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{"sheet":"理由書","index":0,"n_rows":98,"n_cols":40,"rows_kept":98,"cut":false,"hidden":false,"merged":[[72,39,72,46],[73,39,73,46],[74,39,74,46],[75,39,75,46],[76,39,76,46],[78,40,78,71],[83,5,83,10],[76,47,76,54],[76,55,76,62],[76,63,76,70],[79,4,79,10],[80,4,80,10],[98,4,98,35],[65,3,67,35],[70,3,70,34],[58,3,63,35],[71,3,76,35],[94,4,96,35],[90,4,91,35],[92,4,93,35],[97,4,97,35],[84,4,87,34],[81,5,81,10],[82,5,82,10],[82,4,83,4],[78,4,78,34],[71,39,71,71],[52,3,54,35],[51,3,51,34],[57,3,57,34],[42,11,42,14],[42,15,42,35],[48,2,48,36],[42,3,42,6],[42,7,42,10],[10,22,10,23],[10,18,10,21],[10,30,10,32],[13,8,17,36],[12,2,17,7],[11,27,11,28],[11,30,11,32],[11,33,11,34],[11,35,11,36],[2,2,2,36],[8,2,8,7],[10,2,10,7],[9,2,9,7],[11,8,11,9],[4,21,4,23],[11,2,11,7],[4,24,4,25],[4,32,4,36],[9,18,9,21],[9,22,9,36],[8,8,8,17],[9,8,9,17],[11,17,11,18],[10,33,10,36],[6,3,6,14],[28,32,28,35],[28,2,28,7],[28,8,28,16],[12,8,12,36],[28,21,28,22],[28,24,28,31],[28,17,28,18],[18,2,22,7],[23,2,27,7],[23,8,27,36],[18,8,22,36],[41,3,41,8],[29,6,29,12],[31,7,31,12],[32,7,32,12],[30,6,30,12],[29,2,33,5],[31,6,33,6],[33,7,33,12],[35,3,36,35],[38,3,38,6],[39,3,39,6],[38,21,38,24],[38,7,38,18],[39,7,39,18],[38,25,38,35]]}
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[null,null,"短期入所サービスの利用にかかる理由書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"提出日",null,null,"令和",null,null,"年",null,"月",null,"日"]
[]
[null,null,null,"芦屋市　高齢介護課長　あて"]
[]
[null,null,"ふ り が な"]
[null,null,"名　　　前",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住　　所"]
[null,null,"被保険者番号",null,null,null,null,null,0,0,0,0,null,null,null,null,null,null,"生年月日",null,null,null,null,null,null,"年",null,"月",null,"日","介護度"]
[null,null,"認定有効期間",null,null,null,null,null,"令和",null,null,"年",null,"月",null,"日","～","令和",null,null,"年",null,"月",null,"日","（",null,"か月",null,"）","有効期間\nの半数",null,null,{"$f":"IF(AA12=3,\"45\")+IF(AA12=6,\"90\")+IF(AA12=12,\"180\")+IF(AA12=24,\"360\")+IF(AA12=36,\"540\")+IF(AA12=48,\"720\")","v":0},null,"日"]
[null,null,"利用者の状況\n及び意向等",null,null,null,null,null,"（身体状況、生活状況、サービス利用状況、家族構成など）"]
[]
[]
[]
[]
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[null,null,"短期入所\nサービスを\n長期利用\nする理由"]
[]
[]
[]
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[null,null,"今後の方針\n及び\n施設等申込状況"]
[]
[]
[]
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[null,null,"利用状況",null,null,null,null,null,"有効期間の半数を超える月",null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月　　","提出月末までの利用日数計",null,null,null,null,null,null,null,null,null,null,null,"日"]
