장기요양인정 조사자와 수급자 및 가족의 등급판정에 대한 만족도 비교

Abstract

본 연구는 장기요양인정 조사자와 수급자 및 그 가족의 등급판정체계에 대한 인식과 등급판정 결과에 대한 만족도를 비교, 분석하여 등급판정체계의 문제점을 파악하고 노인장기요양보험 제도의 개선방향을 제시하고자 하였다. 조사 대상자는 노인장기요양보험 운영센터 소속 직원(조사자)과 등급판정을 받은 수급자 및 그 가족을 대상으로 각각 105명씩 자기 기입씩 설문조사를 실시하였고 조사자는 64부, 수급자 설문지는 77부 회수하였다. 연구도구는 황태희(2011), 김지웅(2012)의 등급판정 체계와 관련한 선행연구와 육홍숙(2011)의 만족도에 관한 설문 문항을 참조하여 수정 및 보완하여 사용하였다. 만족도를 측정하기 위해 ‘전혀 그렇지 않다’, ‘그렇지 않다’, ‘보통이다’, ‘그렇다’, ‘매우 그렇다’의 5점으로 구분하여 평가하였고, 만족도에 관한 독립변인들은 요인별로 등급판정 기준에 관한 사항, 등급판정 위원에 관한 사항, 인정조사 과정에 관한 사항, 노인장기요양보험 제도 전반에 관한 사항으로 구분하였다. 조사 기간은 IRB 승인 후 2013년 12월 31일부터 2013년 3월 31일까지이며, 방문 또는 전자우편으로 실시하였다. 수집된 자료는 SPSS Win 18.0 프로그램을 이용하여 분석하였으며 각 변인들에 대한 기본적은 특성을 알아보기 위해 빈도, 백분율 등 서술통계, 독립표본 t-검정을 실시하였고, 등급판정 결과 만족도에 영향을 미치는 요인을 산출하기 위해 다중회기분석, 일원 분산분석을 실시하였다.

