介護　介護職のチカラ（中）短期滞在で回復

【ゆうゆうＬｉｆｅ】介護　介護職のチカラ（中）短期滞在で回復

　介護状態になって「死にたい」と嘆くお年寄りが、少なくありません。年をとったからといって、人生をあきらめなければならないのでしょうか。介護のプロは、生きる意欲を引き出し、その人の人間性を取り戻します。尊厳を支える介護の力は、医療との連携で、いっそう発揮されます。（寺田理恵）

　座ることもできなかったお年寄りが、短期間の介護で生きる意欲を取り戻し、再び自分で歩く。岐阜市の加藤治雄さん（８３）＝仮名＝も、そんな体験をした１人だ。

　ジャケットに茶のスーツ。穏やかな笑みを絶やさない。知的な風貌（ふうぼう）からは認知症とは分からない。

　しかし、一時は認知症の悪化で昼夜が逆転。食欲がなく、表情は乏しく、ほとんど寝たきりの状態だった。

　高齢者向けの住宅への引っ越しを控え、その慌ただしさから疲れが出た様子だったが、妻は転居の諸手続きで度々外出しなければならなかった。介護保険の訪問介護では、長時間の見守りはできない。加藤さんはデイサービスを「姥（うば）捨て山」と呼んで行きたがらず、自費で訪問ヘルパーを頼んだ。引っ越しに、老々介護の疲れも重なって「がけっぷちに立たされたようでした」と、妻は打ち明ける。

　加藤さん自身も「ここに来たときは病人みたいでした」と振り返る。

　加藤さんが利用したのは、短期滞在で集中的なケアを受けられる８室だけの有料老人ホーム「シティタワー・アンキーノ」。ＪＲ岐阜駅直結の超高層ビルにあり、高級ホテルのような内装。同じフロアに診療所や調剤薬局、美容室、保育所などもあり、街の暮らしの延長にある印象だ。

　加藤さんは昨年１０月に２０日余り滞在し、目を見張る回復を遂げた。

　現在は妻の介護で、自宅で暮らす。夜間に数回の排泄（はいせつ）介助が必要なものの、アンキーノに併設のデイに１日４時間、週５日通うようになり、妻の介護負担も軽減された。土曜には同じフロアで開かれるコンサートを、妻と聴きにくるのが楽しみ。

　　　　　　　　　　　　　　　　　　　◇

　加藤さんの回復は、利用者に何が必要かを的確に把握するアセスメント（課題分析）の成果だ。

　アンキーノは主に、自宅復帰を目指す人が対象。「起きるのをおっくうがる」「もの忘れがひどい」といった不安のある人や家族に、自宅での介護方法を提案したり、生活リズムの回復をサポートしたりする。利用期間は１週間から３カ月と短い。

　加藤さんの場合、問題は食欲がないこと。筋力はあるが、持久力とやる気がないため、歩行が安定せず、座っていられないことだった。

　昼夜が逆転していた加藤さんに「まず、着替えていただきました」と、管理者の若原邦宏さん。「昼も寝間着姿で過ごすのは、人生をあきらめた状態」というのが、ホームを運営する「新生会」の考え方だ。滞在中は、加藤さんが興味を持つよう、昔好きだった曲を流した。

　また、「社交性がある」とみて、併設のデイ利用が適していると判断した。「周囲に気配りができる人。例えば、自分だけがスリッパを履いて、職員がはだしだと気遣われる」というのが理由だ。加藤さんはデイで、ほかの利用者の話し相手になったり、隣接する保育所の幼児とも、楽しく過ごしたりするようになったという。

　食欲不振も解消した。併設する訪問看護ステーションの管理者、川瀬由起子さんは「食べ物が口の中に残るから、むせてしまい、疲れるから食べたがらない。最初は、残渣（ざんさ）が少ないものを召し上がっていただきました」と話す。

　食事時の姿勢と環境、排泄介助や衣類交換の方法なども、医師、看護師、理学療法士ら専門職がそれぞれの視点で確認する。チームでケアに当たるが、メーンでかかわるのは介護職だ。「介護職は、利用者をよく見ていますね。短時間のかかわりで病気をみる看護師とは、視点が違います」と川瀬さん。

　　　　　　　　　　　　　　　　　　　◇

　新生会の特別養護老人ホームでは３０年前から、認知症の人に対する抑制の廃止や、寝たきりの人の離床を進めてきた。

　石原美智子理事長は「日本では、寝たきりの人を起こすという発想がなかった。今も多くの人が、人生をあきらめて死んでいく。しかし、人は元来、離床する、口から食べる、排泄を自分でするなどを、基本的なニーズとして持っている」と現状を批判する。

　サービスはこうしたアセスメントケアと終末期の緩和ケア。介護保険が使えないため、利用料は１泊２日で約４万円（食費・介護費込み）かかるが、石原理事長は「介護の力は必要なときに集中的に投じた方が、効果が高い。ここは来たときと、出るときの違いがはっきりと見える。『介護の専門性』を示すことで、こうしたやり方に介護保険が使えるようになれば」と話している。

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