• 한국콘텐츠학회논문지
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• 제13권4호
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• pp.170-186
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• 2013

인구가 고령화되면서 전체 인구의료비 가운데 고령인구에 지출되는 의료비의 비중은 증가하여, 건강보험 의료급여 등의 재정을 압박하는 경향은 갈수록 심화될 전망이다. 노인성 질환으로 인해 의료비용 부담이 증가함으로서 사회적 문제로 발전됨에 따라 노인보건의료의 현황을 분석하고, 현행 관련법제도를 살펴보고 문제점을 도출하고자 하였으며, 외국의 노인보건실태와 동향을 토대로 시사점을 도출하여 우리나라에의 법제도적 개선방안을 제시하고자 하였다. 그 결과 현행 노인보건의료보장의 관련법 체계의 문제점, 현행 노인장기요양보험법상의 문제점을 도출하였고, 법적 개선방안으로서는 건강보험의 보장성 강화, 장기 요양보험료 재정의 건전성 확보문제, 노인복지와 장기요양보험제도의 연계와 상호보완 기능을 강화, 치료요양에 대한 노인장기요양보험제도와 노인복지법의 중복성 문제, 등급판정체계의 개선, 재가서비스 지원강화 등 노인의 특수성을 반영하여 의료서비스의 질적 수준의 개선이 필요하다고 보고 노인장기요양법제의 개선과제를 제기하는 등 노인의료서비스의 지원확대 방안을 제시하였다. 노인을 대상으로 하는 중증응급 의료서비스의 질을 제고하기 위해서는 적정 응급의료자원의 확보뿐만 아니라, 그 효율적 운영체계의 마련도 필요하다. 아울러 급증하고 있는 노인의료비에 대응하기 위해서 "노인의 의료확보에 관한 법률"을 제정할 필요성을 제시하였다.

• 사회복지연구
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• 제44권3호
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• pp.31-56
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• 2013

한국에서 2008년부터 시행된 노인장기요양보험제도는 요양욕구가 인정된 모든 노인에게 장기요양서비스 공급이라는 사회적 지원을 제도화하였다. 이를 계기로 한국 노인돌봄의 사회적, 제도적 환경은 새롭게 형성되었다. 이러한 새로운 조건에서 가족돌봄의 위치와 의미를 재조명하고자 하는 것이 본 연구의 문제의식이다. 이를 위해 공식적인 돌봄서비스를 이용하는 노인들에 대한 가족돌봄의 변화를 분석하였다. 분석의 초점은 공식과 비공식, 제도적 서비스와 가족돌봄의 통합으로서 노인돌봄의 양상을 파악하고 이 안에서 공식적 돌봄의 역할과 가족돌봄에서 일어난 변화를 파악하는 데 있다. 이를 위해 노인장기요양보험제도를 이용하는 가족돌봄자(노인의 배우자 및 자녀) 중 재가서비스 이용자 18명을 대상으로 심층면접조사를 실시하였고, 질적내용분석을 통해 연구결과를 도출하였다. 연구 결과, 표준화된 방문요양 및 방문목욕 등 노인장기요양서비스는 개별 사례별로 상이한 비중과 의미로 이용되고 있었다. 공식돌봄과 비공식 가족돌봄의 결합양상은 다양하게 나타났는데 본 연구에서는 네 가지 서로 다른 양상을 발견할 수 있었다. 요양보호사에 의한 노인장기요양서비스를 중심으로 노인돌봄을 구성하는 양상, 가족돌봄자가 다양한 돌봄자원을 동원하며 조정하는 역할을 하는 돌봄혼합의 양상, 중증노인이 재가서비스를 이용하면서 형성되는 노인돌봄의 양상, 그리고 무엇보다 노인장기요양보험제도의 현실화과정에서 공식돌봄과 비공식돌봄을 일치시키는 변종(hybrid)방식으로 가족요양보호사 방식의 노인돌봄 양상이 그것이다. 본 연구는 표준화되고 공식화된 노인장기요양보험제도의 재가서비스 이용이 실제 다양한 노인의 욕구와 가족돌봄자원이라는 현실을 만나면서 다양한 노인돌봄의 양상으로 현실화되고 있는 것을 드러냈다는 데 의미를 가진다. 이는 노인돌봄이 공식, 비공식 돌봄의 결합으로 작동하고 있음을 증명하는 것이며 공식적 돌봄서비스의 공급이 실제 가족돌봄의 조건과 현실 위에서 이루어져야 한다는 것을 보여준다. 따라서 노인장기요양서비스 공급에서 노인이용자의 삶의 조건이자 공간으로서 가족과 지역사회의 다양한 특성이 포함되어야 한다는 시사점을 준다고 하겠다.

