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本研究の目的は，ヴァルネラビリティに対する意向確認のとらえ方を社会福祉制度の動向に沿って考察することである．生活保護法をはじめとする戦後の社会福祉に導入された申請・措置方式，社会福祉基礎構造改革以降，福祉サービスの提供方式として用いられている契約方式の下では，自らの社会生活課題に対する認識の乏しい人や申請・契約の能力が十分に備わっていない人が支援から取り残されるという課題が生じた．そのようなヴァルネラビリティに対する支援上の課題は，申請・措置方式の時から指摘されていたが，生活困窮者自立支援法の施行によって漸くヴァルネラビリティに対する支援システムが制度化され，意向確認とそれに基づく支援の取り組みがはじめられたところである．また，障害者福祉の領域では，障害者権利条約の批准，障害者差別解消法の施行等を契機に，障害の状態にある人の意思決定支援のあり方の検討が進められている．社会福祉はヴァルネラビリティに対する支援に本格的に取り組みはじめており，そのような状態にある人に対する意向確認のあり方の検討は，個人を尊厳するというソーシャルワークの価値の具現という意味においてとりわけ重要な検討課題である．

application/pdf, 本研究は、奄美諸島と八重山諸島における、地域住民の生活と福祉ニーズを一般成人調査 より紐解こうとするものである。調査対象地として、島喚都市部からは奄美市と石垣市を、島喚集落 部としては瀬戸内町の加計呂麻島、請島、与路島と、竹富町からは西表島、鳩間島を選出した。両諸島とも相互扶助としての「結い」の精神の色濃く残る集落群であるが､鹿児島県と沖縄県の諸島では、集落の有り様に差異があることが明らかになった。 本稿では食生活、保健・医療福祉サービス、地域の課題等についての分析結果を示す。飲酒に関しては、「毎日飲む」と答えた人は、都市部より、集落部において高かった。「生活習慣病に関する催しへの参加」では、「参加したことが無い」と回答した人は､都市部の方が高かった。地域で感じている問題点については、奄美市と瀬戸内町では「ハブ」の問題、集落部である瀬戸内町と竹富町では日常の買い物の不便があがっていた。総じて、集落部における地域問題の指摘が多かった。国や自治体に望む重点施策について、４地区とも「在宅介護のための、自宅を訪問するサービスの充実」を第１位にあげていた。, The purpose of this study was to analyze the life styles and the social welfare needs of the adults who live on the Amami islands and the Yaeyama islands. The regions surveyed were the urban areas of Amami City and Ishigaki City, and the rural areas of the Kakeroma island, Uke island, Yoro island (Setouchi Town) and the rural areas of Iriomote island and Hatoma island (Taketomi Town). Both islands have kept the spirit of mutual helping and the traditional cultures. But it is clear that the conditions of the rural areas in Kagoshima Prefecture and Okinawa Prefecture are different. In this paper we report analyses of the eating habits, the evaluation of health-care services, welfare services, and other regional subjects. The number of the respondents who drink every day was larger in the rural areas of the island than in the urban areas. The number of people who participate in the events concerning life-style rerated diseases was larger in the urban areas. Regional issues in the Amami City and in the Setouchi Town were "habu", inconvenience of daily shopping in Setouchi Town and Taketomi Town, which are in the rural areas of the island. In general, there were many regional issues in the rural areas of the island. The four areas want the national and local governments to "improve the visiting service for homecare" in the first place., 論文(Article)

