Home Care Services in the Last Year of Life by Type of Care Management.

Care management of home-based long-term care is vital for community-dwelling older adults. Regarding care planning, which is a part of care management, appropriate care plans according to individual conditions are extremely important for older adults to continue living independently in their familiar environment for as long as possible. We compared the use of care services in the last year of life between advanced and conventional care management. The results showed that among the older adults with a care-need level of 3, 4, or 5, the advanced care management group had a significantly higher rate of use of home-visit nursing services than the conventional care management group. These differences could be attributed to differences in the care planning knowledge, experience, and the training environment of the care managers' offices.

Patterns of long-term care service use and multimorbidity in older Japanese adults: A cross-sectional study of claim data.

AIM: The long-term care (LTC) insurance system provides a combination of several services in Japan; therefore, it is important to clarify service utilization. Furthermore, it is important to consider multimorbidity among older adults, who frequently present several diseases. This study aimed to clarify LTC service utilization patterns, including those for newly added multifunctional services, and to describe the basic characteristics, including multimorbidity, of these patterns. METHODS: We included 37 419 older adults in care need levels 1-5, living at home, who used LTC services in October 2017. We used LTC and medical claims data that were linked using unique identifiers from the National Health Insurance, Advanced Elderly Medical Insurance, and LTC Insurance of Shizuoka Prefecture in Japan. LTC service utilization patterns were identified using cluster analysis based on service fees. Multimorbidity was analyzed using the Charlson Comorbidity Index (CCI) and compared characteristics in these patterns. RESULTS: Six LTC service utilization patterns were identified: light use (51.0%), intensive use of day care (33.7%), intensive use of short stay (6.3%), intensive use of home help (5.1%), multifunctional LTC in small-group homes (MLS) use (3.7%), and MLS and home-visiting nurses (MLSH) use (0.2%). MLSH use had the highest CCI (3.6 ± 2.3). Intensive use of day care and short stay had the lowest CCI (2.6 ± 1.9). CONCLUSIONS: The characteristics of multimorbidity differed by LTC service utilization patterns. Our findings are useful for considering service utilization that takes into account the characteristics of older adults. Geriatr Gerontol Int 2024; 24: 283-289.

Structural visualization of expert nursing: Dialysis patient education program "PD catheter management".

Structural visualization was implemented on catheter management education for peritoneal dialysis (PD) patients requiring expert nursing. An education program utilizing electronic images was proposed as a method of monitoring the exit site, which is of high importance in PD catheter self-management. Recording images of the exit site and utilizing them as part of the education program encouraged a common understanding of the exit site between nurses and patients, and helped to achieve a better quality of patient education. It is thought that visualization of nursing practice and the thinking processes of expert nurses which have not been expressly stated previously can become a foundation for more advanced nursing care throughout the profession.

Structural visualization of expert nursing: Dialysis patient education program "vascular access management".

Structural visualization was implemented on vascular access management education for dialysis patients requiring expert nursing. As listening to and recording the sound of the Vascular access is important, an education program involving the electronic recording of sounds was proposed. Recording the Vascular access sounds and utilizing them as part of the education program encouraged a common understanding of the sounds between nurses and patients and helped to achieve a better quality of patient education. It is thought that the visualization of nursing practice and the thinking processes of expert nurses which have not been expressly stated previously can become a foundation for more advanced nursing care throughout the profession.

Structural visualization of expert nursing: Hemodialysis patient education program "behavior modification program for hemodialysis patients".

Behavior modification programs (BMP) have been suggested to be useful for the self-management of hemodialysis (HD) patients. To provide more systematic care, we structured the procedure of the thinking process and care in BMPs as an algorithm. BMP developers produced a temporary algorithm based on previous studies, discussed it with nurses with BMP experience, and added and revised necessary items. As a result, an algorithm of BMP with high reproducibility that allows maintenance of consistent quality for the self-management of HD patients could be developed.