Title : How do Japanese outpatient day long-term care workers perceive independence support care?
Abstract:
Background:
In outpatient day long-term Care (ODLC), a person requiring long-term care is promoted through support for daily living and functional training. However, activities of daily living (ADL) are severely limited among those who require care, and their conditions range from those who have difficulty walking to those who can go out. Achieving this goal is not always easy if the goal is to lead an entire life without the help of others. This raises the question of what constitutes independent daily living. Since the concept of "independence" is not clearly defined in the Long-Term Care Insurance Law, the specific details of independence support care are also unclear. This study aimed to determine how people working at ODLC perceive independent supportive care.
Method:
The data was collected from a self-administered, unmarked questionnaire survey by mail targeting 199 people engaged in ODLC. The questions included qualifications (some people more than one)?and an image of independence support care (open-ended). The analysis used KH Coder to extract frequently occurring words and to create co-occurrence networks. The study was conducted with the approval of the affiliated university's Ethical Review Committee (no. 22043).
Results:
A total of 150 questionnaires were collected, and 100 were analyzed. The national qualifications were as follows: 12 physical therapists, 6 occupational therapists, 10 nurses, 6 assistant nurses, 16 judo therapists, 7 social workers, one mental health worker, and 38 care workers.
In terms of the frequency of occurrences (10 or more) of commonly used words, the most frequent ones were "able," "the person," "life," "me," "function," "do," "training," "maintain," "care," "ODLC," "now," "home," "daily," "need," and "ability," in that order. "Social" and "participation" each occurred 8 times. The analysis of the co-occurrence network resulted in five subgraphs: "able to do it on their own," "living daily life at home," "training at ODLC," "ability to do," and "maintaining the present situation."
Discussion:
Image of Independence-support care in ODLC on maintaining the ability to perform daily living. This is consistent with reports (Yama, Japanese Journal of Geriatric Therapy. 2022) that the goal of ODLC is often to maintain or improve physical function. However, independence includes multiple elements such as physical, mental, and social; physical independence is one aspect of independence. In this study, support for social participation, such as connecting with people in the community, was envisioned as independent support care, but its frequency of occurrence was low. Since social participation is affected using transportation and the presence of supporters (Utsunomiya, Japanese Journal of Gerontology. 2019), transportation support for those who need care and coordination with supporters is also essential for independence support care.
Furthermore, self-determination underlies self-independence (Shin, Shitennoji University bulletin. 2008). Nevertheless, the participants in this study did not recall that support for self-determination was a form of independence support. Therefore, ODLC workers must recognize that support for judgment, decision-making, and expressing self-decision contents are part of independence support care. Moreover, workers should support a person requiring long-term care to help them make decisions.
Audience Take Away:
- It provides an insight into what Japanese ODLC workers consider ‘independence support care.’
- They emphasize the different aspects of independence in care for older people (e.g., physical, mental, and social factors), with physical independence being one kind of independence.
- There is a need for ODLC workers to recognize and incorporate a broader perspective on independent support care, such as mobility support, coordination with supporters, and decision-making support, beyond maintaining and improving physical function.