application/pdf, 本研究の目的は、琉球弧の北に位世する鹿児島県の奄美諸励と南に位置する沖縄県の八重山諸島における島嘆地域の高齢者の生活の現状と福祉ニーズを把握することである。調査対象地は、奄美諸島の中心である奄美市(島嶼都市部)および瀬戸内町の加計呂麻島、請島、与路島(島嶼集落部)、八重山諸島の中心である石垣市(島嶼都市部)、竹富町西表島西部および鳩間島(島嶼集落部)であった。鹿児島県の場合、特に島嘆集落は過疎高齢化が進行し、集落機能の低下を余儀なくされている。沖細県の場合、鹿児島県ほどの過疎高齢化は進んでいない状況であるが、島嶼地域のもつ生活上の課題を共有している。いずれも、相互扶助の伝統等の地域文化あるいはその精神が残っているという共通点を持つ地域である。 本稿では、前稿に引き続き、日常生活の不安と生きがい感､食生活､保健医療･福祉サービス、暮らし向きと地域の問題等についての分析結果とそのまとめを示す。将来の生活不安は島喚集落部の方が島嶼都市部よりも不安を感じる人が多かった。一方、生きがい感は、島嶼都市部の方が高かった。食生活では、栄養面のバランスを欠きやすい環境下にあった。保健医療では、島嶼集落部は医療サービスの地域格差への不満や問題が見られると同時に、健康に対するセルフケア意識の高さが伺えた。福祉サービスでは、島嶼集落部では天候や交通手段によるサービスの中止や困難性などが生じていた。暮らし向きと地域の問題では地域差はなく、共通して台風､交際費､老後の生活の不安があげられ、特に瀬戸内町で地域の問題を感じている人が多かった。, The purpose of the study was to investigate the life styles and the social welfare needs of the elderly who live on the Amami Islands and the Yaeyama Islands through a questionnaire survey. The regions surveyed were the urban area of the Amami Ohshima (Amami City) and the rural area of the Kakeroma Islands (Setouchi Town) in Kagoshima prefecture, and the urban area of Ishigaki Island (Ishigaki City) and the rural area of Iriomote Island and Hatoma Island (Taketomi Town) in Okinawa Prefecture. The people who dwell on these remote islands are usually under unfavorable conditions geographically and economically and the communities there are under functional decline due to depopulation and aging. On the other hand, these islands keep the spirit of mutual helping and the traditional cultures. In this paper we report analyses of the anxiety about future life, the feeling that life is worth living, the eating habits, the evaluation of health-care services and welfare services, the family finances, and other regional issues. The anxiety about future life was higher in the rural areas of the islands than in the urban areas. On the other hand, the feeling that life is worth living was higher in the urban areas of the islands than in the rural areas. Respondents were prone to eat poor-balanced meals. In the rural areas of the islands, while they expressed their dissatisfaction with regional gaps of health-care services, they showed high awareness of self-care about their own health. In the rural areas of the islands, welfare services at home were sometimes cancelled by bad weather or transportation trouble by sea. There was no difference in the family finances and regional issues between areas. Regional issues shared by all islands were the vulnerability to typhoons, high social expenses, and the anxiety about life in the future, and especially the elderly in the Setouchi Town listed more regional issues than those in other areas. area of the Kakeroma Islands (Setouchi Town) in Kagoshima prefecture, and the urban area of Ishigaki Island (Ishigaki City) and the rural area of Iriomote Island and Hatoma Island (Taketomi Town) in Okinawa Prefecture. The people who dwell on these remote islands are usually under unfavorable conditions geographically and economically and the communities there are under functional decline due to depopulation and aging. On the other hand, these islands keep the spirit of mutual helping and the traditional cultures. In this paper we report analyses of the anxiety about future life, the feeling that life is worth living, the eating habits, the evaluation of health-care services and welfare services, the family finances, and other regional issues. The anxiety about future life was higher in the rural areas of the islands than in the urban areas. On the other hand, the feeling that life is worth living was higher in the urban areas of the islands than in the rural areas. Respondents were prone to eat poor-balanced meals. In the rural areas of the islands, while they expressed their dissatisfaction with regional gaps of health-care services, they showed high awareness of self-care about their own health. In the rural areas of the islands, welfare services at home were sometimes cancelled by bad weather or transportation trouble by sea. There was no difference in the family finances and regional issues between areas. Regional issues shared by all islands were the vulnerability to typhoons, high social expenses, and the anxiety about life in the future, and especially the elderly in the Setouchi Town listed more regional issues than those in other areas., 論文(Article)