• 동서간호학연구지
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• 제21권1호
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• pp.18-27
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• 2015

Purpose: The purpose of this study was to investigate the relationship between health knowledge and health promoting behavior in the elderly. Methods: The participants of this study were 114 men and women over 65 years at P-myeon, Yeongju-si, Gyeongsangbuk-do. Data were collected from March 1st to April 9th in 2011. The survey was carried out via the face to face interview using structured questionnaires. Results: Eighty nine percent of the participants responded that they were aware of the types of healthcare service. The most desirable service was 'long term care insurance system'. The average of health knowledge was 7.94 (${\pm}1.51$) out of 10 and average of health promoting behavior was 2.81 (${\pm}0.30$) out of 4. Health promoting behavior showed a positive correlation with health knowledge (r=.189, p=.044). Conclusion: The health promoting behavior in the elderly was related with health knowledge. Therefore, the enhancement of health knowledge is needed to improve health promoting behavior in the elderly. Education for self care and providing information for health care are needed for health maintenance and improvement in elderly. In addition, program development for providing health knowledge and nursing intervention for supporting health promoting behavior are in need.

• Perspectives in Nursing Science
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• 제7권1호
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• pp.10-22
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• 2010

Purpose: Through a thorough examination of the CCSC (Community Comprehensive Support Center) system in Japan, this study suggests a scheme to provide community-based preventive health care services for the elderly in Korea. Methods: The study inquired into the applicability of the Japanese model by reviewing the data related to the CCSC project, aided by both in-depth interviews with staff in the field and consultations with specialists. Results: Rearrangement of the Visiting Health Management Project system is needed to manage the collective or individual visiting care management for frailty prevention of the elderly in communities. The delegated service system for preventive care in the community, including direct management by one of the public health centers, also needs to be reviewed and the application of stricter standards for the selection of the agency or corporation to run the delegated service is necessary. Long-Term Care Insurance, along with national and local grants, is to be considered as a financial resource for the community-based preventive health care model for the elderly. By making active use of education rooms at district offices, senior citizen centers in neighborhoods for the elderly with easy access can be created. The project needs to raise active supports from communities, develop programs which can be absorbed into particular local cultures, and promote the understanding of the preventive project in local communities. The preventive program should focus on first solving the problems of depression, seclusion, and lack of mobility of the elderly. Second, the program should instruct physical self-management for exercise-nutrition-dental maintenance, and third, the program should strengthen the cognitive abilities of the elderly. In addition, it is necessary to systematize and implement counter-plans of the family and community to protect the elderly who has mental and cognitive problems. Finally, by establishing a network of public health welfare resources based upon research on a community level, assessment and planning for the health of the elderly should be one with their family, and comprehensive consultation and recommendations should be provided to the family. Conclusion: Taking into consideration the experience Japan has had with respect to a similar project, it is appropriate to develop and implement a service system which would combine the Visiting Health Management Project system which has already been established and a preventive health care model for the elderly on a community level.

