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「一次判定は軽度化、二次で覆す」―新要介護認定
一次判定で軽度に判定されても、二次判定で重度に―。今年4月からスタートした新要介護認定制度の影響が注目される中、ケアマネジャーで厚生労働省の「要介護認定の見直しに係る検証・検討会」の委員でもある結城康博・淑徳大准教授らは、要介護度の更新申請結果を分析し、6月30日、結果を公表した。結城准教授らは、一次判定では軽度に判定される傾向が見られたが、二次判定で覆されるケースが多かったと指摘。「極端な軽度化や重度化」はなかったとの見方を示している。
調査は、5月末から6月末にかけて、千葉、東京、鳥取、大分の4都県の計15自治体の更新申請者5049人の判定結果を、5月審査分を中心に調べたもの。
それによると、一次判定では申請時の要介護度より軽度に判定されるケースが43%を占めたが、二次判定を経ると、軽度化の割合は23%に減少した=グラフ=。一方、重度に判定される割合は、一次判定で20%、二次判定で22%と、「ほぼ同じ」だった。申請時の要介護度と「変わらず」と判定される率は、一次判定では37%だったが、二次判定では55%と高くなった。
この結果について、結城准教授らは「一次判定で軽度に判定されても、二次判定で重度に覆されている」と指摘。最終的には、極端な軽度化や重度化は見られなかったとしている。また全体的に、二次判定で重度に変更される割合が「新制度によって高くなる可能性が予測できる」としており、認定審査会の果たす役割が大きくなっていると指摘している。
また結城准教授は、新要介護認定制度では、訪問調査時に記載される「特記事項」が判定に大きな影響を与えるため、「訪問調査を行う認定調査員や、認定審査会の審査員の負担が大きくなっている」として、対応を講じる必要があると指摘している。
ただ、結城准教授らは調査について、あくまでケーススタディーであり、更新申請者のサンプル数も全国の更新者数と比べて少ないため、厚労省が全国規模で行っている調査の結果を待たなければ、詳細な分析・検証は難しいとの見方を示している。
新要介護認定をめぐっては、要介護度が一律に軽度に判定されるのではないかとの不安の声が市民団体や介護現場から上がっていた。4月2日には、小池晃参院議員(共産)が参院厚生労働委員会で、要介護認定に関する厚労省の「内部資料」を示し、厚労省が自治体に対し、要支援2と要介護1の割合を7対3にするよう指導していたのではないかと質問。介護保険の給付額を抑えるために、故意に要介護認定の基準を厳しくしたのではないかとただしていた。こうした批判を受け、厚労省は4月13日、新要介護認定について検証するため設置した「要介護認定の見直しに係る検証・検討会」の初会合を開き、新要介護認定で審査・判定された要介護度が以前の判定より軽くなった場合、申請者が希望すれば、新制度の検証期間中は以前の要介護度とする経過措置を示した。
■「非該当」や予防給付への移行、審査員が「無意識」に阻止？
結城准教授によると、申請時の要介護度によって、軽度化の割合が異なる傾向も見られた。
調査結果によると、申請時に要支援2、要介護2、要介護3だった人は、二次判定で軽度化した割合がそれぞれ34%、26%、27%で、「軽度に判定される傾向」があったが、要支援1からの軽度化は11%で、要介護1は19%。結城准教授は、要支援1より軽度に判定されると「非該当」に、要介護1より軽度に判定されると介護給付から予防給付の対象となるため、「審査員も無意識のうちに、慎重に判定をしたのではないか」と話している。要介護4、要介護5から軽度化する割合は、共に18%だった。
また結城准教授らは、要支援2や要介護2、要介護3といった人は在宅生活者が多い一方で、要介護4や要介護5などの重度者には施設生活者が多い傾向があると指摘。今後、「在宅と施設での認定調査結果を比較する必要がある」としている。
■「地域差を注視」
一方、一次判定と二次判定の結果に、ほとんど違いが見られない自治体が4か所あったという。いずれも首都圏以外の自治体だった。結城准教授らは「今後、全国規模のデータを見て、この地域差を注視すべき」としている。
