METHOD OF EVALUATING THE FEELING OF BURDEN EXPERIENCED BYCAREGIVERS: FROM CONCEPT OF SYSTEM MAINTENANCE
Kotomi UEMOTO*, Yoshinori NAKAGAWA*, Seigo NASU*
Kochi University of Technology*

ABSTRACT: The purpose of this study is to find out the methodology in the decision making that the local
government should execute the policy which is population's effect becomes the maximum. The
administrative management system is proposed as a system that considers the environment. We proposed themethod of the decision making based on the NPM in the waste administration. We are examining it in thenursing care insurance now. This paper proposes the method of evaluating the nursing insurance service fromthe side of the main caregivers. The main caregiver uses the nursing insurance service to reduce the burdenof nursing. It doesn't have the feeling of burden by caregivers, if the main caregiver is using the nursing
insurance service corresponding to the cause of the nursing burden. I classified the element of the feeling ofburden by caregivers through the hearing investigation. The classification of this nursing burden wasconsidered to be able to understand the potential needs the main caregiver's. Here, the problem structuring
can make a reasonable logical model. The strategic target of the logic model in this paper is reduction ofnursing burden. The logic model can logically show the relation between the outcome and the output. This
research proposes the method of deciding the measure. The method to propose by this research has thefunction of the system maintenance. The systems that get by this method can be used for the review
corresponding to the management cycle.
KEYWORDS: NPM, system maintenance, the feeling of burden by caregivers
examination of the policy in advance. It is not done

1. INTRODUCTION

about not only it but also the analysis of effect by thepolicy.

1.1 Background of he research
Public service is provided by the tax and insurance
from the people. As for the administration, theFor example, I state "compost making of garbage"

operation of the efficient capital is being requested

that is one of the "reduction of waste" measures. The

by the people. Therefore, it is important that the

population will request the collection and the use ofadministration offer the people an appropriatecompost to the administration, so that the population

content of service and the amount of service. We did

may cooperate in making to compost with the house.

thePublicThe use of compost was difficult at home because ofManagement（NPM） in the local government. We

the change in the house form such as housing

investigated the decision making process when thecomplexes. The administration should correspond toadministration did the service offer in the research.

the

However, the administration has not made an

Nevertheless, the administration doesn't have theintroduction

researchonNewchangeinpopulation's

life

environment.

system (decision making process) to correspond to
the population's environmental change. In addition,

1.2 Purpose of the research

the administration doesn't understand the effect

The purpose of this research is a methodology of the(amount of the burnable waste reduction) of spreaddecision making that does the policy selection thatthe garbage disposal. The decision making process

population's effect becomes the maximum in thesuch as to confirm the effectiveness of the policy andlimited budget. The nursing insurance system aims at

to propose the improvement of it is insufficient in therich aging society by achieving the following two.

administration. The method of designing the system

1. The patient's independence is supported.

maintenance has not been necessarily established in

2. Nursing by the family makes established partiallythe administration. The concept of the systemof the society.

maintenance is necessary in the administration.

The patient's independence and caregiver’s reduction

Because the administration necessary to knowof incidence are obtained to this system in thewhether the provided service is appropriate. The

limited resource. It is necessary to achieve thiscombination of measures to achieve the target

system in the limited resource to the patient's

efficiently is not examined in the decision making

independence and caregiver’s reduction of incidence.

process of the administration now. Moreover, theIt is important that the administration provide theadministration doesn't have a concrete strategic

nursing service that user's effect becomes thetarget. It is an actual condition that the effectivenessmaximum.

of the investment is not quantitatively appreciable.
The amount of use and the number of users ofThen, it proposes the design and the business skill of

nursing service increase well after enforcing thethe management system that adds a technologicalnursing insurance system. Nursing is established as

viewpoint in this research. This is necessary to

the mechanism of the society. The family nursing ismanageA

80 percent or more given even after execution of thetechnological viewpoint is to keep quantitative. For

system Even if the nursing service is used, theexample, it is an evaluation function of the social

family's nursing is necessary. How much nursing

benefit (effect) that the population receives by

insurance system led to the supplementation withservice. First of all, the effect and the cost of an

nursing by the family? This answer is to understand

individual policy are quantified. And, the budget

how nursing was established to the mechanism in theallotment as the entire administration can besociety. The evaluation method is whether the family

understood by organically evaluating as each policy.

caregiver uses the nursing service, and how much

In a word, the selection of an efficient, effective

burden of nursing has been reduced. First, we

policy can be done to the target. The evaluation

investigate the burden of nursing that individualfunction obtained by a technological finding is usedcaregivers are holding. In this paper, the caregivers

as a criterion of the decision making. This research

are a person who is nursing the patient (certification

applies the idea of the decision making to thefor long-term care person) by staying at home.

efficientintheadministration.

nursing insurance system. The nursing insurance
system is one of the social securities. Cost of Social

2. ANALYSIS OF NURSING INSURANCE

Security is large in the budget of the local

SYSTEM

government.

