This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes.

A Delphi questionnaire was developed based on a review of the literature using the keywords “nursing homes,” “workforce,” and “quality of care.” A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged.

A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea.

To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.

The purpose of this study to develop a fringed fall prevention program based on King's goal attainment theory and education. This study is applied to the personal, interpersonal, and social systems of fall high-risk patients to test its effects.

This study was a nonequivalent control group pre- and post-test design. There were 52 fall high-risk patients in the experimental group and 45 in the control group. The experimental group received six sessions, with the group sessions lasting 60 minutes and the individual sessions lasting 20~30 minutes. Data were analyzed using descriptive statistics, an χ²-test, a paired sample t-test, and a Wilcoxon signed-ranks test utilizing IBM SPSS software.

For the 3-month intervention period, the fall prevention program was found to be particularly effective for patients in the experimental group (from 3.38 to 1.69 per 1000 patient days; p=.044), as opposed to the control group (from 1.94 to 1.49 per 1000 patient days; p=.300). For the 6-month follow up period, the fall prevention program was again found to be effective for patients in the experimental group (from 3.26 to 0.76 per 1000 patient days; p=.049) compared to the control group (from 1.98 to 1.01 per 1000 patient days; p=.368).

These results indicate that the fringed fall prevention program is very effective in reducing falls, not only during the intervention period, but also after the intervention period has ended. We can therefore recommend this program for use concerning fall high-risk patients in long-term care hospitals.

We developed and tested the effects of a coping skill training program for caregivers in feeding difficulty among older adults with dementia in long-term care facilities.

A non-equivalent control group pretest-posttest design was used. The subjects comprised 34 caregivers (experimental group: 17, control group: 17) and 40 older adults with dementia (experimental group: 20, control group: 20). The developed program was delivered in 4-hour sessions over 6 weeks (including 2 weeks of lectures and lab practice on feeding difficulty coping skills, and 4 weeks of field practice). Data were collected before, immediately after, and 4 weeks after the program (January 3 to April 6, 2016). The data were analyzed using t-test and repeated measures ANOVA using SPSS/WIN 20.0.

Compared to their counterparts in the control group, caregivers in the experimental group showed a significantly greater improvement in feeding knowledge and feeding behavior, while older adults with dementia showed greater improvements in feeding difficulty and Body Mass Index.

The study findings indicate that this coping skill training program for caregivers in feeding difficulty is an effective intervention for older adults with dementia in long-term care facilities.

The purpose of this study was to identify factors predicting behavioral and psychological symptoms of dementia (BPSD) in persons with dementia. Factors including the patient, caregiver, and environment based on the multi-dimensional behavioral model were tested.

The subjects of the study were 139 pairs of persons with dementia and their caregivers selected from four geriatric long-term care facilities located in S city, G province, Korea. Data analysis included descriptive statistics, inverse normal transformations, Pearson correlation coefficients, Spearman's correlation coefficients and hierarchical multiple regression with the SPSS Statistics 22.0 for Windows program.

Mean score for BPSD was 40.16. Depression (β=.42, p<.001), exposure to noise in the evening noise (β=-.20, p=.014), and gender (β=.17, p=.042) were factors predicting BPSD in long-term care facilities, which explained 25.2% of the variance in the model.

To decrease BPSD in persons with dementia, integrated nursing interventions should consider factors of the patient, caregiver, and environment.

The purpose of this study was to measure the functional status of stroke patients cared for in different long-term care settings.

We assessed all stroke patients in two home health care agencies, four nursing homes and one geriatric hospital in Korea (n=171) using the Resident Assessment Instrument (RAI), which comprises Activity of Daily Living (ADL), urine incontinence, bowel incontinence, a Cognitive Performance Scale (CPS),and being understood and understanding others. Data was collected by face-to-face surveys with patients.

The mean ADL score, urine incontinence score, bowel incontinence score, CPS, and being understood score and understanding others score were lowest for the patients receiving home health care, and highest for the patients in nursing homes. Low scores described poor and high scores good functional status. The results showed significant differences in physical and cognitive function scores between the three groups of patients.

This study suggests that there may be large differences between the patients in these three types of long-term care settings. These findings can be used to help develop and implement efficient long-term care programs.

