Dilemmas between care managers and office managers in care plan preparation:The current state and challenges
Masakazu ShirasawaYoshihito TakemotoKazutaka MasudaRyousuke Hata
J.F.Oberlin UniversityOkayama Prefectural UniversityThe International University of KagoshimaHokusei Gakuen University
摘要：While care managers across the globe work for governments and insurers, under the Japanese long-term care insurance system, many care managers work for care service provider organizations. Consequently, Japanese care managers tend to have dilemmas with office managers when preparing care plans; this situation makes it difficult for them to keep fair and neutral perspectives. Hence, in this study, the authors examine how frequently dilemmas occur and how these dilemmas are resolved. Base on the results, the authors discuss the ideal care management organizations. The authors randomly selected 3,500 care managers across Japan, mailed a survey form to them in January 2017, and received 1,725 responses. According to the study results, 1/4 of the care managers had dilemmas（frequently or sometime） with office managers in care plan preparation. Among those who did have dilemmas, 2/3 reported that office managers’ opinions would be prioritized in dilemma resolution while the other 1/3 reported that care managers’ opinions would. Next, the authors ran binomial logistic regression analyses. The dependent variables were whether or not dilemmas existed and different dilemma resolution methods. The independent variables included 4 items related to characteristics of the care manager’s organization and 8 items related to the care manager. The results showed that dilemmas were less common at organizations that were independent without provision of care services（p<.0001） as well as non-profit organizations（p<.05）. As for care managers’ characteristics, those who were female（p<.05）, younger（p<.05） and without a qualification as a senior care manager（p<.05） were less likely to have dilemmas. Regarding methods of dilemma resolution, care managers’ opinions were significantly more likely to be prioritized at independent organizations（p<.05）; none of the care manager’s characteristics showed a significant difference.As care managers prepare care plans with service users based on the users’ needs, they may face dilemmas with office managers. In order to minimize such dilemmas, the study results suggest that the ideal care management organizations would be the independent ones that do not provide care services and the non-profit ones with more emphasis on the public interest. Moreover, the authors have also found that, at independent organizations, care managers’ opinions are more likely to be prioritized even when the dilemma occurs. Therefore, we need to provide incentives to transform care management organizations from the ones that also provide care services to the ones that focus exclusively on care management. The efforts should also be made to transform these care management organizations to the non-profit ones.