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直通!!ケアマネジャーサポート事例

Q 訪問看護と同時に算定できないサ-ビスはなにか教えてください。よろしくお願いします。

Aご質問ありがとうございます。少々長いですが下記返答になります。

 
利用者が、短期入所生活介護、短期入所療養介護もしくは特定施設入居者生活介護又は認知症対応型共同生活介護、地域密着型特定施設入居者生活介護若
しくは地域密着型介護老人福祉施設入所者生活介護を受けている間は、訪問看護費は算定できません。
 
 
もっと詳しくは、(ここからは試験には出題されないと思います。)
 
算定できないケース
 
*介護老人保健施設及び介護療養型医療施設の退所(退院)日又は短期入所療養介護のサービス終了日(退所・退院日)については訪問看護費は算定できない。
*施設入所(入院)者が外泊又は介護保健施設若しくは経過的介護療養型医療施設の試行的退所を行っている場合の外泊時又は試行的退所時は居宅サービスは算定できない。
算定できるケース

*介護老人保健施設及び介護療養型医療施設を退所・退院した日については、厚生労働大臣が定める状態(厚生省告示23号第4号※特別管理を行う状態にある者)にある利用者に限り、訪問看護費を算定できることとする。なお、短期入所療養介護のサービス終了日(退所・退院日)においても同様である。
*入所(入院)当日については、当該入所(入院)前に利用する訪問看護は別に算定できる。
※別に厚生労働大臣が定める状態にある利用者(注)に限り、介護老人保健施設及び介護療養型医療施設の退所(退院)日又は短期入所療養介護のサービス終了日(退所・退院日)であっても訪問看護費を算定できる
 
 
訪問介護との同じ時間帯での併用については、

利用者は、同一時間帯にひとつの訪問サービスを利用することを原則としますが、ただし、訪問介護と訪問看護、又は訪問介護と訪問リハビリテーションを同一利用者が同一時間帯に利用する場合は、利用者の心身の状況や介護の内容に応じて、同一時間帯に利用することが介護のために必要であると認められる場合に限り、それぞれのサービスについて、それぞれの所定単位数が算定されます
 
例えば、家庭の浴槽で全身浴の介助をする場合に、適切なアセスメント(利用者について、その有する能力、既に提供を受けている指定居宅サービス等のその置かれている環境等の評価を通じて、利用者が現に抱える問題点を明らかにし、利用者が自立した日常生活を営むことができるように支援する上で解決すべき課題を把握することをいう。)を通じて、利用者の心身の状況や介護の内容から同一時間帯に訪問看護を利用することが必要であると判断され、30分以上1時間未満の訪問介護(身体介護中心の場合)と訪問看護(訪問看護ステーションの場合)を同一時間帯に利用した場合、訪問介護については402単位、訪問看護については830単位がそれぞれ算定されます。
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