노인 식사서비스 질 제고를 위한 자원 효율화 방안 연구 = A study on resource efficiency development to improve the quality of meal services for the elderly

노인 식사서비스 질 제고를 위한 자원 효율화 방안 연구 = A study on resource efficiency development to improve the quality of meal services for the elderly

김정선(Kim, Jeongseon) ; 오수진 ; 곽우성 ; 황은미 ; 정진욱 ; 김연정 ; 강창렬 ; 김경래(Kim, Kyeongrae)

Kim, Jeongseon ; Oh, Sujin ; Kwak, Wooseong ; Whang, Eunmi ; Jeong, Jinwook ; Kim, Yunjung ; Kang, Changyeol ; Kim, Kyeongrae
노인 ; 식생활 ; 식사돌봄 ; 정책
이 연구는 노인의 건강 유지 및 증진을 목적으로 적절한 식품 전달 및 식사서비스 제공의 지속가능성을 담보할 수 있는 인적․ 물적 자원의 활용과 효율성을 높이는 데 필요한 정책적ㆍ제도적 지원방안을 모색하였다.

식사수행 인력인 요양보호사, 간호사/간호조무사, 사회복지사, 식사준비 인력인 영양사, 조리사 및 지역사회 식사서비스 운영자인 식사배달영업자, 돌봄식당운영자 대상 식사서비스에 대한 현장중심 전문성 강화와 노인의 특징별 식생활 욕구에 적합한 식사서비스의 제공을 위한 정책과제들을 제안하고, 커뮤니티케어 도입 기반 구축을 위한 시급성에 따라 우선순위를 제시하고 있다,

1. Background and purpose of the study
For maintaining and promoting the health of the elderly, it is necessary to efficiently provide human and material resources in order to ensure the sustainability of adequate food delivery and meal services. For implementation of community care, professional manpower expansion and suitable foods are required to provide proper meal services by each target, especially in the local community sites, and, if needed, to discover new food types.
The purpose of this study is to diagnose the role and utilization of human and material resources related to community-centered meal services for the elderly under home and community care with the aim of improving quality of life of the elderly in preparation for a super-aged society. Our target is to come up with applicable plans for its efficiency increase.

