介護保険給付の住宅改修における設備使用の継続性や安全性の課題

Problems regarding continuous and safe use of equipment provided by home modifications under a Long-term Care Insurance grant

要旨：介護保険給付の住宅改修の課題を，設備の使用継続性と安全性の視点から調査した．長野市の要介護1以上の利用者106名(78.2±8.8歳)の自宅を改修6ヵ月後に訪問した．訪問時までに設備使用を中断した者は15名(14％)であり，理由として疾患の発症・進行，過大な介護負担，ADL自立化のための再改修などが挙げられた．使用中断群には着工時に屋内自立歩行でない者が多かった(p＜0.05)．安全性の問題として，設備の劣化・破損や段差解消工法の施工不良などを8件確認した．利用者への危害発生が推定される事例もあった．使用中断リスクを考慮した改修計画の必要性，および介護保険給付の改修における安全性確保の施策の必要性を指摘した．

　The problems of home modifications supported by a grant from long-term care insurance (LTCI) were investigated from the viewpoint of continuous and safe use of the equipment. One hundred and six residents in Nagano city (age 78.2 ±8.8 years), belonging to care levels 1 to 5 who availed of the LTCI renovation services participated in this study. The participants were visited at their homes six months after renovation. We found that 15 users (14%) had stopped using the installed equipment. The reasons were onset or deterioration of diseases, excessive care burden, or re-renovation aimed at becoming independent. Among the subjects who had stopped using the renovation equipment, there was a significant number of users who could not walk independently indoors at their renovations, compared to those using the equipment continuously (p＜0.05). Regarding safe use, we found eight problematic cases, which included damaged equipment and facilities, and poor construction techniques due to elimination of steps. Some of these problems might have caused harm to the users. We suggest the need to take account of the risks of discontinuing the use of the equipment during planning of the modifications. These results also revealed a need to consider measures to guarantee the safety of the renovations under LTCI.