在宅介護へ向けて準備って何が必要?

久しぶりの友人から突然の電話
私:「久しぶりー元気してた?どうしたの?」
友人「私は元気なんやけど・・・。ちょっと親がね・・・。久しぶりでこんな話ごめんね」
私:「何かあったの?」
友人:「実は父親が家でコケて、大腿骨骨折しちゃって入院中なのよ。
で、今度退院することになったのは良いんだけど、主治医から退院後の生活どうされますか?退院後は介護保険を使った生活をしてみては?って話があって、とにかく聞いてたんだけど、申請とかヘルパーさんがどうとか言われても全然わからなくて・・・。」

目次

そもそも介護保険って何ができるの?

介護保険で出来ることは、生活の自立支援です。
日常生活の上で、ご本人自身ができる事を確認した後、何を手助けするかを考える事です。
日常生活は、私たちが日々の生活で当たり前に行っている朝昼夕の食事に買い物や調理、日常の掃除、トイレ、入浴等です。
また、地域コミュニティに参加しての社会参加やかかりつけ医への定期的な通院をしてきた人には、それも日常生活の一部でしょう。

逆に、普段しない換気扇や網戸の掃除、夏物と冬物の衣類の入れ替え等の大掃除と言われるものは、日常生活ではないのでヘルパーが仕事をする事は出来ません。

退院前の準備は?

「じゃーうちの親が退院してくる時に考えれば良いか。でも、本人がどれぐらい家で生活できるかなんて、家に帰ってきてからじゃないとわからないでしょ」

実際の在宅生活は、退院後にしかわからないところは多いでしょう。
でも、その前に家庭環境を整えておくことは必要になってきます。

私:「お父さんの骨折したところは、入院前と同じ状態に戻ったの?」
友人:「いやそれが、杖をつかないと歩きにくい状態なの」
私:「じゃあ、家の段差で引っかかってしまったり、立ち上がりの手すりが必要になるかもね」
友人:「そうなのよ」
私:「そのために今入院している病院のPT(理学療法士)さんに退院前に自宅を見てもらって、どこに手すりがいるとか、段差解消工事が必要などを教えてもらった方が良いよ」

病院には・・・
①急性期(1カ月程で退院か②へ転院)
②回復期(いわゆるリハビリ病院、約3~6ヵ月入院)
③慢性期(療養型で長く入れる)

があります。

①の急性期病院で手術を受けて、簡単なリハビリ後に②のリハビリ病院へ転院するか在宅生活へと退院するかになります。②のリハビリ病院で保険適用の6ヵ月前になると、退院しての在宅生活か③の療養型病院(いわゆる老人病院)に転院して長期で入院生活を続けるかを選択することになります。

在宅生活を選択し退院することになり退院後もリハビリが必要であるとなったら、近くのリハビリ病院へ通うか、訪問リハビリの先生に来てもらうかになります。
在宅においては完全なバリアフリー化は難しいと思いますが、日常生活に戻るにはある程度、生活環境を整えておかないといけないところが出ると思います。
そのためにはリハビリ専門家(セラピスト)にどこが危険個所か、どのような気をつけたほうが良いかを確認しておくことが大事です。
そこで、入院施設で自身を担当してくれたリハビリ専門職(セラピスト)が、一番その人の方だの状態を知っているので、その方は自宅を見てもらうことになるのです。

セラピストとは

リハビリ専門職はセラピストと呼ばれます。
セラピストにはPT・OT・ST(略称)がおり、全て国家試験になります。

①PTは理学療法士
②OTは作業療法士
③STは言語聴覚士(言語障害や嚥下障害等のリハビリ)

と言います。

セラピストの代表的な資格で理学療法士について少しご説明します。

理学療法とは病気、けが、高齢、障害などによって運動機能が低下した状態にある人々に対し、運動機能の維持・改善を目的に運動、温熱、電気、水、光線などの物理的手段を用いて行われる治療を言います。

人が日常生活を過ごす上で基本となる動作に「寝返る、起き上がる、立ち上がる、歩く」などの動作があります。病気やケガにより、体力や筋力などが低下したことによって、行いにくくなった基本的動作能力の回復を図ることが理学療法なのです。つまり、理学療法士は、理学療法を行い、患者さんやご利用者さんの基本的動作能力の回復を図るリハビリ専門職になります。

理学療法士(PT)と作業療法士(OT)の違い

理学療法士は上記に述べたように歩行練習などの運動療法や、電気・温熱・光線などを使った物理療法を用いて、身体の機能や動作の回復をうながし、自立した日常生活が送れるようにバックアップします。
それに対し、作業療法士は、入浴や食事など日常生活の動作や、手工芸、園芸及びレクリエーションまであらゆる作業活動を通して、身体と心のリハビリテーションを行う専門家になります。

在宅生活への環境を整えよう

住環境の整備について
病院から自宅へ帰るとなった時、病院内と自宅の住宅環境の違いから考えてみて下さい。
自宅の入口から手すりがない、段差がある部屋から部屋への移動の時の手すり、部屋の間の間仕切り段差、階段手すり等々、ご自宅は病院と違って、転倒する要素が多く存在します。
そういった違いを踏まえ、病院でご本人の状態を良く知るセラピストさん(理学療法士等)に、退院前に自宅を見てもらい、環境整備をしておくことが大切です。
それを介護保険の住宅改修を使って手すりを付けたり、上り框の段差解消工事をしたり等、必要な準備は事前にしておきましょう。

住宅改修については、ケアマネジャーがいなくても出来ます。
住環境コーディネーターという資格を持った人が住宅改修の書類を作成し申請することで可能になります。

住宅改修に掛かる費用の1割負担分が、介護保険で20万円の枠まで使えます。
それを超える分は全額負担となります。
住民票のある住宅に適用されます。

しかも介護度での差はありません。
転居された時は、転居先の住所で20万円の枠が使えます。
また介護度が2段階上がると、身体状態が変わるのに合わせて、必要な住宅改修が増えることもあり再度20万円の枠を使うことができます。

業者によって金額設定が変わりますので、よくご確認下さい。
※特に飛び込みで訪問販売してくる詐欺まがいの事業所もありますのでお気を付けください。

ご本人やご家族にとっては待ったなしの状態で住宅改修工事をされるのがほとんどなので相見積をしたりする余裕はないと思いますので、お知り合いかケアマネジャーさんに信頼できる業者を選定してもらって下さい。

住宅改修でできる工事は以下の通りです。

・手すり取付
・床の段差解消
・扉の取り換え(開き戸から引き戸やアコーディオンドア等)
・床材の変更(車イス移動しやすいように畳からフローリングへ等)
・便器の取り換え(和式から様式へ)

まとめ

入院前と退院前、また在宅から病院、病院から在宅と、ご本人の心身の状態が変わったり、環境が変わると予想できない変化が起こってきます。
ご家族にとっても、入院前の親の状態が理想であり、入院中や退院後の姿や状態はなかなか受け入れがたく、何よりもご本人が一番歯がゆい思いをされておられると思います。
在宅になってからバタバタしてご本人やご家族が心身共に疲れるような事がないよう、ご本人ができるだけ自立した生活を維持するために、リハビリや環境について整備をしていってあげることが大事です。


介護の相談窓口
  • 「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。

介護在宅介護

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