ケアサポート９／ケアマネージャー（介護支援専門員）試験／ＴＯＰへ

介護サービスの監査強化

　東京都はこのほど、2008年度に社会福祉施設などに実施した指導検査の結果を報告書にまとめた。介護報酬の請求や介護給付などの対象サービスに不正があると疑われる場合に実施される監査は、前年度の34件から倍以上の79件となった。06年度の介護保険法の改正以降、保険者による実地検査が進んだことなどにより、悪質と思われる事例が発見されるケースが増えているようだ。

　都の「08年度指導検査報告書」によれば、都内に990ある社会福祉法人のうち、349法人に実地検査が行われた。このうち、問題点を指摘されたのは131法人(件数は250件)だった。最も多く指摘されたのは「経理事務処理が不適切」で78件。次いで、「理事会等の開催が不適正」が44件、「事業経営の管理体制・計画性が不十分」が26件、「定款が不備または実態と不一致」が25件と続いた。
　介護保険施設では、都内に385施設ある特別養護老人ホームのうち、195施設で実地検査が行われ、171施設が問題点を指摘された(同504件)。指摘されたのは「介護報酬算定の誤り・不備」が59件で最も多く、以下は「施設サービス提供に当たっての体制が不適正」が55件、「経理処理が不適正」が45件、「感染症や食中毒の予防・まん延防止策が不適正」が42件と続いた。
　「介護報酬算定の誤り・不備」では、「栄養マネジメント加算」を利用者や家族に同意を得ずに算定したり、同意を得た日以前から算定したりしている事例が挙げられている。
　訪問や通所介護、居宅介護支援事業所などが対象の「介護保険在宅サービス事業(福祉系)」では、1066事業所に実地検査、1638事業所に集団指導が行われた。
　この中で877件の問題点が指摘され、最も多かったのは「計画の適切な作成・交付や同意を得ることが不十分」とされた事例で、居宅介護支援で213件、訪問介護で118件あった。
　福祉系の施設や事業所からの介護報酬の返還金は3億7662万円で、このうち訪問介護事業所(介護予防含む)が2億6494万円で最多だった。
　介護保険施設を除いた高齢者施設では、都内にある有料老人ホーム389施設のうち95施設に実地検査を行い、52施設で92件の問題点が指摘された。
　主な事例として、▽消防計画などに基づいた避難訓練などを定期的に行っていない▽年2回の健康診断の受診機会を与えていない▽身体的拘束など利用者の行動を制限する行為を行っている。やむを得ず行った場合も、必要な記録が整備されていない-ことが指摘されている。

　介護保険サービスにおける監査は、08年度に79件が実施され、このうち18件で指定の取り消し(取り消し相当を含む)および効力停止に至った。
　監査は前年度から倍以上に増えたが、この理由について都福祉保健局の村田由佳指導調整課長は、「この3年ほどで、かなり保険者による実地指導が進んでいる」と説明している。
　区市町村が保険者として情報を得ているほか、06年度の介護保険法の改正で監査権限が与えられ、地域密着サービスにおいて指定をはじめ実地検査、監査なども行ってきたことから、事業所の情報が集まっているという。
　村田課長は、「悪質性が高いと思われるケースは、保険者からの情報提供がある。実地検査に行ってみると、監査に切り替えるケースが増えている」としており、情報が増えたことによって、悪質な事例が見つかるケースも増えているようだ。(医療CBニュース)

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To do that I forward a little note I sent to my brother not long after viewing the program as well as the comments below. We kids grew up for a time just this side of 8 Mile Road (that is, between 7 and 8 Mile Road) in Detroit, Michigan the exact area referred to in your film. That is, Mo-Town, Hockey Town, The Motor City, land of Stevie Wonder, Bob Seger et.al. 8 Mile Road, for those unfamiliar is the citys northern most border, was once following WWII a thriving Levittown affordable FHA housing area, and our home was surely within a rocks throw of the 1941 Levittown real estate developers red-line cement wall portrayed in your film.

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The very fact that the Giants (in other words, Brian Sabean) dont realize what kind of value Fred Lewis has is the EXACT thing thats holding our franchise back. Its the root cause for our signing overpriced, overaged veterans and running a shitty offense out there year in and year out. Its the root cause for our undervaluing the attributes that actually lead to runs, that is, not making an out on offense. The fact that Fred Lewis is sitting on the bench is crazy, is stupid, is beyond a fireable offense. If I was running another team in MLB who needed a corner outfielder, Id trade for Lewis in a heartbeat, you know it wouldnt take much to get him from Sabean. Lewis is a very good value baseball player that will help his team win baseball games.

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