This study was conducted to identify health problems and support received from the health and welfare service using MDS-HC(Minimun Data Set for Home Care) in the aged living at home.

Eighty-one elderly persons were selected from those listed in community-welfare service centers in Seoul and Kyunggi Province between December 2002 and January 2003.

Eleven health problems per elderly person on average were identified, and the frequent care needs were in order: preventive health measure, health promotion, visual function, depression & anxiety, communication disorders, social function, pain, environmental assessment, oral health, cognition and falls. The number of health problems by the level of ADL was ‘ ADL 1(Independence)’ 9.87, ‘ ADL 2(Partial independence)’ 12.78, ‘ ADL 3(Dependence)’ 13.73. Utilization of formal health & welfare services among the elderly was ‘ meals on wheels’ 40.7%, ‘ home helper’ 38.2%, ‘ visiting of social welfare worker’ 21.0%, ‘ physical therapy’ 19.6%, ‘ day care center’ 12.3%, ‘ volunteer's service’ 9.9%, ‘ home visiting care’ 3.7%, ‘ occupational therapy’ 3.7%, and ‘ speech therapy’ 2.5%.

The results suggest that using the MDS-HC 2.0 is applicable to help decide criteria for both health and welfare service supplied to the elderly.

The purpose of this study was to explore the link between health and welfare service and barrier's factors by reviewing the connection between the public health center's visiting nurse and social welfare center's social workers

A survey by mail or a face-to-face interview of 151 visiting nurses in 25 public health centers and 48 social welfare workers in general social welfare centers in Seoul, was preformed from Feb. 12, 2001 to Mar. 15, 2001. The data were analyzed with frequency, percentage, mean value, paired t-test and independent t-test using SPSS/WIN 7.5 program.

1. ‘ The necessity and degree of cooperation with social welfare workers of visiting nurse’ scored average 4.49 and 3.19, and ‘ The necessity and degree of cooperation with visiting nurse and social welfare workers’ scored average 4.81 and 3.15 on the five-point scale ; there was a significant difference between the two variable in visiting nurse and social welfare workers. 2. In barrier's factors which health and welfare service offer to, visiting nurses showed statistically significant higher score than social welfare staff ; ‘ job factor’, ‘ resource factor’, ‘ clients factor’, ‘ individual ability factor’

In order to provide link system that hold clients in common in public health center and social welfare center, it is recommended a case management team should be constructed and educate visiting nurses for case manager.