This chapter analyzes the problem of the nursinginsurance system.
2.1 Nursing insurance system
The number of certification for long-term carepeople have 1.6 times after the system starts (Figure
1) Paying attention in Figure 1 is a remarkableincrease of a slight number of certification for(ten thousand people)
500
SupportNursing level 2
400
Nursing level 4

Nursing level 1
Nursing level 3
Nursing level 5

300
200
100
0
2000

long-term care people. Figure 2 shows the transition

2001

2002

2003

2004

2005 (year)of the nursing supply expense of the average for one

Figure1. The certification for long-term care person's

month. The expansion of the nursing supply expense

transitionof the house service is larger than the supply of the
facilities service. An increase in the nursing supply
expense is an increase of the house service by anincrease of a slight certification for long-term careperson. The number of senior citizens who neednursing will keep increasing in the future. It has(Hundred million yen/month)
5,000House service
Facilities service

4,000

total
3,000
2,000
1,000

misgivings about not only the caregiver's burden0

increase but also the tenability of the nursing
insurance system. The nursing insurance system is a

2000

2001

2002

2003

2004

2005 (year)

Figure2. Transition of nursing supply expense

health system that the people equally pay. Thissystem has been managed by the insurance 90

not done.

percent and the user weight 10 percent. Therefore, anincrease of the user means the people's burdens.

2.2 Problem of nursing insurance system
The service offer entrepreneur provides uniform

On the other hand, the foundation of the nursing

service and a uniform reward is paid. The country

insuranceof

has uniformly decided service and the charge.

decentralization. The local government who is the

Therefore, the market mechanism doesn't function ininsurance person decides the insurance. The local

the nursing insurance system. The cost reduction of

government reviews the system management every

the service offer entrepreneur is not related to thethree years. Insurance is set from the system of offer

price decrease. Moreover, providing service by aand the amount of the expectation of service. The

uniform charge becomes deterioration of finance forsetting of insurance can be decided in each local

the local government. The nursing insurance systemgovernment. However, the nursing service has beenhas stiffened according to uniform service and astrictly decided by the country. Therefore, the local

uniform charge. The local government cannot devise

government cannot originally judge it. The content

the method for raising efficiency. And, there is noof the plan reviewed every three years is an amountsystem that refunds insurance. If he or she doesn'tof the expectation of service and an estimate value of

receive service, the people become disadvantageous.

the nursing supply expense. There is no policy that

But then, there is a case where it is necessary tosenior citizen doesn't enter state of nursing necessary

depend on the family's nursing because the payment

in the plan. The plan from the image of the future isof 10 percent is difficult. Uniform service has thesystemiscalledproceeding

The increase innursing supply
expenseIncreases of the certification
for long-term care person

Increase of person who
uses nursing service
The nursing service can beused by paying ten percent.
Offers by the uniform
service and charge
The best level cannot
be understood.

Sudden rise in theinsurance of nursing care

The usage of revenue islimited to the nursing service.
The offer cost is not a setting thatthinks about the state of the revenue.

The anxiety to population's
insurance administration isan increase
The market mechanism
doesn't work

Sudden rise of
insurance premium

The offer cost is not a setting thatthinks about the state of the revenue

Offers by the uniform
service and charge

The cost reduction of the service
offer entrepreneur is not related tothe price decrease.

The local government cannot
devise the method for raising
efficiency.

Deterioration offinance

Figure3. Problem of nursing insurance system

Excessive use ofhome care service

The use of the nursing
facilities increases

Accumulationof stress

The content of nursing
is different individually
Acknowledgment of
Deficiency ofLife-style related
the nursing
nursing knowledge
diseaseinsurance system
The restraint by nursing
The payment
is an increase
It is necessary
Increase of
The method ofof 10%
Increases of functional disease
to enhancecertification for longnursing is not
person (diabetes, cerebral infarction…)
home careterm care person
appropriate
Increases of disease
Increase of infirmity
Decrease inperson by aging
senior person
Caregiver's increasefunction by aging
Deficiency of recognition (Osteoporosis, …)
about nursing prevention
Change of the policy
Deficiency of discovery andto home welfare
prevention at early stage Increase of certification for
long-term care person
The consultation
The service
rate is low
The function to
Hospitalization for no
method is bad
discover in the
medical reasons
Decrease in function
Crisis of medical
early stage is weak
insurance system
Deficiency of nursing
Participation in aLong-term nursing
Weakening of activity inprevention project
preventive class is a little
resident organization
Deficiency of housing
modernization

The market mechanism
doesn't work.

