국공립 노인장기요양시설 장기간 수요 및 적정공급량 추정

주은선(Eun-sun Joo),이미진(Mi-jin Lee) 한국사회복지교육협의회 2020 한국사회복지교육 Vol.49 No.-

본 연구는 2020~2050년 노인장기요양시설 수요 증가량과, 향후 10년 간의 국공립 노인장기요양시설의 적정 공급량을 추정한 것이다. 한국에서 국공립요양시설 증설은 공공성을 강화를 통해 시장 위주의 노인요양시설서비스의 문제를 완화시켜 서비스 질을 높이는 방안이자, 빠른 고령화로 인한 시설서비스 수요 증가에 대응하는 방안이다. 이에 국공립 노인장기요양시설 증설을 적극적인 정책 대안으로 추진하기 위해 적정공급량 추정을 시도하였다. 본 연구에서는 고령화와 함께 연령대별 입소율 차이, 대도시 및 수도권과 기타 지역의 인구분포, 지역별 적정 시설규모 등을 고려하여 요양시설서비스 수요와 국공립요양시설 적정 공급량을 추정하였다. 요양시설서비스 수요는 2020년 12월 231,175명에서 2050년 822,978명으로 증가할 것으로 예상된다. 장기요양서비스 공급에서 국공립 비중이 30% 수준이 되도록 하기 위해서는 2021~2030년에 시설요양 수요 증가분의 50%를 국공립 요양시설로 충당하도록 해야 하며, 누계로 대도시 및 수도권에 총 394개, 기타지역에 총 334개(합계 728개)가 공급될 필요가 있다. 이는 2022년까지 70인 정원 국공립시설을 약 50개 추가로 지어 총 160개소로 늘린다는 2차 장기요양기본계획의 정책 방향이 확대되어야 함을 의미한다. 본 연구는 장기간의 노인장기요양시설 수요 추정치와, 국공립 요양시설 적정 공급에 관한 상세한 수치를 제시하여 국공립요양서비스 강화정책에 시사점을 제공한다. This study estimated demands of public nursing homes for older adults between 2020 and 2050 and the adequate supply for the next 10 years. In Korea, increasing the number of public nursing homes for older adults is aimed for reinforcing publicness, enhancing the quality of care by reducing the negative effects of marketization, and directly dealing with the demands of nursing home placement primarily due to rapid aging. This study attempted to describe the detailed-estimate of demands and supply for nursing home for older adults in order to advocate for raising the number of public nursing homes, which should be the policy alternative of strengthening publicness. It is expected that Korea will exhibit the fast growth of the absolute number of older adults, the changes in the proportion of aging population, and the changes in the regional distribution of older adults for the next 30 years of rapid aging. This study estimated the demands of public nursing homes for older adults by using the nursing home placement rate of older adults by age groups, the regional distribution of older adults, and the regionally differential number of nursing home beds. The results indicated that the demands of nursing homes for older adults will be increased from 231,175 on 2020 to 822,978 in 2050. To satisfy fifty percent of the total increasing demands, 394 public nursing homes in the metropolitan cities and Gyeonggi-do (near Seoul) and 334 in other regions should be built until 2030. This findings imply that the 2nd national long-term care plan that stated the additional 50 public nursing homes (70 beds per home) should be expanded. This study provides policy implications by showing the estimate of demands of nursing homes during the extended-period, and proposing detailed-adequate supply for public nursing homes.

간호대학생이 인지한 노인요양시설에 대한 주관성: Q 방법론적 연구

하은호,이영미 한국보건간호학회 2019 韓國保健看護學會誌 Vol.33 No.1

Purpose: Nursing homes are a type of residential care that provide diverse services such as planned activities, convalescent care, skilled nursing and memory care. Nursing homes are good facilities for old people with dementia to improve their quality of life. On the other hand, the subjectivity toward nursing homes can vary to greater or lesser degrees. The purpose of this study was to identify the subjective attitudes and viewpoints toward nursing homes in undergraduate nursing students. Methods: The Q methodology, which is a research method to study the people's subjectivity, was used. The 40 Q-statements selected from each of 43 participants were classified into the shape of a normal distribution. The data collected were analyzed using the QUANL program. Results: Three types of subjectivity toward nursing homes emerged: ‘TypeⅠ, in terms of usage of nursing homes-hesitative perspectives;’, ‘Type Ⅱ, in terms of running of nursing homes-progressive perspectives;’, and ‘Type Ⅲ, in terms of admission to nursing homes-constructive perspectives’. Conclusion: The findings of this study suggest that nursing intervention programs should be developed for the three types. The study results will lead to further research.

