介護老人保健施設の看取りにおいて専門職が提供するケアと多職種連携の実態

The purpose of the present study is to clarify the practical conditions of care and collaboration performed during end-of-life care by specialists at geriatric health service facility. A questionnaire survey was conducted on specialists working for 39 facilities that provide end-of-life care. Valid responses were collected and analyzed from various specialists including 162 nurses（response rate 48.5%）, 536 care workers（42.1%）, 66 rehabilitation staff members（36.7%）, 28 social workers （35.9%）, and 28 nutritional management staff members（41.8%）. Each specialist made the most of his/her expertise so that the resident and his/her family could preserve his/her own lifestyle and live a comfortable life. However, the specialists complained that end-of-life care was not what should be provided at geriatric health service facility. Moreover, they experienced conflict because of NHI and long-term care insurance ceilings on medical care and nursing services. Some specialists who participated in multidisciplinary teams were able to provide satisfactory end-of-life care. Other specialists, however, felt as if they were being excluded from the multidisciplinary teams once the teams were involved in end-of-life care. The specialists should organize a team that produces a sense of reassurance through their mutual support so that each specialist can leverage his/her own strengths during end-of-life care at geriatric health service facility.