application/pdf, 本研究の目的は、琉球弧の北に位歴する鹿児島県の奄美諸島と南に位歴する沖縄県の八重山諸島における島嘆地域の高齢者の生活の現状と福祉ニーズを把握することである。調査対象地は、奄美諸島の中心である奄美市(島嘆都市部)および瀬戸内町の加計呂麻島、請島、与路島(島嘆集落部)、八重山諸島の中心である石垣市(島填都市部)、および竹富町西表島西部および鳩間島(島喚集落部)であった。鹿児島県の場合、特に島填集落は過疎高齢化が進行し、集落機能の低下を余儀なくされている。沖縄県の場合、鹿児島県ほどの過疎高齢化は進んでいない状況であるが、島填地域のもつ生活上の課題を共有している。いずれも、相互扶助の伝統等の地域文化あるいはその精神が残っているという共通点を持つ地域である。 本稿では、調査対象者の属性、健康状態、家族の状況、社会参加状況および社会関連性指標についての分析結果を示す。居住地域と年齢の両方に回答した対象者は714人(男性284人、女性430人)であった。健康状態では、すべての調査対象地で健康な人の割合が高かった。家族の状況では、対象地ごとに特徴がみられた。集落行事への参加は島嘆集落部の方が高かったが、社会とのかかわり状況全般では島喚集落部の方が低かった。, The purpose of the study was to investigate the life styles and the social welfare needs of the elderly who live on the Amami islands and the Yaeyama islands through a questionnaire survey. The regions surveyed were the urban area of the Amami Ohshima (Amami City) and the rural area of the Kakeroma islands (Setouchi Town) in Kagoshima prefecture, and the urban area of Ishigaki island (Ishigaki City) and the rural area of Iriomote island and Hatoma island (Taketomi Town) in Okinawa Prefecture. The people who dwell on these remote islands are usually under unfavorable conditions geographically and economically and the communities there are under dysfunctional state by depopulation and aging. On the other hand, these islands keep the spirit of mutual helping and the traditional cultures. From the data of 714 respondents (284 males and 430 females) , we analyzed the health states, the family situations and the social involvements. Almost 90 percent of the elderly reported that they were healthy. There was no difference in the self-rated health condition among these islands. The number of the single elderly people was higher in Setouchi Town and the number of the multigenerational households was higher in Ishigaki City. Although the percentage of the elderly who participate in community events was higher in the rural area of Setouchi Town and Taketomi Town than in the urban area of Amami City and Ishigaki City, the index of social interaction was lower in the rural area than in the urban area., 論文(Article)

本研究では,介護支援専門員の仕事のやりがいと困難に着目し,介護保険制度のさまざまな変更に対応しながら仕事を続けてきた経験年数の長い介護支援専門員の仕事のやりがい,業務上の困難を主任介護支援専門員に対する調査によって明らかにした｡調査の結果,介護支援専門員は｢利用者の笑顔や感謝の言葉｣｢利用者の変化｣｢自分自身の成長｣などに仕事のやりがいを感じていた｡そして,介護支援専門員の大部分が｢記録の業務｣に困難を感じていた｡さらに,介護支援専門員の7割が｢ケアマネジメントの力量に対する不安｣｢書類の作成に追われて利用者に対して充分な支援ができない｣｢残業や休日出勤｣などの理由で転職を考えるという経験をしていた｡, The purpose of this study is to examine the worth doing of work and difficulty of duties of Care managers which have continued working for many years. I conducted research of the worth doing of work and difficulty duties of chief Care managers. The results show that Care managers find worth doing of the work "smiles and thanks of users", "changes of users" and "own growth" and most feel difficulty for "duties of records". Additionally, 70% of Care managers thought about changing their job by the reason of "unease with the competence of care management", "inability to sufficiently care for users due to paperwork", and "overtime or holiday work" etc.

2006年に行われた介護保険法改正では､自立の維持や介護状態の悪化を防ぐために､介護予防のしくみが設けられた｡ところが法改正後､その主旨とは異なる状況が生じていることが報告されている｡そこで本研究は､沖縄県の居宅介護支援事業所に対する調査から､法改正後の介護予防ケアマネジメントの実態を明らかにすることを目的とした｡本研究は､2006年の介護保険法改正後の沖縄県内の居宅介護支援事業所に対する調査をとおして､介護予防ケアマネジメントの実態､介護給付から介護予防に移行した利用者の生活状況の変化､法改正が居宅介護支援事業所の運営や介護支援専門員の業務に与えた影響などを明らかにすることを目的としたものである｡調査項目は､(1)介護予防ケアマネジメントの受託､業務上の問題､介護予防プラン様式､(2)介護予防給付後に生じた利用者の生活上の問題と介護支援専門員の対応､(3)認定調査や審議会等の認定審査､(4)地域包括支援センターとの連携や地域の介護予防ケアマネジメントの現状､(5)介護支援専門員の悩みの5項目23問を設定し､242ヶ所の居宅介護支援事業所に自記式で回答を求めた｡単純集計および自由記述に対する内容のカテゴリー化による分析の結果､約8割の居宅介護支援事業所が介護予防ケアマネジメントを受託し､約半数の事業所の収入は減少して経営状態が悪化していた｡さらに法改正後の1年間に介護から介護予防に移行した利用者の4人のうち1人に生活上の問題が生じ､介護支援専門員はサービス調整や､利用者への制度説明に関する悩みを抱えていることなどが明らかになった｡これらの結果から､｢利用者の自立した日常生活の保障｣､｢軽度者に対する支援システムの構築による重度化の防止｣という介護保険法の目的や法改正の主旨とはかけ離れた実態が生じていることが示唆された｡, The objective of our research was to clarify, through an investigation of in-home long-term care support offices in Okinawa prefecture following Long-term Care Insurance amendment Act 2006, the true state of preventative care management, the changes in the lives of those users who transferred from nursing benefits to preventative care, and the influence the legal reform had on the administration of the in-home nursing support office and the duties of specialized nursing support personnel. The matters inspected were, 1) the commission of preventive service to long-term care management, problems encountered in business, and preventive service to long-term care planning patterns, 2) problems which arose in the lives of users after preventive service to long-term care benefits, and how they were dealt with by long-term care support specialist, 3) the certification reviews of certification inspections and commissions of enquiry, 4) cooperation with a community general support center and the present state of regional preventative care management, and 5) the concerns of specialized nursing support personnel. We prepared 23 questions for these 5 items, and collected the answers in written form from 242 in-home nursing support offices. According to the results of an analysis by simple tabulation and by the categorization of the contents of freeform accounts, approximately 80 percent of in-home long-term care support offices consigned their preventative care management, while the income of approximately half of the offices had decreased, and their economic condition worsened. It also became clear that, in the year after the legal reform, problems had arisen in the lives of 1 in 4 users who had transitioned from nursing to preventive service to long-term care, and that specialized long-term care support personnel held concerns about service adjustments and explaining the system to users. These results suggest a state of affairs far different from the intent of the amendment act and the long-term care insurance law' s objectives for "supporting on Insured Person for an independent daily life in the community" and of "preventing mild cases from developing into serious ones through the construction of a support system".