노인부모를 위한 유료노인요양시설에 대한 요구 조사

김옥수,김소선,김경옥,김영애,김희승,박정숙,최원자 노인간호학회 2005 노인간호학회지 Vol.7 No.1

Purpose: The purpose of this study was to investigate the needs about paying nursing homes for elderly parents. Method: Subjects consisted of 249 adults with elderly parents. A structured questionnaire was developed by researchers for this survey. The general characteristics of subjects, recognition and an intention of utilizing about paying nursing homes, expenses of paying nursing homes, an operator of paying nursing homes, environment of paying nursing homes, and service of paying nursing homes were included in the questionnaire. Result: The frequency of subjects with intentions of utilizing nursing homes for elderly parents was 32.5%. Forty-one percent of them wanted paying nursing homes. Gerontological nurse practitioner was preferred as a operator of nursing homes by 82.3% of subjects. They hoped that medical and nursing service were provided in nursing homes. Conclusion: The results indicate that health is a main concern for elderly parents considered by adult children. It is needed to provide services of goof quality and a low expense for ideal model of paying nursing homes.

중년 대상자의 유료노인요양시설에 대한 요구 조사

김옥수,김소선,김경옥,김영애,김희승,박정숙,최원자 노인간호학회 2006 노인간호학회지 Vol.8 No.1

Purpose: The purpose of this study was to investigate the needs for paying nursing homes for the middle-aged. Method: The subjects consisted of 365 people aged from 40 to 59 residing in Seoul. The questionnaire was composed of the general characteristics of the subjects, recognition and the intention of utilizing paying nursing homes, expenses of paying nursing homes, the operator of paying nursing homes, environment of paying nursing homes, and the service of paying nursing homes. Result: The frequency of the subjects with intentions of utilizing nursing homes was 48.2%. Gerontological nurse practitioners were preferred as the operators of nursing homes by 72.9% of the subjects. The majority of the subjects hoped to receive medical and nursing service in paying nursing homes. Conclusion: The results indicate that there are needs for high quality, low expense paying nursing homes. Therefore, it is necessary to reflect the needs of the subjects when designing the facility.

Nursing Staff Views of Barriers to Physical Restraint Reduction in Nursing Homes

공은희,Lois K. Evans 한국간호과학회 2012 Asian Nursing Research Vol.6 No.4

Purpose: There are few studies globally regarding the barriers to restraint-reduction. The purpose of this study was to describe the views of nursing staff (both nurses and geriatric care assistants) regarding the barriers to reducing physical restraint use in Korean nursing homes. Methods: Forty registered nurse and geriatric care assistant informants participated in the first round of interviews and 16 of them participated in second confirmatory interviews. All interviews were conducted on site, one-on-one and face-to-face, using semi-structured interview protocols. Qualitative descriptive method was used and qualitative content analysis was employed. Results: Six themes were identified: (a) being too busy, (b) lack of resources, (c) beliefs and concerns, (d) lack of education, (e) differences and inconsistencies, and (f) relationship issues. Conclusion: The findings of this study provide a valuable basis for developing restraint reduction education programs. Korean national leaders and nursing homes should develop and employ practice guidelines regarding restraints, support nursing staff to follow the guidelines, provide more practical and professional education, employ alternative equipment, use a multidisciplinary team approach, and engage volunteers in care support as well as employ more nursing staff to achieve restraint-free care. Purpose: There are few studies globally regarding the barriers to restraint-reduction. The purpose of this study was to describe the views of nursing staff (both nurses and geriatric care assistants) regarding the barriers to reducing physical restraint use in Korean nursing homes. Methods: Forty registered nurse and geriatric care assistant informants participated in the first round of interviews and 16 of them participated in second confirmatory interviews. All interviews were conducted on site, one-on-one and face-to-face, using semi-structured interview protocols. Qualitative descriptive method was used and qualitative content analysis was employed. Results: Six themes were identified: (a) being too busy, (b) lack of resources, (c) beliefs and concerns, (d) lack of education, (e) differences and inconsistencies, and (f) relationship issues. Conclusion: The findings of this study provide a valuable basis for developing restraint reduction education programs. Korean national leaders and nursing homes should develop and employ practice guidelines regarding restraints, support nursing staff to follow the guidelines, provide more practical and professional education, employ alternative equipment, use a multidisciplinary team approach, and engage volunteers in care support as well as employ more nursing staff to achieve restraint-free care.

