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要介護認定調査「介助の方法」などでQ&A-厚労省
厚生労働省は6月18日付で、今年度からの要介護認定方法について、都道府県の介護保険担当者などに事務連絡を行った。要介護認定調査において、どのような介助が提供されているかを聞く「介助の方法」の項目を調査する場合などのQ&Aをまとめている。
Q&Aでは、「介助の方法」を調査する場合、調査対象者に「常時、介助を提供する者がいない場合」や「介助が不足の場合」における選択肢の選び方などを示している。
「常時、介助を提供する者がいない場合」とは、介助者が実質的に存在せず、「介助の方法」を評価できないケースを指す。具体的には、独居や同居者も介護が必要な状態で、介助を行えない場合や介護を放棄した場合などが該当する。調査員はこの場合、不足している介助を想定しながら選択肢を選び、根拠となる事実などを特記事項に記載するとしている。
一方、「介助が不足の場合」とは、介護者が存在しているものの、介護方法が不適切だったり、不十分なために問題が発生したりしている場合が当てはまる。この場合、調査員は実際の介助の状況に基づいて選択肢を選び、不足したりしていると思う介助を特記事項に記し、要介護認定審査会の二次判定で評価することになるとしている。
また、二世帯住宅などに同居しているものの、介助者との実質的な交流がなければ、「常時、介助を提供する者がいない場合」に当てはまるとしている。
一方で、独居者であっても、必ずしも「常時、介助を提供する者がいない場合」に当てはまるとは限らないとされた。調査項目の一つである「洗身」は、独居者でも親族の訪問時に介助されている場合などが考えられるため、実際の介助の状況で評価すべきとしている。しかし「排尿」は、行為と親族の訪問とは無関係なことから、「常時、介助を提供する者がいない場合」に当てはまるとしている。
「介助の方法」の調査で、時間帯や体調などにより介助の方法が異なる場合、「おおむね1週間の状況でより頻回に見られる状況や日ごろの状況で」項目を選択し、日ごろの状況などを特記事項に記載するとされた。
例えば、「移動」において、状況により介助の方法が異なる場合、おおむね1週間の「移動」の全体量を把握した上で、介助がどの程度行われているかで選択を行い、特記事項に記載するとされた。
Q&Aはこのほか、「意思の伝達」と「日常の意思の決定」の調査項目の違いも示している。「意思の伝達」は、決定された意思を「伝達する能力」のみを評価する項目であり、意思の「決定」の内容の合理性は問わないほか、意思が伝達されれば、筆談などでも「(伝達)できる」に該当するとした。
「日常の意思の決定」については、対象者が決定すべき内容を理解し、決定ができていれば「できる」に当てはまるとしている。
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