[null,null,"直近の\n短期入所\nサービス\n利用",null,null,null,"利用（予定）月",null,null,null,null,null,null,null,"月",null,"月",null,"月",null,"月",null,"月",null,"月",null,"月",null,"月",null,"月",null,"月",null,"月",null,"月"]
[null,null,null,null,null,null,"利用（予定）日数",null,null,null,null,null,null,null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日"]
[null,null,null,null,null,null,null,"うち連続利用制限",null,null,null,null,null,null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日"]
[null,null,null,null,null,null,null,"うち限度額超過",null,null,null,null,null,null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日"]
[null,null,null,null,null,null,null,"当該月までの累計日数",null,null,null,null,null,null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日",null,"日"]
[]
[null,null,null,"　上記の理由により、短期入所サービス利用日数が認定有効期間の半数を超える計画を作成しましたので届け出ます。"]
[]
[]
[null,null,null,"事業所名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電　話"]
[null,null,null,"担 当 者"]
[]
[null,null,null,"【芦屋市確認欄】"]
[null,null,null,"承認日",null,null,null,"／",null,null,null,"備考"]
[]
[]
[]
[]
[]
[null,null,"「短期入所サービスの利用にかかる理由書」の提出について"]
[]
[]
[null,null,null,"【短期入所サービスの長期利用について】"]
[null,null,null,"　短期入所サービス（短期入所生活介護又は短期入所療養介護）は、利用者の自立した在宅生活を維持するため、利用者の心身機能の維持と家族の身体的・精神的負担の軽減を図るためのサービスであり、長期的利用を想定したものではありません。"]
[]
[]
[]
[]
[null,null,null,"○指定居宅介護支援（指定介護予防支援）の具体的取扱方針"]
[null,null,null,"　介護支援専門員（担当職員）は、居宅サービス計画（介護予防ービス計画）に短期入所生活介護（介護予防短期入所生活介護）又は短期入所療養介護（介護予防短期入所療養介護）を位置付ける場合にあっては、利用者の居宅における自立した日常生活の維持に十分に留意するものとし、利用者の心身の状況等を勘案して特に必要と認められる場合を除き、短期入所生活介護（介護予防短期入所生活介護）及び短期入所療養介護（介護予防短期入所療養介護）を利用する日数が要介護認定（要支援認定）の有効期間のおおむね半数を超えないようにしなければならない。"]
[]
[]
[]
[]
[]
[]
[null,null,null,"　上記より、短期入所サービスを長期利用しないための検討を行っているか、また、利用者の心身状況や環境、意向等を勘案しつつ適切な評価に基づきケアプランが作成されており、「特に必要と認められる場合」であるか確認するために理由書の提出をお願いします。"]
[]
[]
[]
[]
[null,null,null,"【提出時期】"]
[null,null,null,"　短期入所サービスが要介護認定（要支援認定）の有効期間のおおむね半数を超えると見込まれる場合、超過月の前月までに理由書の提出をお願いします。（例：認定有効期間が12か月（360日）であれば累計の利用日数が180日になる前月まで。）ケアプラン作成段階から半数を超えることが見込まれる場合は、プラン作成当初に提出いただいても構いません。\n　また、超過月以降も短期入所サービスを引き続き利用される場合は、その利用月において、短期入所サービスの利用が15日を超えると見込まれる月の前月中に提出をお願いします。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（提出時期参考）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・認定有効期間６か月⇒累計の利用日数が90日になる前月まで"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・認定有効期間12か月⇒累計の利用日数が180日になる前月まで"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・認定有効期間24か月⇒累計の利用日数が360日になる前月まで"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・認定有効期間36か月⇒累計の利用日数が540日になる前月まで"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・認定有効期間48か月⇒累計の利用日数が720日になる前月まで"]
[]
[null,null,null,null,"（例）認定有効期間が24か月（720日）の場合における理由書提出のタイミング"]
[null,null,null,null,"利用（予定）月",null,null,null,null,null,null,4,"月",5,"月",6,"月",7,"月",8,"月",9,"月",10,"月",11,"月",12,"月",1,"月",2,"月",3,"月"]