입원환자의 의료보장형태에 따른 가정간호 이용의사에 대한 연구

김명희,조은지,박형숙,강인순,Kim, Myung-Hee,Cho, Eun-Ji,Park, Hyoung-Sook,Kang, In-Soon 한국가정간호학회 2005 가정간호학회지 Vol.12 No.2

Purpose: This study is a descriptive research which is designed to investigate hospitalized patients' intent to use home care nursing according to the types of medical security. Method: This researcher surveyed 236 patients who were hospitalized at B medical center located in Busan,. Data were collected from Sep. 1 to Nov. 30, 2005 using a questionnaire survey, medical records, face-to-face interviews and observations. Collected data were analyzed in terms of frequency, percentage, mean and standard deviation through $x^2$-test and t-test under SPSS WIN 10.0 Program. Result: Out of the total subjects, 59.3% were medical aid clients and the remaining 40.7%, health insurance ones. The hospitalized period and frequency of the former group were 38.0 days and 4.0 times, respectively, while those of the latter, 37.7 and 3.4. When home care nursing clients were examined using a given classification device, it was found that out of the total 236 subjects, 205(86.9%) were needed to receive home care nursing, 121, medical aid and the other 84, health insurance. 24.0% of medical aid clients heard about home care nursing ever before, lower than 39.3% of health insurance clients. 43.8% of the former clients said cost for home care nursing was high while, 47.6% of the latter group responded expense for the nursing intervention was low. 30.6% of medical aid clients had intent to use home care nursing, lower than 47.6% of health insurance clients. 71.7% of those patients whose monthly income was 99 million won or below had no intent to use home care nursing, higher than 62.5% of those who were 100 million or over in monthly income(p<.05). 76.4% of those clients who had no nursing provider intented to use home care nursing, higher than those who had nursing provider(p<.05). Concerning contents of home care nursing, 85.1% of medical aid clients needed education, training and counseling while, 77.4% of health insurance aids wanted medication and injection. Conclusion: In conclusion, the use of home care nursing by medical aid clients should be promoted through improving conditions for home care nursing in terms of expense, family and residence and making public relations about activities and contents of the home care nursing.

Level of Resident Care Need and Staffing by Size of Nursing Home under the Public Long-term Care Insurance in South Korea

Bae,Sung-Heui,Kim,Hongsoo 한국노인간호학회 2020 노인간호학회지 Vol.22 No.1

Purpose: Formal long-term care in nursing homes became a popular means of caring for frail elders in South Korea. This universal long-term care (LTC) insurance for elders was introduced in 2008. The aim of this study was to provide information on the extent of and variations in residents’ care needs and nursing staffing characteristics across nursing homes. Methods: This was a population-based secondary analysis of a large national survey study involving 1,472 older residents in 92 nursing homes in South Korea in 2013. Characteristics of residents and nursing homes were collected by functional assessment and an examination of administrator surveys for nursing home size was done using descriptive analysis. Results: Small and small-medium nursing homes were more likely to provide care to non-Medical-aid beneficiaries and older people with lower care need level. These smaller homes also better met the minimum nursing staffing standard. However, they were less likely to hire registered nurses (RNs), as it is not yet a staffing requirement for nursing homes in Korea. Conclusion: South Korea has a policy agenda to increase nursing staffing level, especially by adding RNs, and decrease variations in staffing levels by nursing home size. Further evidence on care-need level, proper resource allocation, and policies designed to strengthen the LTC workforce is essential to advance the LTC system in Korea.