The increase in nursing
supply expense

The usage of revenue islimited to the nursing service
Service is notsuitable for needs

Diversificationof life-style

Deteriorationof finance

Deficiency ofrevenue

Increase ofnursing burdenof the caregivers

Urbanization anddepopulation

Deficiency informationof each projectIncrease of seniorperson (aging society)case where the nursing of the family doesn't
substitute easily. The uniform serving the uniform

Figure4. Problem of nursing insurance systemcharge is a source of the vicious circle of the nursing
insurance system. The uniform serving and thedoesn't change. The problem solving by OR ischarge is can not discuss a reform in the local

composed of the structure of established system.

government. Figure 3 is a structure of the problem ofHowever, the management model must think about

the nursing insurance system.

the environment that changes at any time. It isnecessary to think about the uncertainty of the

3. STRUCTURIZING OF PROBLEM

human's action and the law. It is not easy to use it in
the society that changes at any time.

3.1 Problem structuring of senior population’s
welfare policy

Then, first of all, the technique of the problem

The author described that the nursing service does

structuring is used in this research. This digs up the

not fit the population's needs because the nursing

problem of the nursing service, and sees theinsurance system was uniform service and a uniform

incidence part of the problem. The concept of thecharge in the preceding chapter. It was described thatproblem structuring is to share the formulation of theit was the local government cannot devise oneself.

problem. The same problem is different knowledge

The purpose of this research is a methodology of thedepending on the person. Kato understands thedecision making that does the policy selection thatstructure of the problem that the person is

population's effect becomes the maximum in therecognizing by the interview. And, the recognition

limited budget. The method of the decision making

maps of stakeholders are integrated into the problem

has OR （Operations Research）to teach the manager

structuring. The starting point of the problem

the optimal solution for the problem. OR keep the

structuring is the discussion among people withdecision making as a mathematical problem. It

different recognition. Therefore, it is a tool for the

supports the decision making by a scientificconsensus

approach. The optimal solution to achieve therelationship between the provided service and the

purpose is requested by a mathematical method. The

strategic target. Figure 4 shows the problem of the

optimal solution is answered in the environment that

senior population's welfare policy. The author showsbuilding.

It

can

know

a

logicalThe anxiety to population's
insurance administration isan increase
The market mechanism
doesn't work

Sudden rise of
insurance premium

The offer cost is not a setting thatthinks about the state of the revenue

Offers by the uniform
service and charge

Diversificationof life-style

The increase in nursing
supply expense

Deficiency ofrevenue

The use of the nursing
facilities increases

Improving of the
Increase ofnursing burdenof the caregivers

Urbanization anddepopulation

Nursing continuancein the house

The encouragement of
independence life of the patient

The reduction of nursing
burden of the caregivers

Excessive use ofhome care service

user's payment
The content of nursing
is different individually
Acknowledgment of
Deficiency of housing
Deficiency ofLife-style related
the nursing
modernization
nursing knowledge
diseaseinsurance system
The restraint by nursing
The payment
is an increase
It is necessary
Increase of
The method ofof 10%
Increases of functional disease
to enhancecertification for longnursing is not
person (diabetes, cerebral infarction…)
home careterm care person
appropriate
Increases of disease
Increase of infirmity
Decrease inperson by aging
senior person
Caregiver's increasefunction by aging Improving of age
Deficiency of recognition (Osteoporosis, …)
for nursing
about nursing prevention
Change of the policy
Deficiency of discovery andto home welfare
prevention at early stage Increase of certification for
long-term care person
The consultation
The service
rate is low
The function to
Hospitalization for no
method is bad
discover in the
medical reasons
Decrease in function
Crisis of medical
early stage is weak
insurance system
Deficiency of nursing
Participation in aLong-term nursing
Weakening of activity inprevention project
preventive class is a little
resident organization
Accumulationof stress

The facilities user's
restraintUpperstrategic target

The usage of revenue islimited to the nursing service
Service is notsuitable for needs