The purpose of this study was to classify the elderly in long-term care facilities using the Resource Utilization Group(RUG-III) and to examine the feasibility of a payment method based on the RUG-III classification system in Korea.

This study measured resident characteristics using a Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. Data was collected from 530 elderly residents over sixty, residing in long-term care facilities. Resource use for individual patients was measured by a wage-weighted sum of staff time and the total time spent with the patient by nurses, aides, and physiotherapists.

The subjects were classified into 4 groups out of 7 major groups. The group of Clinically Complex was the largest (46.3%), and then Reduced Physical Function(27.2%), Behavior Problems (17.0%), and Impaired Cognition (9.4%) followed. Homogeneity of the RUG-III groups was examined by total coefficient of variation of resource use. The results showed homogeneity of resource use within RUG-III groups. Also, the difference in resource use among RUG major groups was statistically significant (p<0.001), and it also showed a hierarchy pattern as resource use increases in the same RUG group with an increase of severity levels(ADL).

The results of this study showed that the RUG-III classification system differentiates resources provided to elderly in long-term care facilities in Korea.

This study was to classify elderly in long-term care hospitals for using Resource Utilization Group(RUG-III) and to consider feasibility of payment method based on RUG-III classification system in Korea.

This study designed by measuring resident characteristics using the Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. The data were collected from 382 elderly over sixty-year old, inpatient in the five long-term care hospitals. Staff time was converted into standard time based on the average wage of nurse and aids.

The subjects were classified into 4 groups. The group of Clinically Complex was the largest(46.3%), Reduced Physical Function(27.2%), Behavior Problem(17.0%), and Impaired Cognition(9.4%). The average resource use for one resident in terms of care time(nurses, aids) was 183.7 minutes a day. Relative resource use was expressed as a case mix index(CMI) calculated as a proportion of mean resource use. The CMI of Clinically Complex group was the largest(1.10), and then Reduced Physical Function(0.93), Behavior Problem(0.93), and Impaired Cognition(0.83) followed. The difference of the resource use showed statistical significance between major groups(p<0.0001).

The results of this study showed that the RUG-III classification system differentiates resources provided to elderly in long-term care hospitals in Korea.

The aim of this study was to identify the effect of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent and to compare it with that of chlorhexidine solution (0.12% dilution).

This study employed a pretest-posttest experimental design in which a single group of patients was exposed to two different treatments over a period of time. The study included 32 patients hospitalized at a longterm care hospital in Korea. Data were collected between August 12, 2016 and September 28, 2016. The patients first used chlorhexidine solution as an oral care agent for 1 week. After an interval of 2 weeks, they used Dongchimi juice for 1 week. Each agent was applied 2 times a day depending on the protocol. The oral status of the patients was measured using Beck's Oral Exam Guide (OEG) scores. The number of pathogens in the oral cavity was counted by culture, and the patients’ subjective satisfaction score for each oral agent was measured using a visual analogue scale. T-test and Mann-Whitney test were performed to identify significant differences between Dongchimi juice and chlorhexidine solution by using PASW Statistics for Windows, Version 18.0 (SPSS Inc., Chicago, IL, USA).

The OEG score was not statistically different with the use of chlorhexidine solution and Dongchimi juice. However, decreasing number of pathogens and the subjective satisfaction score were higher with Dongchimi juice than with the chlorhexidine solution.

These findings support the use of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent for Korean patients.

The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress.

A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3.

Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult.

The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.

The aim of this study was to evaluate the validity and reliability of the Korean version of the Person-centered Care Assessment Tool (P-CAT).

The English P-CAT was translated into Korean with forward and backward translation. Survey data were collected from 458 staff in 17 long-term care facilities in Korea. Construct validity and criterion related validity were evaluated. Cronbach's alpha was used to assess reliability.

The Korean version of P-CAT was shown to be valid homogeneously by factor, item and content analysis. Internal consistency reliability was satisfactory in which the values of factor 1, factor 2 and the total scale were .84, .77 and .86 respectively. Exploratory factor analysis supported the construct validity with a two-factor solution. Factor loadings of the 13 items ranged in .34~.80. Criterion validity to the Person-centered Climate Questionnaire-staff (PCQ-S) was .74 (p<.001).

The Korean version of the P-CAT was found to be an applicable instrument with satisfactory reliability and validity for further use in measuring successful person-centered care in long-term care facilities for older persons.

