ABSTRACT
To clarify the proposed support of home care in elderly-only households in a rural area in Japan, we analyzed the actual supplies of long-term care insurance services in February 2002. The insurance benefit receivers were classified into the following three categories: the aged living alone, elderly-only households and other kinds of household. Participating in this study were 502 users of long-term care insurance services (males; 160, females; 342, average age; 83, range; 54-100) in Asuke town, Shimoyama village, Asahi town and Inabu town in Aichi prefecture.<BR>In the 502 subjects, 79 lived alone, 82 in the elderly-only households, 341 in other kinds of household. Among them, there were no remarkable differences in the degree of necessity of long-term care. However, those who received various types of home services were 37 (46.8%) in the aged living alone, 62 (75.6%) in the elderly-only households, and 262 (75.6%) other kinds of household.<BR>In the aged living alone category, the number of those who received home services decreased rapidly as the conditions requiring nursing care were aggravated. However, in the elderly-only households and other kinds of household, the rate of home care remained almost the same even if the classification of the conditions requiring care was changed.<BR>Comparing the kinds of home services between elderly-only household and other kind of household, the rate of receiving home-visit nursing increased as the severity in the degree of necessity of long-term care became severes. On the other hand, the rate of commuting for day care decreased in other kinds of household but high in the elderlyonly households.<BR>These findings revealed that most of the care receivers in the elderly-only households were provided home care on a long-term basis by receiving home-visit nursing which reduces the anxiety of patients and their families and that commuting for day care that relieves families was popular in these rural communities.
ABSTRACT
To clarify characteristics of home care in rural areas in Japan, we investigated the actual status of home care in a rural area (Asuke town, Asahi town, Inabu town, northern part of Toyota city and Shimoyama village) in Aichi prefecture. The subjects were 149 patients who were under medical care and nursing supervision at home for the last 2 years and a half. Age, sex, ADL, prognosis, principal care-givers of the patients and distance from patients' houses to our hospital were compared with the average data of all the nurse stations in Japan (1996). The percentage of patients over 90 years old was 23.4% in this area as against 13.5% of the national average. Sex and ADL levels were similar to the average. The proportion of females as principal care-givers of patients was 80%, which is about average. However, the proportion ofdaughters-in-law was 51.7%, double of the national average. In 48 cases (32%), the time required to get to the hospital by car was over 31 min. This ratio was 3 times higher than that of the average data, and it took 50 min from farthest patient's house (35km). In prognosis, 66 patients died-44 cases (67%) in hospital and 22 cases (23%) at home.<BR>Our questionnaire survey regarding patients' and care-givers' wishes was responded to by 38 of 47 principal care-givers who utilized our home care and nursing survice program. One half of care-givers were over 60 yearsold and had taken care of a patient for over 5 years. Mental stress, feeding and toileting were major problems most principal care-givers cited. However, they required services at a day-care institution for elderly patients and recovery of used paper diapers. Death at home was wished by 23 (61%) patients and care-givers, if they received enough medial care and welfare services.<BR>These findings revealed that elderly people take care of elderly patients, their houses are far from the hospital and they wish to die at home. More collaboration among all providers of medical care and health and welfare services, and the establishment of an information network are necessary to improve these problems, resulting in safe, acceptable and satisfied home care for patients and care-givers.