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ＮＥＷＳ】12年度介護報酬改定の基本的視点を提示- 厚労省が介護給付費分科会に【介護支援専門員 ＮＥＷS】介護施設の総量規制「堅持を」- 政令市などの担当課長が要望 【介護支援専門員 ＮＥＷＳ】限度額超過者の8割超がサービス2種類以下- 介護給付費分科会 【介護支援専門員 NEWS】地域包括支援センター職員数、大幅に増加 【介護支援専門員 NEWS】ユニット型個室の居住費助成を拡充- 横浜市が10月から【介護支援専門員 ＮＥＷＳ】ユニット型個室の居住費助成を拡充- 横浜市が10月から 【介護支援専門員 ＮＥＷS】24時間訪問介護、エリア担当見送りで調整- 検討会最終報告で 【介護支援専門員 ＮＥＷS】国保収納率、2年連続で過去最低を更新 【介護支援専門員 NEWS】介護未経験者雇用の助成金廃止で経過措置- 厚労省が周知 【介護支援専門員 NEWS】「GHと小規模多機能の一元化を」 【介護支援専門員 ＮＥＷＳ】ケアマネ業務せず不正請求、指定取り消しへ- 神奈川県 【中医協】医療費の伸び率は3.9％ 【介護支援専門員 ＮＥＷS】安心生活創造事業で論点を整理- 厚労省検討会 【介護支援専門員 ＮＥＷS】医療・福祉の就業者、増加幅が全産業で最大- 労働力調査 共通番号制度、導入は15年1月から- 政府・実務検討会 医療・福祉の就業者、増加幅が全産業で最大- 労働力調査 新たな高齢者医療制度、「13年3月施行」を強調－細川厚労相【介護支援専門員 ＮＥＷＳ】歯を失うと認知症になりやすい- リスク1.9倍、厚労省研究班が調査 【介護支援専門員 ＮＥＷS】高齢者住宅の供給割合を3－5％に- 住生活基本計画案 【介護支援専門員 ＮＥＷS】アルツハイマー型認知症治療薬「メマリー錠」販売承認取得【介護支援専門員 NEWS】要介護認定の有効期間、上限延長でパブコメ募集―厚労省【介護支援専門員 NEWS】24時間巡回型、公募式は民間参入制限だ【介護支援専門員 NEWS】ケアマネは「介護保険サービス以外にも注目を」【介護支援専門員 NEWS】次期改定での介護報酬アップ「有効な財源確保策を示せず厳しい」 【介護支援専門員 NEWS】厚労省、法改正で重大労働法規違反は指定取消に！【介護支援専門員 NEWS】介護福祉士国試、実務経験者に「450時間研修」義務化へ【介護支援専門員 NEWS】24時間巡回介護で国「協力を」、都は「疑問」―在宅協セミナー【介護支援専門員 NEWS】複合型事業所、「当面は小規模多機能と訪問看護で」【介護支援専門員 NEWS】やさしい手が法改正で生活援助切り捨てを示唆【介護支援専門員 NEWS】 ｢抜き打ち検査」「夜間サービスの質の確保」を提言【介護支援専門員 NEWS】国保などの保険医療費、高知がトップ【介護支援専門員 NEWS】虚血性心疾患治療の現状と将来展望――民間調査【介護支援専門員 NEWS】「消費税25％払ってもお年寄りが安心できる制度に」―ワタミ渡邉会長【介護支援専門員 NEWS】「抜き打ち調査」で質の確保を―特養を良くする会が細川厚労相に提言 【介護支援専門員 NEWS】与謝野担当相、社会保障費は「無理に削れない」【介護支援専門員 NEWS】医療行為も対応する「緊急ショートステイ事業」開始――杉並区【介護支援専門員 NEWS】介護従事者の半数以上「要介護認定は必要だが簡素化を」－淑徳大・結城准教授ら【介護支援専門員 NEWS】厚生労働省、介護福祉士・社会福祉士の受験料改定で意見募集【介護支援専門員 NEWS】病院の病床数、1年間で8600床減－10月末概数【介護支援専門員】アルツハイマー治療薬は2,900億市場に――民間調査【介護支援専門員】アルツハイマー治療薬は2,900億市場に――民間調査【介護支援専門員 NEWS】「潜在ヘルパー」有資格者の79％【介護支援専門員 NEWS】サービス提供責任者の責務に介護報酬を―ホームヘルパー協会が要望書【介護支援専門員 NEWS】「高齢者向け食品・飲料購入のきっかけはケアマネジャー」電通調査結果【介護支援専門員 NEWS】厚生労働省、介護給付費実態調査月10月分を公表【介護支援専門員 NEWS】介護業界売上トップ10！2000億超の企業は？