The reduction in the nursing
supply expense

Deteriorationof finance

Deficiency informationof each projectIncrease of seniorperson (aging society)bottomstrategic target

Improvement oflifestyle

Improvement of
nursing prevention

The certification for
long-term careperson's restraint

Upper
policy and project

Discovery andprevention at early stage

Execution of effective
nursing prevention

Maintenance ofnursing environment

Support offamily nursing

Bottompolicy and project

Maintenance of nursing
prevention project

Promotion of activity inresident organization

Giving information ofeach project

Providing withappropriate service

Figure5. Process of policy logic model

Figure6. Logical structure charta part for the convenience of space.

called the policy logic model. The logic model is alogical model which the outcome and the output

The problem and the necessary target are written in

were shown. The outcome means the result of the

Figure 4. There are the researches in the past and the

project to the strategic target. The output is thehearing from entrepreneur who is providing service

project result of using management resources. The

and care-manager in the base. I made Figure 4 bylogic model functions as a management system toolsystematically through arranging each element basedof the confirmation and the review. But the logicalon the causal relation. Figure 4 visualizes themodel is composed of the environment that doesn't

mechanism of the problem. A true cause of thechange. According to it has the possibility that not

problem can be found. The local government can

only the causal relation of element but also theconsider measures against the cause. The problem

logical structure changes. This means the change ofhas a lot of causes. However, the cause is usually athe logical model that composes the management

layered structure. A true cause is understood bysystem. The shift procedure from the structure of theinvestigating the cause from beginning to end. The

problem of Figure 4 to the policy logic model isapproach of the problem structuring is good at notshown. Figure 5 shows the process.

only the finding of true problem but also the

1. Present elements are linked by the causal relation

planning of the policy.

(Figure 4).
2. The policy idea that thinks about extension of

3.2 The policy logic model's construction

option is added (Figure 5).

Figure 4 has linked elements dug up by the causal

3. The element of the environment and the attribute

relation. The element is a present target, an

is removed.

environment and an attribute. It is necessary to make4. The system of the problem is arranged to thethe administrative management system. Therefore,

hierarchy (Figure 6).

the strategic target is clarified, and the policy

For example, the policy idea is the improvement ofnecessary to achieve is linked with the target. This is

the user's payment and the age in which the service

can be received as an option of measures of the

3.3.1 Research in the past of the feeling of burden

certification person increasing. The policy option isby caregivers

enclosed with the square in figure 5. And, the system

The outcome of reduction of nursing burden which isof the frame of the policy logic model is done based

the feeling of burden by caregivers knows how muchon the structure of the problem. A concrete target is

reduced by using the nursing service. It is necessary

obtained by turning over the problem in the structure

to understand the problem structuring of theof the problem at that time. The problem; formechanism that the burden of nursing for the findexample, "the increase of nursing burden of themeasures of the reduction of nursing burden. First,

caregivers" becomes "the reduction of nursing

the author surveys the research of the past of theburden of the caregivers". The main problem isfeeling of burden by caregivers.

enclosed with the circle in figure 5. The element thatturned over element enclosed with the circle

The feeling of burden by caregivers is understood bybecomes the element of the policy logic model.

using the Japanese Version of the Zarit Caregiver

Figure 6 is the policy logic model of this research.

Burden Interview (J-ZBI) in the past research. The

The reduction of the nursing supply expense is thefactor of the point of J-ZBI and the attribute is

final outcome of the local government. The bottom

analyzed. This result is difficult to make it link withoutcomeandthe policy to reduce the feeling of burden bycaregiver's reduction of incidence. Figure 6 shows acaregivers. This attribution analysis is not dug up

logicalwith the feeling of burden by caregivers recognized.

is

the

patient's

relationshiptoindependence

achievetheoutcomeThen, we clarify the structure which is the burden of

efficiently and effectively.

nursing that individual caregivers are holding. We
There are many people engaged in the senior

understand the reduction of nursing burden by using

population's

instance,

this structure. That is, we monitor the change of thecertification for long-term care person, caregivers,

structure of the nursing burden by the service use,

welfarepolicy.

Forinsurance person's local governments, insured person, and the outcome is get.
entrepreneur

who

is

providingserviceandcare-manager. Thus, there are many stakeholders.

