% 24 (, 1997) 2020 10% 100.,. 65 46.3%( 109 ) 2,020 182. 2.,...,, 134
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.,,,,,..,,,,,,,.,,. 30, 1 32 (, 1998).. 15 57.6%.,,., 30%.. 97% 5% (, 1999)... 1) 2) 3) 4),,,, 5) 6) 7).,,.,, 136
. ( ). 3., 1) ( ), 2003 4 (,,, ). 2) 1, ( ). 3),,,,,,,,,. 4),,,,,,,,,,, 4. 1) (1) :,.,,,,,,. (2) :, 137
.,.,,,.,,,. (3) :, 1-2.,.,,, 2.,. 1) 2), 3) 4) 5),,,,,,,. 1), 2),, 3), 4),. 2),,,..,,,. 138
,,. 3) (1) (2),,,,. (1),, (2),,, (3), (4), (5), (6) (1), 2). (1),,,,,,,,, (2). (1), (, ) (3) (,,, ). (1) (2),. 4),, (neglect),, (1): ( ),, (2) :,,,,,, (3) :,,.,,,,,,,,,,,... 139
5) (1), (2),, (3) (4) (5),,,, (6) (7),, (8) (9),,, (10), (11) (12). (1),,,,,,,,, ( ),,, (2),,. (3),,,, (4) (5)., (1) (2),,,,,,, (3),,. 6) (1) (,, ), (2), (1) (2) (3) :,,, (,, ),, (massage, ) (4) ( ). (1) (2). (1) (2) :,,,, 140
(3) ;. (1) (2) (3) (4) (5). (1), (2) (3). (1), (2) :,,,,, (3) :, CT, MRI. (1) (2) (3) (4) (5) (6). (1), (2),,, (3) (4). 5.,,.. 1) 1988 1993 (residental care) (home care). 1993 (70.0%). 65-69 17.0% 80 42.0%.,,,. 141
3,..,,..,,,,,,,,,,.. 47% 2%, 37% 92%, 16% 6%. 70 1,000 100. 40, 50, 10.,,,. 50 (Community Nurse), (ACAT, Aged Care Assessment Team). (HACC, Home and Community Care).,.. (HACC). HACC 142
18,000. 7,000, 16% 1,000, 6,000..,,,,,,,,,.,,.. 56,950 1,365 41.. 1,450 51. self care unit, retirement apartment. 1. 70 1 1,000 399 583,293 114 167,246 169 249,251 22 32,760 156 230,355 440 648,405 40 58,882 ( ) 680 1,002,345 ( ) 109 160,805 143
65,... -. -. -,,. -,,. -. -.,,.,.,,,,,,.. 2).. (1) 1) (home-helper service) 144
2) (day service) 3) (short stay service) 4), 5), 6) 7),,,,, (),. 1),,, ( ),,,,,.,,.,,,,..,,,,. 65,,,. 1995 24 ( ).,.,,,,,,,,,,, 3., 1 4, 1 6,. 1987, 360,. 1991 1 (360 ), 2 (90 ), 3 (40 ) 3. 145
1979(day service),., 1-2,,,. 1) (,,,,, ) 2) (, ) 3) (,, ). ( ; ).. (day care center) ( 2). 2.,,,.,... 24.,. 24. Short stays,. 7. (, ). 1.,,,. 146
(Short Stay), ( 7),. (2) 1982,,,,.,,,,,., (1) (2) (3) (4) (5) (6)..,,,,. (home helper).,, (nursing station),.,. 70, 40.,,,.. 147
..,. 6. : 1),.. 9,000. 1966 40 405,,. 1974 () (bedridden-free community).,,,,,. 17, 480 ( 40 ), 405, (4 8 ) 7. (150, 40 ), ( 100, 20 ), (, 100 ), (19 ), 148
( ), (20, / ), ( ), ( ) /,.,. 17% 28% 5.7% 0.8%. 2) (1) (2) (3) (4) 2.. 2, 3 - care,, care team station, - care team 40,,,,,, care worker, home helper, care plan,,, Station 149
. Station :, Direct Service : : (,, ) net work station care 5-6 / care team - care,, station,,, - -, - station station 150
3), comprehensive community care system.,,,,,,,,., 200-300.,,,,,,. 1/3,,.. 151
Citizens (elderly at home) visiting nursing and request nursing rehabilitation visit/consultation request free consultation Hospital Health and welfare center (Home help station) Centralized home care Support Center Primary Physician order report Visiting nurse station request report Community based home care support center Geriatric health facility (outpatient/inpatient) Day Service center reimbursement reimbursement order fee Local government Long term care insurance system Health scheme for the elderly (Municipality) Health Insurance law (National Health Insurance) Community Health Law Fig. 3. Linkage betwen the visiting nurse stations and other facilities (Mitsugi Town). 4) ( ) - - 150 ( 100, 50 ) - (, ) 30 18 191 -. -,,, 4. 152
. 80% 97.7. - ( ) 8.5.. - 56 2,,,. (44 ), 2. tea time 8 10. - 50,, check list,., ( ), care worker( ),,,. () - 100, 20 -,. - 3 1. -,. -,,,. - () ( ),. - 19 (4 4, 2 1, 1 1 ) 153
- (rehabilitation center),,. -. -. - 7. rehabilitation rehabilitation (100 ) () -. -, : 2002 4 9 6 ( 2, 2, 2. 3, 1 ).,,. 40,.. - 30 -, 154
. - 3 27 2 ( ) 9.. 60. -. -,,,. -,. - : - :,, ( ) ( ) - ( ) -. - 24. -,,. (1999).. 10(1): 106-120. 155
(2001).. :. (2003)., 33, 8-26. (2003)... (1997). Mapping.., (1999)... (2002). -. (1999).. 99, ( ). (2000). 21 :.., (1999).. 32: 325-332.,,,,, (1998). 1998., (2002)., 11, 4-13 (1996). (Quality of Life). 43(11): 941-945. Mitsugi general hospital(2002). -, 1-12. Mitsugi general hospital(2002). Comprehensive community care system in Mitsugi town strategy for bedridden-free community and cooperation of health care, medical care and welfare. 1-24. Takako Sodei(1999).. - 21.. 99 53-60. 156