――帝国データバンク【介護支援専門員 NEWS】健康状態の悪化や、退職の割合に介護が影響【介護支援専門員 NEWS】厚労省の社会保障検討本部が発足【介護支援専門員 NEWS】「どこでもMY病院」など情報化促進に15億円－経産省11年度予算案【介護支援専門員 NEWS】世界80カ国で承認の2型糖尿病治療剤「パイエッタ」発売【介護支援専門員 NEWS】29兆円のうち、介護2兆2,037億円――平成23年度予算案【介護支援専門員 NEWS】「地域医療支援センター」に意見が集中―社保審医療部会【介護支援専門員 NEWS】サービス付き高齢者住宅、24時間介護との組み合わせで【介護支援専門員 NEWS】サービス付き高齢者住宅の促進に325億円―国交省11年度予算案【介護支援専門員 NEWS】一部ユニット型施設、省令改正で廃止へ【介護支援専門員 NEWS】来年度の平均保険料率9.5％に引き上げへ－補助率の据え置き受け入れ【介護支援専門員 NEWS】認知症の要介護認定について【介護支援専門員 NEWS】「ケアプラン有料化」見送り！厚労相が改正6要点を表明！【介護支援専門員 NEWS】新規アルツハイマー病治療薬などの承認を了承―薬事分科会【介護支援専門員 NEWS】来年度予算案を閣議決定、厚労省分は約29兆円【介護支援専門員 NEWS】横浜の市民団体、配食サービス時の認知症見守りハンドブック発行【介護支援専門員 NEWS】「福祉士研修の大幅削減はバナナの叩き売り」――検討会レポ2【介護支援専門員 NEWS】民主政調、介護保険改革の提言を決定―細川厚労相に提出【介護支援専門員 NEWS】ケアマネ対象の医療研修など「10年後の東京」を策定――東京都【介護支援専門員 NEWS】交付金の影響でケアマネも1.1万円昇給【介護支援専門員 NEWS】新高齢者医療制度、国保のあり方など地方と協議へ―厚労省方針【介護支援専門員 NEWS】他国に比べて高コスト体質の日本の介護保険【介護支援専門員 NEWS】「重症」の医療区分1の患者が急増―医療療養病床【介護支援専門員 NEWS】「利用者負担導入反対決議文」を厚労省に提出――日本介護支援員協会【介護支援専門員 NEWS】マクドナルドが高齢者宅へ宅配開始、創業40年で初！【介護支援専門員 NEWS】介護職の医行為、2012年実施へ【介護支援専門員 NEWS】ケアマネ試験、合格率は過去最低の20.51％【介護支援専門員 NEWS】「介護保険制度改正ができないなら、政権担当能力はない」【介護支援専門員 NEWS】障がい者改革会議、現状認識に関係省庁と隔たり【介護支援専門員 NEWS】介護職員の医行為の範囲など示した中間まとめを了承―厚労省検討会【介護支援専門員 NEWS】介護療養廃止「3年延期」などの提言を大筋了承―民主・厚労部門会議【介護支援専門員 NEWS】成年後見制度の改善求め厚労相らに提言―日本社会福祉士会【介護支援専門員 NEWS】600万人の高齢「買い物弱者」支援マニュアル―経産省が公表 【介護支援専門員 NEWS】「介護なんでも110番」電話殺到で対応は約3％【介護支援専門員 NEWS】シルバーマークは「時代的役割終えた」？―省内仕分けで議論【介護支援専門員 NEWS】「男女雑魚寝」「2年連泊」、お泊まりデイの実態調査を―共産都議団【介護支援専門員 NEWS】平成22年 介護保険部会の取りまとめ【介護支援専門員 NEWS】精神障害者への訪問支援で大幅なコストダウンも―民主PTがヒアリング【介護支援専門員 NEWS】首都圏の介護事業者団体「地域係数見直しを」―細川厚労相に要望書【介護支援専門員 NEWS】24時間巡回型に1.5億、医行為研修2.8億円計上――第2次補正予算案【介護支援専門員 ＮＥＷＳ】介護療養型医療施設は「医療・介護の連携にベストな施設」【介護支援専門員 ＮＥＷS】高いレベルの介護福祉士、職能団体が認定―厚労省案【介護支援専門員 ＮＥＷＳ】都が介護事業所の指定取り消しへ、1億5千万円超の返還求める【介護支援専門員 ＮＥＷＳ】特養も有料老人ホームも高専賃も「高齢者住宅」―類型簡素化を ケアプラン有料化は未決着、賛否両論併記で国会提出！――社保審レポ【介護福祉士 NEWS】24時間訪問介護やお泊まりデイは区市町村が指定を―都が提言【介護支援専門員 NEWS】介護職員交付金、報酬への組み入れに疑問も―民主・介護WT【介護支援専門員 NEWS】介護保険、4割強が税負担を容認―内閣府調査【介護支援専門員 ＮＥＷS】新規アルツハイマー治療薬2品目の承認を了承―医薬品第一部会【介護支援専門員 ＮEWS】高専賃での居宅介護支援、集中減算に批判―高齢者集合住宅研究大会【介護支援専門員 ＮＥＷS】認知症患者の見守りネット、稼働の自治体は1割未満【介護支援専門員 ＮＥＷS】定額訪問介護、「報酬28万―30万円必要」―ジャパンケア・対馬会長【介護支援専門員 ＮＥＷＳ】介護保険制度の見直しに向けた素案を提出―厚労省【介護支援専門員 