Nursing Staff Characteristics on Resident Outcomes in Nursing Homes

Lippincott WilliamsWilkins 2019 The journal of nursing research Vol.27 No.1

<P><B>ABSTRACT</B></P><P><B>Background:</B></P><P>The outlook of administrative staff and registered nurses (RNs) plays a critical role in the management of nursing homes. No previous study has compared the outcomes of nursing homes with RNs on staff with those of nursing homes without RNs on staff in Korea.</P><P><B>Purpose:</B></P><P>The aim of this study was to investigate the association between nurse-led nursing homes, staff turnover, and resident outcomes in nursing homes in Korea.</P><P><B>Methods:</B></P><P>Using a cross-sectional design, 36 nursing homes with 30 or more beds participated. Primary data included 15 quality indicators.</P><P><B>Results:</B></P><P>Nursing homes with RNs had statistically significant better resident outcomes. RN turnover related positively to the prevalence of falls ( β = 1.68, <I>p</I> < .05) and tube feeding (β = 1.71, <I>p</I> < .01) and negatively to incontinence (β = −1.53, <I>p</I> < .01). Nursing homes with RNs with tenures greater than 1 year had statistically significant lower prevalence of falls (β = −0.47, <I>p</I> < .05), incontinence (β = −0.45, <I>p</I> < .05), weight loss (β = −0.53 <I>p</I> < .05), and bed rest (β = −0.54, <I>p</I> < .01) and increased range of motion (β = 0.51, <I>p</I> < .05). Interestingly, having a nurse as a director for more than 1 year related negatively to the incidence of urinary tract infection (β = −0.56, <I>p</I> < .05) in residents. The rate of RN turnover was found to impact fall prevalence (β = 1.68, <I>p</I> < .05) and tube feeding (β = 1.71, <I>p</I> < .01) positively and to impact incontinence (β = −1.53, <I>p</I> < .01) negatively.</P><P><B>Conclusions:</B></P><P>Turnover of nursing home staff and length of tenure may contribute to the more effective management of nursing homes, higher-quality long-term care insurance, and RN-staffing-related laws. Assessing staff characteristics and the tenure of employees promotes the effective management of nursing homes.</P>

노인장기요양 방문간호 현황 및 추이

황라일 ( Hwang Rah Il ),박소영 ( Pak So Young ) 경희대학교 동서간호학연구소 2019 동서간호학연구지 Vol.25 No.2

Purpose: This study aims to provide basic data for the development of measures and promoting home health nursing by examining the current status and trends in home health nursing for long-term care (LTC) insurance beneficiaries. Methods: Secondary data, including annual LTC insurance statistics reports for 2010-2017 and LTC manpower data, were used to compute current status and trends in the provision of home health nursing. Results: Beneficiaries of home health nursing under LTC insurance, insurance-covered costs for home health nursing, home health nursing provider, and home health nursing providing institution only accounted for 3% of all insurance-covered home care services, and were on a consistent decline since 2010. In particular, vulnerable rural regions with high proportion of individuals had poor infrastructure in terms of home health nursing institutions and manpower, but had a higher home health nursing utilization rate compared to urban regions. Conclusion: In addition to measures to support home health nursing service beneficiaries, policy measures are needed to support home health nursing service personnel and institutions. Furthermore, programs to cultivate the expertise of home health nurses and improve quality of home health nursing services should be developed in order to promote home health nursing utilization in vulnerable rural regions.

노인간호요양시설의 QMI 개발과 현장 실태분석

조혜숙,Cho, Hye-Sook 한국가정간호학회 2005 가정간호학회지 Vol.12 No.1

Purpose: Expecting a new system of nursing security for elderly in operation in 2007, a substantial expansion of nursing facilities for elderly and quality management of those facilities are imperative now. Therefore. specific quality management measures or schemes which could be used for the operation of small-scale nursing homes are in urgent need. The purpose of this study was to develop a Quality Management Index(QMI) to guide Nursing Home management. Method: This study developed a QMI for small-scale nursing homes, which focused on quality management in structural dimensions such as environment, staffs, local community network, atmosphere, and quality management in process dimensions such as nursing, communication, resident satisfaction. The QMI developed in this study is based on extensive review of literature and the actual experiences of nursing home operation. It consists of 7 dimensions, 39 components and 148 indexes, which have been verified by three times validity tests of experts group. Then the QMI was used to evaluate the quality management levels of nursing homes in Korea. Result: In sum, after analyzing all nursing homes in Korea operated by nurses, this study found that there were significant differences of quality management level among facilities in several dimensions such as environment, staffs, local community connections, communication. In dimensions such as nursing, atmosphere, resident satisfaction, however, little differences of quality management level among facilities were reported. It is considered that this result has to do with several factors like the size of facilities, operation expenses, operation forms, the disposition of professional human resources, and philosophy and management policy of the owners. As far as generalization is concerned, however, it needs to be noted here that the sample size for this study is not statistically big enough to generalize the results. Conclusion: Having Developed a QMI for small-scale nursing home with 7 dimensions, 39 components and 148 indexes, this study is expected to be used in developing more elaborated quality evaluation tools for nursing homes, and also function as a practical guide of quality management for those who are opening and managing nursing homes. I hope this quality index could lead to further development of a standardized quality management index, and eventually contribute to quality improvement of nursing homes.