• 한국콘텐츠학회논문지
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• 제13권5호
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• pp.234-242
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• 2013

2007년 노인장기요양보험법이 제정되었고 이 법은 질병 및 장애가 있는 노인들에 대한 요양비용을 사회구성원들이 함께 부담하는 체계를 구축하여 노인 및 그 가족구성원의 삶의 질을 향상시키는데 그 목적이 있다. 노인장기요양보험제를 실현하기 위해 요양보호사제도가 마련되었다. 요양보호사란 거동이 불편한 노인을 시설에서 돌보거나 또는 노인이 거주하는 가정을 방문하여 보호활동을 벌이는 사람들을 말한다. 그런데 최근 발표된 국가인권위원회의 조사에 의하면 요양보호사들의 근무환경이 매우 열악한 것으로 드러났다. 저임금, 포괄임금의 남용, 장기간 근로, 인력배치기준 및 휴게시설 미비, 요양보호서비스 이외의 노무제공, 수급자에 의한 성희롱 등의 문제가 있는 것으로 나타난 것이다. 인구의 고령화가 빠른 속도로 진행되고 있고 노인들에 대한 요양보호의 중요성과 요양보호사들의 역할이 증대되고 있는 상황을 고려한다면 이들의 업무환경에 대한 개선이 절실히 필요하다. 이러한 견지에서 이 논문은 국가인권위원회가 발표한 자료를 바탕으로 노동인권의 측면에서 요양보호사들이 겪고 있는 문제점들을 살펴보고 효과적인 개선방안에 대해 논의 해본다. 결국 요양보호사들이 직면한 문제들을, 정부의 철저한 관리 감독과 요양보호사의 처우 개선 그리고 수급자의 인식 개선 등을 통해 바로잡는다면 더 나은 노동환경에서 요양보호사들이 질 높은 서비스를 제공할 수 있을 것으로 기대한다.

• 노인간호학회지
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• 제20권sup1호
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• pp.137-143
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• 2018

Purpose: The purpose of this study was to examine effectiveness and usefulness of Information Communication Technology (ICT) in communication between physician and visiting nurses who provide visiting nursing services under long-term care insurance. Methods: Structured questionnaires were used to measure usefulness and satisfaction of the system, both accessibility and convenience to visiting nurses (31 people) and users (182 people). Results: From the user perspective, accessibility and convenience in terms of service users were both satisfactory as shown by users' percentage. No statistically significant difference was found for satisfaction between before and after using the system. The usefulness of the system for visiting nurses was satisfactory for most the nurses. Also most nurses answered that the system is needed and is very useful. Most of the participants (both visiting nurse and service users) were satisfied with use of the ICT system. However, there was no statistically significant difference in satisfaction between the pre and post service because the service provision period was too short (three months). Conclusion: The consensus from both users and service providers is that an ICT based visiting nursing system needs to be introduced but a more user - friendly environment for system development will be needed.

• 보건행정학회지
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• 제3권1호
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• pp.53-83
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• 1993

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the elderly patients. They have spent 814.126won per on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Goverment should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

• 호스피스학술지
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• 제5권1호
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• pp.50-62
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• 2005