2. Main Research Results
As relevant human resources, the roles and utilization were reviewed of nursing care workers, nurses/nursing assistants, social workers, meal preparation workers, nutritionists, cooks, and meal delivery service operators, and caring restaurant operators, etc. Their status quo was derived through interview surveys, and their curriculum contents were examined in detail.
The occupational groups without academic background restrictions are culinary technicians, nursing care workers, life support workers, nursing assistants, and caregivers. Nursing assistants must pass the national qualification test after completing the course of the relevant education and training institution, while life supporters and caregivers do not need to take the national qualification test, but on-site education and training for them are urgently needed. As per the status of statutory compulsory education and job training of food care service personnel, the occupational groups under the professional manpower training course for the elderly are only nutritionists, nurses, and nursing assistants. However, since the current data of the professional manpower training process has not been disclosed so far, it was difficult to grasp the size of the professional manpower produced or the utilization of the curriculum. In future, expansion of home care is expected so that there will be an increase in the demand of professionalism of food-care services not only by nutritionists and cooks, but also by nursing assistants, caregivers, and care workers, while cooking, hygiene management, recipes, etc. are very scarce, and there is no basic data on systematic meal service education for the elderly, which should be urgently set up.
As for the related material resources, we looked into the business status by industry, such as food for the elderly (excellent age-friendly food), food for special use (including patient food), and food manufacturing, distribution and delivery companies, and restaurants. Currently, there is no separate distribution or delivery company for age-friendly foods. However, as 27 types of excellent age-friendly food were designated in October 2021 based on the Age-friendly Industry Promotion Act, number of age-friendly food manufacturers is expected to gradually increase. Currently, utilization and awareness of the elderly-friendly food are very low, and the actual field distribution is very insufficient. Therefore, it is necessary to prepare a systematic support plan to increase distribution of excellent elderly-friendly foods in the elderly meal service system.
As like Korea, Germany and Japan are operating a public-private mixed provision system as a social insurance method for the financial management of long-term care insurance systems and are expected to represent similar systems for the at-home elderly, of which advanced cases were investigated and analyzed.
Japan is efficiently managing the services of material resource support and elderly safety by combining the food delivery service with safety checking by the delivery personnel. Lunch box for the elderly by German private companies can be purchased by the general public, but at a higher cost than public meals(EaR). Japan has disseminated the nutritional management guidelines for the health support lunchbox project, the ‘meal balance guide to support healthy living for seniors’. Germany has implemented the nutrition management expert standard for long-term care institutions (2010) and the development and certification of food quality standards. The German Health Insurance Corporation (MDK) has secured effectiveness through annual evaluations by making an evaluation index with the items of expert standards. The evaluation index items in the nutrition management area are documentation, food intake, water intake, weight change, and whether or not special nutrition is taken care of.
Japan’s long-term care insurance system, which is the model of Korea’s long-term care insurance system, was implemented in 2000, and through revisions, free meals were converted to self-pay. Essen auf Rädern (EaR), a meal delivery service for the elderly in Germany, is a kind of social pay service. In Korea, it is desirable to provide diversified and high-quality services to meet the needs of users for free and differentially paid public meals in preparation for the diverse needs of the elderly.
Japan’s ’Home-visiting management nutritionists’ are the nursing personnel who know the status and the thoughts of the invalid or their families, and can support them for oral intake until the end, prevent nutritional deficiencies, and support dietary changes of feeding functions, which are mainly applied to the elderly at home. Korea also needs to set up qualification standards and test requirements for management of nutritionists with sufficient experience in food care for the elderly. German care workers are subdivided into ‘specialized caregivers for the elderly’, ‘geriatric assistants’, ‘general assistants’, and ‘family caregivers’. Korea also needs the curriculum and the supplementary education for acquiring the qualifications of nursing care workers, whose remuneration should be made by the level or status of qualifications. In particular, we need the curriculum and program that can foster the professionalism of caregivers for nationwide uniform promotion of dietary management for the elderly in need of care.
In order to understand the actual experience of providing meal services in the field, qualitative interviews were conducted with 3 to 4 people each from 7 occupational groups on the level of awareness and role of workers in the management of meals and nutrition for the elderly, and the actual conditions of meal service provisions. The results were compared and analyzed by five categories, such as awareness, role, field conditions, education system, and field satisfaction, and the implications were reflected in the policy proposals.