ＮＥＷＳ】第5期の介護保険料、1000円超アップの5200円―厚労省が試算【介護支援専門員 ＮＥＷS】障害者自立支援法改正案を可決―衆院厚労委【介護支援専門員 ＮＥＷＳ】「国保の都道府県単位化」に異論なし―民主・高齢者医療WT【介護支援専門員 ＮＥＷS】介護予防事業の再仕分け、前回同様「予算要求の縮減」【介護支援専門員 ＮＥＷＳ】「ケアプランの利用者負担は断固反対」――JCMA提言【介護支援専門員 ＮＥＷS】「介護職員の医行為は、医療・介護の新たな線引きを考える糸口」【介護支援専門員 ＮＥＷＳ】仕事に関する相談窓口、職場に「なし」が9割――ヘルパー満足度調査【介護支援専門員 NEWS】「介護政策、財源足りない」―小宮山厚労副大臣【介護支援専門員 NEWS】「地域医療支援センター」に意見が集中―社保審医療部会【介護支援専門員 NEWS】『VIPSですすめるパーソン・センタード・ケア』発行【介護支援専門員 ＮＥＷＳ】静岡で過去最大級の報酬不正受給―介護療養型医療施設の指定取り消しへ【介護支援専門員 ＮＥＷS】特養の運営「社福に限定を」約5割―施設長有志団体【介護支援専門員 ＮＥＷＳ】75歳以上の医療費負担、「税金の割合増で」が4割超【介護支援専門員 ＮＥＷＳ】全老健、老健の医療に関する意見書を発表【介護支援専門員 NEWS】【11月13日】ケアマネ独立開業セミナー 【介護支援専門員 NEWS】全老健、介護保険制度に対する意見書を発表【介護支援専門員 NEWS】通所サービスの見直しも―厚労省老人保健課長【介護支援専門員 NEWS】日本介護福祉士会が人員配置、処遇改善などの提言書を提出【介護支援専門員 NEWS】末期がんで福祉用具貸与、軽度者でも保険適用可能―厚労省が事務連絡【介護支援専門員 NEWS】区分支給限度基準額の運用見直しなどを提言―ホームヘルパー協議会【介護支援専門員 NEWS】ケアプラン作成「利用者負担」導入を提示――社会保障審議会【介護支援専門員 NEWS】介護福祉士資格の600時間研修案「現実的ではない」【介護支援専門員 NEWS】1万人超の障害関係者が「自立支援法の廃止を」【介護支援専門員 NEWS】介護職員養成13万円、救急搬送7,600円――埼玉県「行政の値札」【介護支援専門員 NEWS】 夜間訪問介護で16億円ムダ、端末機は倉庫保管でホコリかぶる【介護支援専門員 NEWS】ユニット型特養の約1割が赤字【介護支援専門員 NEWS】介護サービス費用額、6000億円超える―給付費実態調査・8月分【介護支援専門員 NEWS】 来年アリセプト以外の新薬認可【介護支援専門員 NEWS】介護福祉士の医行為追加研修と上級資格創設――厚労省会議 【介護支援専門員 NEWS】特養入所申し込み者、実際の待機は22.5％―厚労省 【介護支援専門員 NEWS】1万円増えた！ケアマネ月給26万3,754円――日本介護クラフトユニオン調査介護支援専門員のための介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS平成21年介護支援専門員実務研修受講試験 合格率介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS平成21年介護支援専門員実務研修受講試験 都道府県別 合格率介護支援専門員の介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員のための介護保険NEWS直通!!ケアマネジャーサポート事例介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員の介護保険NEWS介護支援専門員のためのNEWSケアマネジャーのための介護保険NEWSケアマネジャーのための介護保険NEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWSケアマネジャーのための介護保険NEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のためのNEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援介護支援専門員のための介護保険NEWSケアマネジャーのための介護保険NEWS介護支援専門員のための介護保険NEWS介護支援専門員のための介護保険NEWSケアマネージャーの介護保険NEWSケアマネージャーの介護保険NEWS