Objective: Currently, standards for evaluating long-term care facilities do not\nexist in Japan. This study aimed to evaluate the quality of healthcare services\nin Japanâ??s long-term care facilities and identify the structural and process indicators\nassociated with the facilitiesâ?? outcome indicators. Methods: This retrospective\nstudy assessed changes in residentsâ?? abilities to participate in\nphysical activities, their cognitive function, and their vulnerability to injuries.\nFrom 2012 to 2013, we collected information on the healthcare services at\n1067 long-term care facilities registered with Japanâ??s Welfare, Health and\nMedical Care Information Network in the Welfare and Medical Service\nAgency. We examined 12 structural indicators, 26 process indicators, and 7\noutcome indicators. We used multivariate linear regression models adjusted\nto analyze relationships between outcome indicators and structural or process\nindicators. Results: Residentsâ?? activity and cognitive function indicators either\nimproved by 80% - 90% or were maintained for one year. The Geriatric\nFunctional Independence Measures, the Barthel Index, and holding conferences\nrelated to care were all considered activities of daily living. Three adverse\neventsâ??tumbles and falls, behavioral problems, and aimless wandering\nor leaving the facility without permissionâ??were factors that restricted residentsâ??\nbehavior and number of residents per care staff member. Conclusions:\nMaintaining or improving levels of independence and cognition in daily living\nrequires a care process system that enables ongoing monitoring of residentsâ??\nactivities of daily living and cognitive functioning. Ensuring the safety\nof residents and improving the quality of care in long-term care facilities\nwithout securing adequate care staff are not possible.
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