[Effects of an interprofessional educational program for homecare professionals on building social capital: a trial in an urban area].

Objectives　The importance of social capital in promoting interprofessional collaborations is well known. This study examined the effects of an interprofessional educational program for homecare professionals on building social capital in terms of homecare in an urban area.Methods　The program was conducted at Kita Ward, Tokyo, from July 2014 to January 2015. We used a self-administered questionnaire before and after the program to collect data from homecare professionals in the ward, as well as from those who were interested in providing homecare. Physicians attended a five-day program, while other professionals attended a four-and-a-half-day program. Participants' attitude toward homecare practices was assessed to evaluate their motivation level for the job (i.e., the formation of a practical view of homecare and efficacy to engage in homecare practices). Regarding social capital, we assessed trust and norm of reciprocity for those in the same profession as the respondent (bonding and cognitive social capital) as well as for those in a different profession (bridging and cognitive social capital). Additionally, to professionals other than physicians, we asked about trust and norm of reciprocity regarding physicians (bridging and cognitive social capital) and collaborative conditions with physicians, which included the two sub-domains of cooperation and interaction (bridging and structural social capital). A generalized estimating equation was used to detect the effect size.Results　Of the 54 program participants, 52 (including two physicians) completed both the pre- and post-program questionnaires. Participants' practical view of homecare was formed after the program, although their efficacy for homecare practices was unchanged. With regard to social capital, scores for both trust and norm of reciprocity for the same profession (bonding and cognitive social capital) increased, while those for different professions (bridging and cognitive social capital) were unchanged. Scores for both trust and norm of reciprocity regarding physicians and cooperation with physicians (bridging and cognitive social capital, and bridging and structural social capital) also increased. Finally, trust and norm of reciprocity for the participants improved after the program.Conclusion　The interprofessional educational program for homecare professionals may foster social capital among the participants. The study results imply that this program can be a possible strategy to foster social capital in the field of homecare.

[A development of the network for functional trainings in daycare services in a large district].

After the Long-Term Care Insurance (LTCI) regulation has been enacted, all the daycare agencies/institutions must provide functional trainings to their clients as one of the standard services. However, the regulation is limited only to their personnel arrangement rather than the service content, which is left to each agency/institution. We feel that functional trainings as a daycare service need more attention so that we can bridge the content gaps between agencies/institutions. To solve this problem, we planned to send training professionals to these daycare providers in the surrounding areas. At the same time, we have been holding training courses for daycare staff and each trainer, which contributed to fill the knowledge and skill gaps between these trainers. The purpose of this paper is to report our study with some suggestions about the ideal functional trainings in the future daycare services.

[A development of the network for functional trainings in daycare services in a large district].

After the Long-Term Care Insurance (LTCI) regulation has been enacted, all the daycare agencies/institutions must provide functional trainings to their clients as one of the standard services. However, the regulation is limited only to their personnel arrangement rather than the service content, which is left to each agency/institution. We feel that functional trainings as a daycare service need more attention so that we can bridge the content gaps between agencies/institutions. To solve this problem, we planned to send training professionals to these daycare providers in the surrounding areas. At the same time, we have been holding training courses for daycare stuff and each trainer, which contributed to fill the knowledge and skill gaps between these trainers'. The purpose of this paper is to report our study with some suggestions about the ideal functional trainings in the future daycare services.

[Present situation of terminal care and home rehabilitation at Karuizawa Hospital].

Rehabilitation is usually considered to have the connotation of regaining function or reintegration into society, and no direction or achievement regarding the time of involvement or details of request has been suggested for the terminal rehabilitation in the patients with cancer who can't expect to have any improvement. Dieatz defines four phases for the goal of rehabilitation in the patients with cancer; Preventive Phase, Recovering Phase, Supportive Phase and Alleviative Phase. This time, we encountered a couple of cases in patients with cancer: patients who gained QOL through developing environment and setting goals that enable them to maintain the active daily life (ADL) at the supportive phase; and patients who realized us when relieving the pain while losing self-consciousness due to psychosomatic changes at the alleviative phase. In this report, we discuss what care can be provided at the phase when trust of the patient/family members is established, at the phase when care providers can grasp needs, and at the phase when the needs can be satisfied. We also report on how the patient and family member reacted to the direct hand massage provided by the physical therapist at the terminal stage. The rehabilitation system for home care at each phase is discussed in association with practical side and problems of the rehabilitation in the future terminal care.