3.3.2 The problem structuring of the nursing

Figure 6 is not a general mode, so it is "Logicalburdenstructure chart". A more detailed problem structuring

Nursing care has not only a negative side of burden

will be able to be get according to the part that the

but also an affirmative side of growth by nursing

policy logic model cuts out. Figure 4 and Figure 6

care. Actually, the author heard an affirmative side

are made from the whole image of the problem thatby nursing care in the hearing to the caregivers. The

the nursing supply expense increases. Reduction ofcaregiver felt challenge by the family’s member

nursing burden that is one of the outcomes isunderstanding and cooperation for the nursing care.

described in this paper. There is the problem

The idea of the caregiver which is the nursing care is

structuring of the mechanism that the burden ofa chance of education to the grandchild. We didnursing increases.

problem structuring of the feeling of burden bycaregivers though the hearing, the nursing care

3.3 Structurizing of the burden of nursing

experience, and the research in the past. The problem
structuring of the feeling of burden by caregivers isto dig up the effect of nursing service and theuneasinessof the caregivers. We

Burden of nursing

make themechanism that the burden of nursing cares. We can

Burden of body

Burden of economy

Burden of mind

be understood both the policy to reduce nursing
Restraintburden and the amount of reduction of nursing

Automaticof burden

Distress

Lumbar pain

Joint pain

Indignation
Irregularcareburden by using the nursing service. The factor to

Duty

Restrictionof timeMind

Embarrassment of
human relations
Between patientsand caregivers

increase the burden of nursing cares only by the

Guilt

Power
less

Tool ofwelfareEconomyBody

increase the burden of nursing cares is different
among caregivers. It cannot explain the element that

Nursing
service

Anxiety

Isolation

Consumption
articlesHousing
modernization

Between families
and caregivers

attribute and the use of nursing service. Recognition
and the situation to the caregiver's nursing are related, Figure7. Structural model of nursing burden
too. The factors that increase the burden of nursing
cares are different according to the patient's

outcome. The preceding chapter described thecondition and the informalsaport. The explaining

reduction of the nursing burden is connection withvariable of the factor is the attribute and the use of

the nursing continuance in the house, and thenursing service. The problem structuring of theconnection with the cost reduction in the entire

feeling of burden by caregivers was arranged as aadministration This shows a part of the logicalstructural model of the nursing burden (Figure 7).

structure chart of Figure 6. From this chapter, The

The structural model in Figure 7 is only an element

author is described that the operation method ofthat composes the burden of nursing.

considering the concept of the system maintenanceby the structural model of the nursing burden (Figure

The reduction of the nursing burden was an outcome. 7).
Fukushima is assumed that the nursing continuanceis enabled by the reduction of the nursing burden in

4.1 The structural model's analysis

the house. The nursing continuance in the house

The author understands the burden of nursing that

decreases the number of users of the facilities service. individual caregivers are holding by the structural
The continuance of nursing connects to the reduction

model. We are scheduling the questionnaire survey

in the nursing supply expense in the house. Because

to the caregivers aiming to confirm the structural

the nursing a person supply expense of the facilities

model. There are two kinds of questionnaires. One

service is about three times those of the home-carequestionnaire aims to understand the problem

service. Then, the nursing continuance was definedstructure and needs. Another one aims to make theas an upper outcome in the house. This connects torelation of the element as a function. The policy

the grasp of the outcome "Reduction in nursing

option to have thought when shifting to the policy

supply expense" of the local government

logic model is needed in making to the function. The
policy option understands the population's reaction

4.

EFFECTIVENESSOFSTRUCTURAL

when there is a policy. The policy option enables the

MODEL

simulation in the plan. This paper describes the grasp

The structural model in the question visualized it byof the problem structure and needs. The question on

the element that composed the burden of nursing.

five stage evaluation is repeated for the structuralHere, the reduction of the nursing burden is anmodel's each element about the burden that thecaregiver

feels

now.

The

purposeoftheThe reduction in thenursing supply expensequestionnaire is to quantify each element. The
structural model in Figure 7 is modeling the

Caregivers

caregivers. Structural model's each element is a

The reduction of nursing
burden of the caregivers

factor to increase the burden of nursing. The
structure model of the nursing burden is different
with the caregiver's situation and patient's condition.

Caregiver

Body

Maintenance ofnursing environment

BurdenMind

Support offamily nursing

Providing withappropriate service

EconomyThen, the author dug up the attribute related from thepastresearchtothenursingburden.

The change in theuser structureThe

zThe amount of the nursing service is increased.
zThe kind of the nursing service is increased.

Body

Mind

Economy…

Serviceusing the nursing service as the caregiver's interface.