This study was done to determine whether muscle strength training programs have an impact on improving symptoms of urinary incontinence (UI) and physical function among elderly women with UI who reside in long-term care facilities.

A randomized controlled trial was conducted. Participants had to be over 65 years, score over 15 score on the mini-mental state examination, and be able to walk alone or with an assistant. Seventy residents were randomly allocated to either the training group (n=35) or control group (n=35). The program consisted of 50 minutes, twice a week for 8 weeks, and included Kegel's exercise, Thera-band training and indoor walking. Main outcomes were UI symptoms, peak vaginal pressure and physical functions measured with timed up and go test (TUG), one leg standing test (OLST), activities of daily living (ADL) and grip strength. Changes in outcome measurements were calculated from baseline to 4 weeks and to 8 weeks using repeated measures ANOVA.

There were significant differences in peak vaginal pressure (p<.001), TUG (p<.001), OLST (p=.012) and grip strength (p<.001) in the interaction between groups and time.

Future studies are suggested to confirm the effect of muscle strength training in long-term care facilities where elderly women with UI reside.

Objectives of this study were to investigate the association between efficiency and quality of health care in Long-term Care Hospitals (LTCH) and determine related factors that would enable achievement of both high efficiency and high quality at the same time.

Major data sources were the "2012 Korean Assessment of Propriety by Long-term Care Hospitals" obtained from the Health Insurance Review & Assessment Service. Cost variables were supplemented by a National Tax Service accounting document. First, data envelopment analysis was performed by generating efficiency scores for each LTCH. Second, matrix analysis was conducted to ascertain association between efficiency and quality. Lastly, kruskal-wallis and mann-whitney tests were conducted to identify related factors.

First, efficiency and quality of care are not in a relationship of trade-offs; thus, LTCH can be confident that high efficiency-high quality can be achieved. Second, LTCH with a large number of beds, longer tenure of medical personnel, and adequate levels of investment were more likely to have improved quality as well as efficiency.

It is essential to enforce legal standards appropriate to the facilities, reduce turnover of nursing staff, and invest properly in human resources. These consequences will help LTCH to maintain the balance of high efficiency-high quality in the long-run.

The purpose of this study was to explore characteristics of eating behavior according to level of functional status of elders with dementia (EWD), and to examine feeding time, change in food intake and body mass index (BMI) according to eating behavior.

Participants were 149 EWD residing in long-term care facilities located in Seoul or Gyeonggi province and evaluated using the Mini-Mental State Exam-Korean version, Korean version-Activities of Daily Living, and Eating Behavior Scale (EBS). Feeding time, change in food intake, and BMI were also measured. Data were analyzed using SPSS 17.0, specifically descriptive statistics, ANOVA, and Chi-square test.

Participants' mean EBS score was 10.43±6.01 and half of them (54.4%) needed moderate or total assistance while eating. The EBS score was significantly lower for elders with severe dementia compared to those with mild or moderate dementia; and elders with severe ADL dependence compared to those with mild or moderate ADL dependence. Lower EBS scores were related to longer feeding time, a greater the rate of participants with decreased food intake and 'underweight' BMI.

Nursing intervention programs which are designed for EWD are needed to maintain functional eating skills and prevent negative consequences in this population.

Purposes of this study were: evaluation of family burden of caring for elders who receive long term care services, and examination of differences in burden before and after the introduction of long term care service in Korea.

Data were collected by questionnaires from 416 caregivers of elders who were registered with the Long Term Care Insurance Corporation in six cities. Data were collected in September, 2010 and analyzed using descriptive statistics, paired t-test, and ANOVA with the Scheffe test, and stepwise multiple regression.

Family burden decreased significantly after long-term care service was initiated. Subjective burden decreased from 2.93 to 2.69 (t=11.78, p<.001), and objective burden, from 3.40 to 3.10 (t=12.73, p<.001). Stepwise multiple regression analysis revealed that factors affecting subjective burden were family relations (F=13.60, p=.003), age (F=5.47, p=.019), job (F=6.98, p=.008), and education (F=4.59, p=.032), and that factors affecting objective burden were living together (F=17.66, p<.001), job (F=13.34, p=.003), monthly income (F=6.61, p=.010), and type of service (F=6.62, p=.010).

