Furthermore, the following information was extracted from each patient's care plan and needs assessments: the purpose of admission to GICF (i.e., rehabilitation, continuing support for care, respite care for caregivers, or awaiting admission to a LTC facility); number of times admitted to GICF; activities of daily living (ADL); level of dementia measured by a Japanese version of the Mini Mental Status Exam (MMSE; Hirono et al., 1997); living arrangement (living alone or living with others); relationship of the primary caregiver to the patient; dates of admission to-and discharge from-GICF; and if the primary caregiver requested a placement in a LTC facility, date of request filed and reason for placement were documented.
As for living arrangements, 40% of the patients lived alone prior to being admitted to a GICF.
After admission to the GICF facility (which may contain several intervals), 27% of the patients' ADLs improved or slightly improved, 43% were unchanged, and 30% worsened.
When admitted to a GICF, 53% of the caregivers reported that they had already decided that they wanted a LTC placement for their older family member, while 30% reported that their intentions for a GICF admission were for the family member's rehabilitation posthospital discharge.
The patient returned to the GICF for rehabilitation for the second time after another hospitalization.
As illustrated in Tables 5 and 7, items showing significant relationships to the presence of conflict among caregivers included prior experience with caregiving at home (p < 0.071), and the duration between being admitted to GICF and applying for placement in an LTC facility (p < 0.05).
In either case, after a certain time spent in the GICF, and trials and errors at home, caregivers were persuaded by GICF staff and accepted the patient's admission to LTC facilities.
It should be noted that of the 22 older adults admitted to facilities (excluding the eight older adults who were not able to receive home care from the initial GICF admission), 12 older adults (55%) were discharged to LTC facilities due to their caregivers' situations.
First, the records were based on interviews with caregivers, which were conducted and transcribed by social workers at the GICF. Hence, the response-set sources of error such as social desirability, acquiescence, or deviation (Grinnell, 2001) may have affected the data.
Ikeda, the entire staff of Minami Yamato GICF, and the older adults and families who participated in this study.