1

2

3

8% 9%10%

12% 13%14%

16%

19%

23%25%

26%

4% 4% 4% 4% 4%5% 6%

8%10%

13%15%

0%

5%

10%

15%

20%

25%

30%

1950 1970 1990 2010 2030 2050

Developed World Developing World

Percent of PopulationAged 65 & Over: History and UN Projection

Source: UN (2005)

4

115 1865-1980

85 1890-1975

26 1970-1996

24 ??1993-2017

Ageing society7%Aged society14%7%14%

2012/11/28 4

5

1996 2000 2004

623

936

1,389

169 190211

1,678

2008

234

2012/11/28 5

6

1.

25-35% ADL

2.

50%15

3.

25%

4.

20-25%

5.

6.

20-40%

7.

100

7

(8)(11.6)(8.5) (29.2)4Tw- DRGsCMS-DRGs

2

49 81

99321

8

Rehab. care

cure care

99321

9

5.5

10-14

12.7

()

()

Medicare

10

-1(Intermediate care, IC)-1(Intermediate care, IC)

(Intermediate care, IC) (2000) (National Beds Enquiry) (National Health

Service)(IC)

11

-2(Intermediate care, IC)-2(Intermediate care, IC)

12

12

- JCAHO - JCAHO

Joint Commission on Accreditation of Healthcare Organization; JCAHO

inpatient care

short term3-30intermediate31-90

13

(care)

14

20

1st Rehabilitation plus Extension services

2nd Rehabilitation

3rd Extension services

4th Special services

5th Clinically complex

6th Impaired cognition

7th Behavioral problems

8th Reduced physical function

9 RUGs

14 RUGs

3 RUGs

3 RUGs

4 RUGs

4 RUGs

4 RUGs

10 RUGs

RUG - Classification Groups

+ =

ADL

M

D

S

15

RUG - Classification GroupsRUG-(Resource Utilization Groups) 2006 744 2008 853(RUG- ) 2010101 866(RUG-)

(intensity)ADL

MDS+ADL=

ADLRUG-

16

(99)

(99)

( )

99

17

18

2005 ()

(CGA)

.:2008

19

:2008

20

(98-101)(98-101)

2012/11/28 20

21

3

22

20092012

23

2009

2009

()

24

25

Longitudinal Older VEterans StudyLongitudinal Older VEterans Study

1.

2.

3.

1.

65

2.

a.

b.

c.

3.

4.

5.

2012/11/28 25

262012/11/28 26

27

1-month functional improvement1-month functional improvement

Week 0 Week 4 P value

Barthel index 46.729.8 71.931.3

28282012/11/28

HR=0.38, P=0.006Cox regression model

2929

30

Group Home

95

()

(97)

Unit care

(96)

99

85

99

98 99

100

3131

3232

2-3

37

3333

3434

33,000 24,000 21,000

500/

3,000/

35,000

38,000 29,000 25,000

500/

3,000/

35,000

3535

---

3636

3737

2-3

3838

3939

ADLMMSEMDSFIM

40

41

4242

4343

98.02100.1298.0298.02100.12100.12

98 63

99 95

100 78 2 26

236 2 26

89%

1%

10%

4444

98.02-100.12 98.0298.02--100.12 100.12

212 119 4 53 36

56%

1%

25%

18%

4545

98.0298.02100.12100.12

64 27.1

acute stroke 61 25.8

47 20

20 8.4

Head injury 14 6DM poor control 14 6

12 5

4 3

61 64

47

2014 14 12

40

10

20

30

40

50

60

70

acut

e st

roke

Hea

d in

jury

DM

poo

r con

trol

4646

98.02100.12ADL98.0298.02100.12100.12ADLADL

60 17 47

31-60 24 35

30 171 130

17

47

2434

170

130

0

20

40

60

80

100

120

140

160

180

60 31-60 30

4747

98.02100.12

98.0298.02100.12100.12

NG Foley Tr.

88 41 17

39 18 7

49 23 10

, 88

, 39 , 41

, 18 , 17, 7

0

10

20

30

40

50

60

70

80

90

NG Foley Tr.

48

99 100 101

5111130

523~1231

11~~

10

5

1A

5

5

1A

5

17 25 7

510 817 137

49

ADLADLADL

Z PMSD MSD

3.134.43 4.694.27 -1.890 .049* 1.562.39 3.752.89 -2.646 .008** .942.02 1.252.24 -1.000 .317 .311.25 1.562.39 -2.000 .046* .00.00 .311.25 -1.000 .317

()2.193.64 3.444.73 -1.342 .180

.311.25 .631.71 -1.000 .317 2.812.56 3.122.50 -1.000 .317 1.882.50 3.442.39 -2.236 .025* 2.193.15 3.123.09 -1.732 .083

15.3115.33 25.3118.7 5 -2.673 .008**p.05p.01

50

FIM

FIMFIM

p.05p.01

Z P

MSD MSD

18.565.06 20.754.93 -2.95 .003** 6.002.53 6.692.49 -1.84 .066

7.632.47 10.003.03 -2.72 .006

5.252.46 8.063.34 -3.07 .002**

9.133.40 9.383.18 -1.41 .157

12.006.00 12.695.58 -1.81 .071

58.5617.24 67.5617.37 -3.41 .001**

51

p.05p.01

Z PMSD MSD

4.371.89 4.691.70 -1.89 .059 2.88

.72 3.31.79 -2.33 .020*

2.56

.81 2.94.68 -2.45 .014* 3.25

.93 3.56.96 -1.89 .059

() 2.75

.78 3.13.81 -2.12 .034* 2.75

.76 3.13.96 -2.45 .014*

3.001.27 3.371.26 -1.86 .063 3.001.26 3.311.25 -1.89 .059

1.63.89 2.941.57 2.83 .005** 2.63.89 3.371.03 -2.76 .006** 2.50.82 3.311.01 -2.74 .006**

2.50.82 3.311.014 -2.74 .006**

2.441.09 3.061.24 -2.47 .013*

52

p.05p.01

Z PMSD MSD

4.751.57 4.811.5 6 -1.00 .317

4.671.63 4.821.6 1 -1.00 .317

1.671.16 4.31.00 0 -1.41 .157

4.131.93 4.311.8 52 -1.73 .083

4.311.85 4.061.9 14 -1.63 .102

53

102-105102-105

54

(102-105)(102(102--105)105)

54

55

()(())

55

(2008)

56

57

58

9999()7782

59

1 :2 : 1001-10

60

1.262.3.4.()5.: () ( PTOT)

61

()

62

()

63

:

:

::

RUG-:PT/OT

64

Meng-chih Lee et al.: The Prospect of the Intermediate Care in Taiwan. J Med and Health 2012;1:1-6.

::

99

65

1 2-1(Intermediate care, IC)-2(Intermediate care, IC)- JCAHO 15 (99) (98-101)2009Longitudinal Older VEterans Study 261-month functional improvement 29 30 31 33- 37 38 40 41 4298.02100.1298.02-100.12 4598.02100.12ADL98.02100.12 ADLFIM 52(102-105)() 65