본 연구의 결과를 요약하면 다음과 같다. 첫째, 조사자의 일반적 특성은 대부분 40∼50대 이상의 여성으로 대학 졸업자인 경우가 많았다. 직종은 사회복지사가 다수를 차지했으며, 건강상태는 양호한 편이었다. 수급자 및 가족의 일반적 특성은 만성질환을 가진 50대 이상의 여성이 대부분을 차지했으며, 한 달 평균 소득 100만 원 이하인 경우가 많았다. 희망급여와 현재 이용하는 급여 모두 방문요양 서비스가 가장 많았고, 수급자 대부분은 3등급 판정 대상자였다. 둘째, 조사자의 일반적 특성에 따른 등급판정 결과 만족도 비교에서 기타직종(기존 공단직원)에서 만족도가 높게 나타났고, 수급자 및 가족의 일반적 특성에 서는 질병기간과 등급유형이 만족도에 유의한 영향을 미치는 것으로 나타났다. 셋째, 등급판정체계 관련 항목에 따른 등급판정 결과 만족도 비교에서 수급자 및 가족은 등급판정에 문제점이 있다고 인식할수록, 치매노인 등급 기준이 완화되었다고 생각할수록 만족도가 낮게 나타났다. 조사자는 치매노인 등급 기준이 완화되었다고 생각하는 반면, 수급자 및 가족 대다수는 치매노인 등급 기준이 완화됨을 느끼지 못한다고 답변하였고, 치매 수발의 어려움과 치매 노인의 등급에 불만을 나타냈다. 조사자는 치매로 인한 인지․행동 기능 장애에 대해 등급판정 어려움을 느낄수록 등급판정 결과 만족도가 낮게 나타났고, 인정조사 과정에서 보호자 진술에 의존하는 치매환자의 인지․행동변화 영역의 정확한 판단의 어려움, 허위 또는 과장 진술 대처 방법 어려움에 대한 경험을 가장 많이 나타냈다. 수급자는 등급판정위원 구성원에 대한 인식이 높을수록 등급판정결과 만족도가 높게 나타났으며, 조사자와 수급자 및 가족 모두 인정조사 시 수급자의 건강상태를 잘 반영한다고 느낄수록, 지역마다 등급판정 결과의 편차가 적을수록 등급판정 결과의 만족도가 높게 나타났다. 또한 조사자는 방문조사 시 노인의 컨디션에 따라 등급편차가 적을수록 결과의 만족도가 높게 나타났다. 본 연구의 이와 같은 결과에 제시한 등급판정 만족도에 영향을 주는 요인은 지속적으로 확대되고 있는 노인장기요양보험 제도 역할 정립에 기초자료가 될 것이며, 등급판정체계에 대한 인식 및 만족도를 향상시킬 수 있는 방안과 장기요양인정 조사자의 전문성과 신뢰도를 높일 수 있는 대책 마련이 필요하다고 생각된다. | The aim of this study was to compare and analyze the awareness of the grading system and satisfaction rate of grading results of long-term care recognition staff, recipients and recipients’ families, in order to understand problems of the grading system and present a direction for improvement of the elderly long-term insurance system. Research subjects were elderly long-term insurance operation center staff, recipients who received grading, and recipients’ families. A total of 105 people participated in a survey from each category, and surveys were collected from 64 staff and 77 recipients. The preceding studies on the level evaluation system by Tae-hee Hwang (2011) and Ji-woong Kim (2012), and a study on satisfaction rate by Hong-sook Yoon (2011) were referenced for the survey structure. The questions from these preceding studies were revised and supplemented for this study. Satisfaction rate was evaluated based on a 5-point scale consisting of ‘not at all,’ ‘no,’ ‘average,’ ‘yes’ and ‘very much so.’ Independent variables related to satisfaction were divided into variables related to the level evaluation standard according to factors, variables related to the grading committee, variables related to the recognition research process, and variables related to the elderly long-term care insurance system in general. The research period was after IRB authorization, from December 31, 2013 to March 31, 2013, and conducted through visits or e-mails. The collected material was analyzed using the SPSS Win 18.0 program, and frequency analysis, t-test and technical statistical analysis were conducted to examine the basic characteristics of each variable. Multiple regression analysis and one-way variance analysis were conducted to extract factors that affect grading results satisfaction. The results of this study can be summarized as follows. First, the general characteristics of the staff showed that most were women in their forties to fifties who were college graduates. Most were social welfare workers, and in good health. The general characteristics of the recipients and their families showed that most were women over the age of 50 with chronic diseases, and many had a monthly average income of 1 million won or less. Most wanted and currently received nursing visits, and most of the recipients were grade 3 recipients. Second, a comparison of satisfaction rate of grading results according to general characteristics of staff showed that the satisfaction rate was highest for those without those with other occupations, and there were significant differences in grading satisfaction rate according to disease duration and grading type of recipients. Third, a comparison of satisfaction rate of grading results according to grading system related categories showed that the satisfaction rate of recipients was lower the more they thought there were problems with the grading, and the more they thought the level standard for elderly with dementia was eased. While staff thought the level standard for elderly with dementia was eased, most recipients said they did not feel like the standard for elderly with dementia was eased, and expressed difficulties with taking care of dementia patients and dissatisfaction with the level for elderly with dementia. The satisfaction rate of staff with the level evaluation results was lower as they felt more difficulties with level evaluation of dementia patients with awareness or action disabilities. The problems that surfaced the most were difficulties in accurately evaluating the range of awareness or action changes of dementia patients in the recognition research process, which depends on the statements of guardians, and difficulties in handling false or exaggerated statements. Recipients were found to be more satisfied with the grading results the more they were aware of the members of the grading committee, and staff were more satisfied with the grading results the more they thought the recipient’s health condition at the time of recognition research was reflected, and the smaller the deviation of grading results was for each area. In addition, the satisfaction rate was higher for staff the smaller the level of deviation was according to the elderly’s condition at the time of visit for research. The factors that affect grading satisfaction presented in this study may be used as foundation material for establishing the role of the elderly long-term care insurance system that is continuing to expand. There is a need to provide a solution to improve awareness and satisfaction rate of the level evaluation system, and improve expertise and reliability of long-term care staff.; The aim of this study was to compare and analyze the awareness of the grading system and satisfaction rate of grading results of long-term care recognition staff, recipients and recipients’ families, in order to understand problems of the grading system and present a direction for improvement of the elderly long-term insurance system. Research subjects were elderly long-term insurance operation center staff, recipients who received grading, and recipients’ families. A total of 105 people participated in a survey from each category, and surveys were collected from 64 staff and 77 recipients. The preceding studies on the level evaluation system by Tae-hee Hwang (2011) and Ji-woong Kim (2012), and a study on satisfaction rate by Hong-sook Yoon (2011) were referenced for the survey structure. The questions from these preceding studies were revised and supplemented for this study. Satisfaction rate was evaluated based on a 5-point scale consisting of ‘not at all,’ ‘no,’ ‘average,’ ‘yes’ and ‘very much so.’ Independent variables related to satisfaction were divided into variables related to the level evaluation standard according to factors, variables related to the grading committee, variables related to the recognition research process, and variables related to the elderly long-term care insurance system in general. The research period was after IRB authorization, from December 31, 2013 to March 31, 2013, and conducted through visits or e-mails. The collected material was analyzed using the SPSS Win 18.0 program, and frequency analysis, t-test and technical statistical analysis were conducted to examine the basic characteristics of each variable. Multiple regression analysis and one-way variance analysis were conducted to extract factors that affect grading results satisfaction. The results of this study can be summarized as follows. First, the general characteristics of the staff showed that most were women in their forties to fifties who were college graduates. Most were social welfare workers, and in good health. The general characteristics of the recipients and their families showed that most were women over the age of 50 with chronic diseases, and many had a monthly average income of 1 million won or less. Most wanted and currently received nursing visits, and most of the recipients were grade 3 recipients. Second, a comparison of satisfaction rate of grading results according to general characteristics of staff showed that the satisfaction rate was highest for those without those with other occupations, and there were significant differences in grading satisfaction rate according to disease duration and grading type of recipients. Third, a comparison of satisfaction rate of grading results according to grading system related categories showed that the satisfaction rate of recipients was lower the more they thought there were problems with the grading, and the more they thought the level standard for elderly with dementia was eased. While staff thought the level standard for elderly with dementia was eased, most recipients said they did not feel like the standard for elderly with dementia was eased, and expressed difficulties with taking care of dementia patients and dissatisfaction with the level for elderly with dementia. The satisfaction rate of staff with the level evaluation results was lower as they felt more difficulties with level evaluation of dementia patients with awareness or action disabilities. The problems that surfaced the most were difficulties in accurately evaluating the range of awareness or action changes of dementia patients in the recognition research process, which depends on the statements of guardians, and difficulties in handling false or exaggerated statements. Recipients were found to be more satisfied with the grading results the more they were aware of the members of the grading committee, and staff were more satisfied with the grading results the more they thought the recipient’s health condition at the time of recognition research was reflected, and the smaller the deviation of grading results was for each area. In addition, the satisfaction rate was higher for staff the smaller the level of deviation was according to the elderly’s condition at the time of visit for research. The factors that affect grading satisfaction presented in this study may be used as foundation material for establishing the role of the elderly long-term care insurance system that is continuing to expand. There is a need to provide a solution to improve awareness and satisfaction rate of the level evaluation system, and improve expertise and reliability of long-term care staff.