3. Conclusions and Implications
Based on the results of major researches on human and material resources related to meal services for the elderly, policy and institutional improvement plans for efficient utilization and collaboration are presented in the conclusion and policy recommendations.
Meal services for the elderly can be largely divided into a food provision service and a nutrition management for oral intake service.
The elderly can be broadly divided into the elderly at home and those in the institutions such as nursing homes or hospitals for a long period of time. The elderly at home can be divided into the healthy elderly and those at risk of dietary factors depending on the degree of independence in daily life. The subjects of this study were the elderly living alone with dietary risk factors; one or both of the elderly households with diseases and unable to run a self-reliance dietary life; ; those over 75 years old living with family members but spending most of the time alone at home; and those with impaired mobility and in need of comprehensive care services. It is important for home care services to grasp the dietary demands depending on the division of the elderly.
For improvement of meal service quality for the elderly, promotion plans are proposed as follows for a better utilization of human resources: Out of the occupational workers related to meal care for the elderly, education processes and contents are suggested for nutritionists in charge of preparing meals, cooks, nurses corresponding to meal execution, nursing care workers, and social workers. In particular, occasional education of meal services for the elderly is required for nursing home care workers, social workers, managers and operators of nursing homes, home care facilities, cooks at welfare centers and nursing facilities, and families providing home care services. Unlike as so far, the educationfor managers should provide field-oriented contents centered on the necessity and case-oriented diet management for the elderly, including the least manageable items (drinking water, prevention of unbalanced diet, low-salt meal, etc.). For care workers and nurses, education should be on the patients with decreased appetite, dementia, swallowing and chewing disorders, eating habits, methods of observing nutritional deficiencies, inducing changes in eating behavior (cooperating with a nutritionist or chef to prevent water intake and unhealthy eating). Regular care is required for finding and coping with meal-related problems of the elderly.
For improvement of meal service quality for the elderly, promotion plans are proposed as follows for a better utilization of material resources: In order to provide suitable meal services for the physical functions and health conditions of the elderly, our suggestions would be ‘nutrition management and meal service guidelines for at-home elderly people’, ‘meal delivery service quality standards and local government’s delivery service registration system’, ‘cause analysis of malnutrition of the elderly by using a nutritional status evaluation tool that can track and manage the nutrition and health of the elderly’, ‘utilization of diet guidelines, preparation of meal checklists, and automation of tracking management combined with ICT’. In addition, ‘a differential meal charge system for the elderly up from the free meals’ may lead that ① the free public meal targeting the economically vulnerable elderly can be open to anyone who wants to use the service, even the elderly of poor health or the ordinary elderly, so that target of the meal service can be expanded; and that ② the meal services under nutrition management can maintain or improve the general health status. It can also promote the development of food production, manufacturing, storage, delivery and catering services, and the aging-friendly food industry.
As a human resource efficiency measure to improve the quality of meal service for the elderly, in terms of institutional aspects, such policy suggestions are made as ‘a plan to support the training and utilization of professional manpower related to the meal services for the elderly’, ‘introduction of the home- visiting nutritionist system(tentative name)’, ‘development of screening tools’, ‘establishment of a delivery system according to the results of nutrition and health assessment’, ‘set-up of a public-private integrated education system to nurture experts for the elderly diet’, ‘utilization of a tool to measure the needs of senior citizens’ meals and customized service operation’, and ‘reorganization of education methods and contents related to meal services for the elderly’.
As a material resource efficiency measure to improve the quality of meal service for the elderly, from the institutional perspective, suggested policy proposals are ‘preparation of quality standard for meal services for the elderly’, ‘guidelines for the meal delivery service reflecting the nutritional management standards’, ‘utilization of senior-friendly excellent foods for meal services for the elderly’, ‘operation of local government’s registration management system for senior meal service companies’, ‘utilization of support organizations to improve the eating habits of the elderly at home such as social welfare meal service management support center’, ‘promotion of free and paid service for senior citizens in free public service meals’. And ‘measures for improvement of the food supply and demand system’, ‘expansion of the participation of nutritionists in implementing the community care’, and ‘expansion of the options of service users’. were proposed as policy suggestions for ‘preparing the measures to improve the quality of senior citizens’ restaurants and lunchbox delivery services’.
If policy tasks are prioritized according to the urgency for establishing a foundation for community care introduction, theshort term promotions should be that the education methods and contents for nurturing the senior meal service professionals are reorganized; the public-private integrated education system is prepared; such support organizations are utilized as the Social Welfare Meals Management Support Center; and the aging-friendly excellent foods are quickly introduced for the elderly. and the mid to long term promotions should be that, based on the results of the pilot project, the quality standards and guidelines for meal service for the elderly are prepared, and that nutrition and health assessment screening tools are developed. It is desirable to apply such other policy tasks to the field as establishment of a delivery system of the results and the introduction of a visiting nutritionist system(tentative name).
Abstract 1
요약 11

제1장 서론 19
제1절 연구 배경 및 목적 21
제2절 연구 내용 및 방법 26

제2장 국내 자원 및 인프라 현황 고찰 29
제1절 인적자원 현황 31
제2절 물적자원 및 법제 현황 68
제3절 시사점 도출 84

제3장 국외 선진사례 고찰 91
제1절 일본 사례 93
제2절 독일 사례 153
제3절 시사점 도출 191

제4장 전문가 조사결과 분석 199
제1절 전문가 조사개요 201
제2절 전문가 조사결과 209
제3절 시사점 도출 230

제5장 결론 및 정책 제언 241
제1절 결론 243
제2절 정책 제언 279

참고문헌 293
부록 305
【부록 1】 국내 유통 고령친화식품 현황 305
【부록 2】 고령친화우수식품 지정 27개 제품 322
【부록 3】 일본 고령자를 위한 식사밸런스가이드 328
【부록 4】 영양평가도구(Mini Nutritional Assessment) 331
보고서 번호
연구보고서 2021-14
KIHASA 주제 분류
사회서비스 > 노인복지
인구와 가족 > 고령화대응
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