The results of this first study to investigate caregiver burden after the Korean Long-term Care Insurance System was begun provide positive information for the development of strategies to decrease family burden in long term care.

This study was conducted to examine activities of daily living (ADL) of older adults admitted to Korean long-term care hospitals (LTCHs), and to explore the patient and organizational factors that have an impact on the ADL of this population.

A secondary analysis of the Korean minimum data set (K-MDS) of patients (N=14,369) and of the profiles of LTCHs (N=358) from the Health Insurance Review and Assessment Service was done between January and July 2008. The outcome variable was ADL score 6 months after baseline assessment. Multi-level linear regression was employed to explore the patient and organizational factors that affected ADL scores.

Of the patients, 45.4% had a baseline ADL score of between 31 and 40, with a score of 40 indicating that the patient was entirely dependent for all items. None of the organizational characteristics were significantly associated with effects on the ADLs of older adults who had been in a LTHC for at least 6 months. However, patient characteristics, such as age, baseline ADL, frequency of physical therapy, urinary incontinence, fecal incontinence, pressure ulcers, and having a tube or catheter, were significantly associated with ADL 6 months after baseline.

In order to maintain and improve the ADL of older adults in LTCHs, we should develop strategies to prevent urinary and fecal incontinence, pressure ulcers, unnecessary tubes or catheters, providing adequate physical therapy. Additional studies should include more detailed information regarding nursing staff, including RN hours for direct care, education level and turnover.

The purpose of the study was to examine the effects of multisensory stimulation (MSS) using familiarity on persons with dementia (PWDs) residing in nursing homes in Korea.

A nonequivalent control group with pre and posttests was used. Fifty one PWDs were included if they: 1) were over 65 yr old, 2) were diagnosed with dementia, 3) had no visual or speech impairments, 4) were able to communicate, and 5) had spent more than one month in a nursing home. The experimental group (n=25) received a 55 min MSS program twice a week for 10 weeks. The outcome variables included were cognition, activities of daily living, grip strength, depression, wandering, and aggressive behaviors. Repeated ANOVA was used for data analysis.

There were no significant differences in demographics or the main variables at pretest. Cognition, depression, wandering, and aggressive behaviors were significant over time between the two groups. Grip strength was only significant when accounting for interaction between group and time.

An intervention of MSS using familiarity was marginally effective in improving cognition, depression, wandering, and aggression. Future study is suggested with a larger sample and longer treatment to retest the effects of MSS.

This study was conducted to examine whether the level of classification for long-term care service under long-term care insurance reflects resource utilization level for residents in nursing homes.

From 2 long-term care facilities, the researchers selected 95 participants and identified description and time of care services provided by nurses, certified caregivers, physical therapists and social workers during a 24-hr-period.

Resource utilization level was: 281.04 for level 1, 301.05 for level 2 and 270.87 for level 3. Resource utilization was not correlated with level. Differences in resource utilization within the same level were similar with the coefficient of variance, 22.7-27.1%. Physical function was the most influential factor on long-term care scores (r=.88, p<.001). The level for long-term care service did not reflect differences in resource utilization level of residents on long-term care insurance.

The results of this study indicate that present grading for long-term care service needs to be reconsidered. Further study is needed to adjust the long-term care classification system to reflect the level of resource utilization for care recipients on the long-term care insurance.

The purpose of this study was to estimate nursing costs and to establish appropriate nursing fees for long-term care services for community elders.

Seven nurses participated in data collection related to visiting time by nurses for 1,100 elders. Data on material costs and management costs were collected from 5 visiting nursing agencies. The nursing costs were classified into 3 groups based on the nurse's visit time under the current reimbursement system of long-term care insurance.

The average nursing cost per minute was 246 won. The material costs were 3,214 won, management costs, 10,707 won, transportation costs, 7,605 won, and capital costs, 5,635 won per visit. As a result, the average cost of nursing services per visit by classification of nursing time were 41,036 won (care time <30 min), 46,005 won (care time 30-59 min), and 57,321 won (care time over 60 min).

The results of the study indicate that the fees for nurse visits currently being charged for long-term care insurance should be increased. Also these results will contribute to baseline data for establishing appropriate nursing fees for long-term care services to maintain quality nursing and management in visiting nursing agencies.