The elderly people was over 8.3% in 2003. This seament is projected to grow to 14.4% by 2019(Aged society) and over 20% by 2026(Super aged society). As the elderly population is increasing and young population is declined social issues around elderly care are emerged in Korea. As a result of that, they are in the condition of poor system of the welfare of the old and it is the worst one in Korea. And because of the worst financial independence and difficulty in Korea, welfare facilities and medical instruments are so insufficient and deteriorated, so the quality of service is getting low. Furthermore the mortality of cancer is rapidely increased in recent years. So it is expected that the number of families who are caring for terminal cancer patient will be increased. We can not solve those problems only with government's policy such as to secure ample budget and to enlarge the aged welfare institutions. Definitely, to acheve the suggetions persistence concern about old people is most important, and family, community and national government should be linked to accomplish to goal. Accordingly, for this study attempts to provide conceptual framework of the respite care, spiritual care and home hospice, nursing home for the elderly. And this study is to discuss the necessity and effect about the construction of housing welfare infrastructure and to make a cooperation and linkage system among the aged welfare institutions, government and the aged welfare programs. As is well known, the issue of the increasing aged people is neither a matter of individuals nor of the family, but rather a complex matter of whol society. Therefore it can be resolved by the active participation of government. Conclusively this study tries to provide an direction of the improvement with regard to the welfare policy for the elderly. The study is as follwos: Chapters 1: The theological base, conception, essentiality, respite care, spiritual care and home hospice, nursing home for the elderly. Chapters 2: Definitions of respite care, spiritual care, hospice, patient of termina cancer and quality of life. And relations between respite care and nursing home. Chapters 3: The necessity of long-term care insurance and the perspectives of spiritual care. Chapters 4: Conclusions and summarizing(The directions of improvement of welfare policy for the elderly). To sum up, the problems of the aged people has not effects only to the aged people. This means that the problems of aged is the problems of the young generation today. Because young generation will be the old generation in the near future.

• 성인간호학회지
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• 제25권4호
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• pp.409-421
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• 2013

Purpose: This qualitative study was designed to explore and describe the nursing staff reported experiences of managing the medical needs of nursing home residents in South Korea. Methods: Using a focus group interview method, qualitative data were collected from March to May 2012. Twenty five registered nurses and nurse aids working in nursing homes were recruited through a convenient sampling method. Participants participated in one of four focus group interviews lasted up to two hours in which their day-to-day experiences of taking care of the medical needs of the elderly residents. All interviews were recorded and transcribed in verbatim, and analyzed according to the qualitative thematic analysis method using MAXQDA software. Results: The overriding theme was 'experiencing differences between the requirements of the regulatory system and the actual reality of the work place.' The findings of differences between what were true and what is required was based in four subcategories. The nursing home residents had far more medical needs than what were reported. Another finding was that the family members were seen as non-supportive and negligent towards the residents. Conclusion: The findings of the study support the need for changes in the regulatory system. The regulatory limitations of current system with a shortage of resources pushed the participants to experience discrepancies between the required regulation and the reality. Additional research could contribute more exemplars to support changes.

• 한국엔터테인먼트산업학회논문지
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• 제15권8호
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• pp.423-432
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• 2021

본 연구에서는 노인의 라이프케어 및 삶의 질향상을 위해 도입되어 시행되고 있는 통합돌봄사업의 미래 가치성 확대와 방향성 제시를 위하여 현황과 문제점들을 알아보고 이를 통해 다음과 같은 연구적 결론을 제시하였다. 첫째, 서비스 수혜 노인의 욕구분석은 조사자 중심이 아닌 환자 중심으로 구성하며, 특히 의료진의 진료방문을 통한 의학적관리 부분이 강화되어야 하며, 성별과 연령, 장애유형과 개인적 욕구취향에 따른 특화된 서비스 항목 부분이 점진적으로 강화되어야 할 것이다. 둘째, 서비스 항목에 대한 만족도 및 중복성 그리고 효과성 등을 분석하여 예산을 절감하며 수요자 중심의 서비스 항목구성과 신규 서비스 필요 항목 적용 등을 고려해 나간다. 셋째, 통합 스케줄관리시스템 도입을 통하여 서비스 제공 직역단체와 수혜자 간의 사전예약 및 방문 스케줄 관리의 전문화가 필요하다. 넷째, 재원 문제해결을 위한 노력으로, 보건의료 재정과 장기요양보험제도 그리고 사회복지재정사업 등과 합리적 재원공유 제도마련이 필요하며, 서비스 관련 산업분야와의 재원의 연계나 순환, 지방 공공의대 출신 인력투입 방안을 고려할 수 있다. 이상의 제안을 통해 통합돌봄사업은 보편적 노인 케어시스템으로의 완성과 미래 가치를 지닐 수 있게 될 것이다.