BurdenService

Caregiver

Servicequestionnaire has these attribute and the amount of

3

2

1

The purpose of the questionnaire is to understand the
problem structure and needs of the caregivers. It is a

Figure8. Effectiveness of structure model

questionnaire based on the structural model. The
relation between the attribute and the amount of

We are connecting the relation between theusing the nursing service and the burden of nursing

explaining variable and the structural mode. For

can be quantified from the questionnaire. The

example, the change in the user structure when the

caregiver's interface is analyzed as an explaining

amount of the nursing service is increased is shownvariable. The first stage of the analysis is an analysis

in Figure 8. The grasp of the conformational change

only of a subjective evaluation of the caregiver. A

can be used to plan and to evaluate the policy.

subjective evaluation is an evaluation that used fiveMoreover, the structural model can be classified bystage evaluation result of each element. In thiseach attribute. We can understand the effect structureevaluation, it thinks about the attribute and theby using the nursing service with the attributeamount of using the nursing service. The evaluation

classification as a unit. The effect structure makes

purpose is demonstration of the structural model thatthe policy logical model quantitative. We can review

constructed it. Next, we evaluate the structural

the plan by monitoring the effect structure. Thismodel that considered the explaining variable of thework is system maintenance.

attribute and the amount of using the nursing service.
It can know the element of the burden of nursing that

4.2 Development in the futureindividual caregivers are holding. Therefore, we can

The starting point of the problem structuring was theunderstand needs that the caregiver is requesting.

discussion among people with different recognition.

The local government can examine whether toAnd, it is a tool for the consensus building. The

consider the policy against caregiver's needs at therecognition of the problem is different amongplan stage.

stakeholders. The caregiver is aiming at the
reduction of the nursing burden while using the

It is possible to monitor it by regularly executing thenursing service. The patient is aiming at thesame questionnaire. The monitor can understand the

independence of life on the other hand. The author

conformational change depends on the change in thelearnt nursing that make a point of keeping an eye on

attribute and the amount of using the nursing service.

the patient was important in the nursing practice.

decision making that does the policy selection that
The reduction in thenursing supply expense

Social public welfare

population's effect becomes the maximum in thelimited budget. We described the methodology that

The facilities
user's restraint

Nursing continuancein the house

Certification for longterm care person

The encouragement of
independence life of the patientunderstood how the nursing burden had been
Caregivers

The reduction of nursing
burden of the caregivers

Maintenance ofnursing environment

Support offamily nursing

reduced by using the nursing service in this paper.
The author will understand the evaluation function
from the questionnaire in the future. And, I want tofind the optimal solution in the trade-off relation

Providing withappropriate service

between the caregiver and the patient. The optimal
solution means the policy selection that population's

Figure9. Optimization of the administration (policy

effect becomes the maximum in the limited budget.

logic model)

Therefore, it is important that the evaluation function
composed of explaining variable of the attribute andEven if it takes a lot of time, the caregiver should

the environment. The function of the system

keep an eye on the patient. It is demanded that themaintenance has been provided for the system. The

caregiver keep an eye on the patient for the patient's

idea of the system maintenance is important when

independence. But the act of keeping an eye on thethe society is changed

patient is the restrain of time and the mental burden
for the caregiver. That is, the burden of nursing
increases. Even if the feeling of burden by caregivers
increases, keeping an eye on the patient is connected

REFERENCES

with the patient's independence. The caregivers will
get into the dilemma.

The Ministry of Health, Labour and Welfare.,Nursing insurance business situation report,

The problem in the future is how it optimizes the

URL:

trade-off relation between the caregivers and the

http://www.mhlw.go.jp/topics/kaigo/osirase/jigyo/05

patient (Figure 9). The solution of this problem/dl/01.pdf, The Ministry of Health, Labour andmeans the management model by which the outcome

Welfare, (last date accessed: 29 February 2008).

is considered. In this paper the outcome is the
reduction of nursing burden of the caregivers and theHironori KATO., 2005. Problem identification andencouragement of independence life of the patient.

structuring for pegional transport planning, Journal

Two outcomes are the bottom outcomes (the bottomof Research Institute of Science and Technology forstrategic target) of Figure 6. This management model

Society, Vol.3:214-230.

means the construction of the system in the entire
logical structure chart. The optimal solution for two

Masako FUKUSHIMA., 2003. Elements that Enableoutcomes is an optimal solution for a upper outcome.

the Continuation of Home Care, Journal of Gunma

In other words, a social public welfare is obtained.

PrefecturalVol.10:81-90.

5. THE END
The purpose of this research is a methodology of theCollegeof

HealthSciences,