本研究の目的は，地域包括支援センターにおけるアウトリーチの現状を明らかにして課題を検討することである。そのためにアウトリーチを構成する「ニーズの掘り起こし」｢情報提供」「サービス提供」「地域づくり」の枠組みに沿って地域包括支援センターの総合相談支援・権利擁護（以下，総合相談）を分析した。その結果，高齢者や家族への直接的なアウトリーチに関しては積極的に行なわれているが，地域を対象にアウトリーチを実施している機関は少なかった。そして現行の地域包括支援センターではアウトリーチの実施を危ぶむ意見が認められた。アウトリーチを構成する要素のなかでも地域づくりはニーズの掘り起こしをはじめとした他のアウトリーチを支えるために必要な機能である。したがって，地域に対するアウトリーチを強化するための地域包括支援センターの業務のあり方や職員体制，他の施策との関連を視野に入れた検討が必要であると考えられる。, The objective of this study is to clarify the current situation of the outreach activities at regional comprehensive support centers and discuss their problems. To attain this objective, the author analyzed the outreach activities at regional comprehensive support centers, focusing on each component of outreach: "identification of needs," "provison of information," "offering of services," and "regional development." As a result, it was found that many centers actively reach out to elderly people and their family members, but few centers conduct activities for reaching out to the local community. There was an opinion doubting the implementation of outreach under the current situation of regional comprehensive support centers. Regional development is a necessary function for backing up other outreach activities including the identification of needs. Therefore, it is necessary to promote outreach toward the local community. To do so, it is considered essential to discuss outreach, while considering the personnel systems and work processes of regional comprehensive support centers, and relations with other measures.

本研究は，介護保険制度のケアマネジメントとソーシャルワークの各段階における類似点および相違点を整理することにより，両者の関係を明らかにすることを目的とした。その対象として，介護保険制度の「指定居宅介護支援等の事業の人員及び運営に関する基準」に示されるケアマネジメント過程と，太田・秋山らがまとめたジェネラル・ソーシャルワークの過程を「開始｣，「アセスメント｣，「計画｣，「実施｣，「モニタリング｣，｢終結」の各段階に分けてケアマネジメントとソーシャルワークの機能に着目して比較検討した。その結果，モニタリングについてはソーシャルワークとケアマネジメントの機能は一致しているが，その他においては両者の機能に相違点が認められた。介護保険制度のケアマネジメントとソーシャルワークの機能には比較的類似点が多いと思われたが，両者の機能には一部共通する部分はあるものの，相違点が多く認められることが明らかになった。, The objective of this study is to summarize the similar and different points between the care management of nursing-care insurance systems and social work at each stage, and then clarify the relation between them. The study method was to divide the care management processes specified in "Standards on the staffing and operation of the businesses such as nursing-care assistance at specified residences" and the processes of general social work summarized by Ohta and Akiyama into "commencement," "assessment," "planning," "implementation," "monitoring," and "termination," and then compare and discuss them by focusing on the functions of care management and social work. As a result, it was found that the functions of the social work and care management were similar for the monitoring stage, but as for other stages, some different points were observed between them. Although it had been expected that the functions of the care management of nursing-care insurance systems and social work would be similar in many points, it turned out that there are a lot of different points in functions between them, as well as some common points.