WHAT KIND OF FAMILY MAKES A CASE DIFFICULT?   PUBLIC HEALTH NURSES' VIEWS ON HOME CARE FOR THE FRAIL ELDERLY

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  • YOSHIE Satoru
    School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo
  • TAKAHASHI Miyako
    School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo
  • SAITO Tami
    School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo
  • KAI Ichiro
    School of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo

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Other Title
  • 同居家族が問題の主体となる高齢者在宅介護の対応困難事例の現状　長野県 A 市の行政保健師へのインタビューから
  • ドウキョ カゾク ガ モンダイ ノ シュタイ ト ナル コウレイシャ ザイタク カイゴ ノ タイオウ コンナン ジレイ ノ ゲンジョウ ナガノケン Aシ ノ ギョウセイ ホケンシ エ ノ インタビュー カラ

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Abstract

Objective Public health nurses (PHNs) played the major role in providing care management for the frail elderly before the Long-term Care Insurance started in 2000. Although the role of care management has now shifted to care managers, PHNs are still consulted by such care managers, service providers and families of the elderly about long-term home care. The purpose of this study was to explore the factors that make a case difficult to deal with from PHNs' viewpoint. This study focuses on the factors related to family living in the same household (living-together family).<br/>Subjects and methods The informants of this study were seven PHNs who worked for a city with a population of 67,000 (proportion of elderly in the whole population is 19%) in Nagano Prefecture. First, a focus group interview (about 90 minutes) with the six PHNs was conducted to extract an outline of difficult cases. Next, semi-structured interviews (about 60 minutes each) with five PHNs were conducted to obtain detailed information on difficult cases. The interviews were tape-recorded and transcribed verbatim. KJ analysis was conducted by defining characteristics, finding similar factors, and grouping these together to form categories.<br/>Results Categories of family related problems emerged for each of two major categories: family characteristics and care related problems. Firstly, existing family characteristics, including the existence of mental or psychological disorders, low motivation towards providing long-term care, conflictual familial relationships, objections to having service providers in the home, and economic difficulties contribute to problems in providing long-term care with living-together families. These characteristics can lead to a second set of problems, relating to the actual provision of care by the living-together family to frail elderly patients. These care related problems include including insufficient care, rejection of formal care services, and deviation from care directives, including to the point of physical mistreatment.<br/>Conclusion This study points to the need for care providers to consider the living-together family's background and the potential for the phenomena, indicated in this study, to negatively impact on the provision of care for the frail elderly.

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