[null,null,null,null,"利用（予定）日数",null,null,null,null,null,null,18,"日",24,"日",25,"日",26,"日",26,"日",26,"日",26,"日",26,"日",18,"日",13,"日",14,"日",17,"日"]
[null,null,null,null,null,"うち連続利用制限",null,null,null,null,null,0,"日",1,"日",0,"日",1,"日",1,"日",1,"日",1,"日",1,"日",0,"日",0,"日",0,"日",0,"日"]
[null,null,null,null,null,"うち限度額超過",null,null,null,null,null,3,"日",6,"日",4,"日",2,"日",4,"日",3,"日",4,"日",3,"日",3,"日",0,"日",0,"日",2,"日"]
[null,null,null,null,null,"当該月までの累計日数",null,null,null,null,null,208,"日",{"$f":"L84+N81","v":232},"日",{"$f":"N84+P81","v":257},"日",{"$f":"P84+R81","v":283},"日",{"$f":"R84+T81","v":309},"日",{"$f":"T84+V81","v":335},"日",{"$f":"V84+X81","v":361},"日",{"$f":"X84+Z81","v":387},"日",{"$f":"Z84+AB81","v":405},"日",{"$f":"AB84+AD81","v":418},"日",{"$f":"AD84+AF81","v":432},"日",{"$f":"AF84+AH81","v":449},"日"]
[null,null,null,null,"　上記の場合、有効期間の半数（360日）を超えると見込まれる10月の前月である9月中までに初回の理由書提出。10月以降は、その利用月において、短期入所サービスの利用が15日を超えると見込まれる月の前月（10月、11月、2月）までに提出。"]
[]
[]
[]
[]
[null,null,null,"【留意事項】"]
[null,null,null,"・","利用（予定）日数には、（介護予防）短期入所生活介護、（介護予防）短期入所療養介護の利用日数を合算した数値をご記載ください。"]
[]
[null,null,null,"・","利用（予定）日数には、連続利用制限及び支給限度基準額を超えて利用した日数も含めてください。"]
[]
[null,null,null,"・","施設入所と変わらない利用を防止するとともに、他利用者の利用を確保するため、連続利用が30日以上に及び場合は、31日目は連続利用制限の対象となり、全額自己負担となります。給付管理の際はご留意ください。"]
[]
[]
[null,null,null,"・","理由書の対象となるケアプランをケアプランチェックの対象とさせていただく場合があります。"]

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[null,null,"短期入所サービスの利用にかかる理由書（記載例）"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"提出日",null,null,"令和",null,3,"年",11,"月",20,"日"]
[]
[null,null,null,"芦屋市福祉部　高齢介護課長　あて"]
[]
[null,null,"ふ り が な",null,null,null,null,null,"あしや　たろう"]
[null,null,"名　　　前",null,null,null,null,null,"芦屋　太郎",null,null,null,null,null,null,null,null,null,"住　　所",null,null,null,"芦屋市精道町○－△△"]
[null,null,"被保険者番号",null,null,null,null,null,0,0,0,0,0,"○","○","×","×","△","生年月日",null,null,null,"昭和",null,"△","年","□","月","◇","日","介護度",null,null,"要介護４"]
[null,null,"認定有効期間",null,null,null,null,null,"令和",null,3,"年",10,"月",1,"日","～","令和",null,4,"年",9,"月",30,"日","（",12,"か月",null,"）","有効期間\nの半数",null,null,{"$f":"IF(AA12=3,\"45\")+IF(AA12=6,\"90\")+IF(AA12=12,\"180\")+IF(AA12=24,\"360\")+IF(AA12=36,\"540\")+IF(AA12=48,\"720\")","v":180},null,"日"]
[null,null,"利用者の状況\n及び意向等",null,null,null,null,null,"（身体状況，生活状況，サービス利用状況，家族構成など）"]
[null,null,null,null,null,null,null,null,"集合住宅に独居。妻は他市の施設に入所している。自宅では週２日のデイサービス，週３日のショートステイを利用し，近隣市に住む長男家族が訪問することで生活を維持してきたが，令和３年１０月に自宅浴室で転倒し，左大腿骨骨折となり，現在は車いす生活。入院中に夜間のせん妄等が出現した。下肢筋力の低下もみられ転倒リスクが高いが，病識が薄く，自身で動こうとするなど，常時見守りが必要な状態。本人は自分でできることは自分でしたいという思いが強く，施設入所には抵抗あり。また，気難しい性格もあり，慣れた支援者以外での支援は受け入れがたい。"]
[]
[]
[]
[]
[null,null,"短期入所\nサービスを\n長期利用\nする理由",null,null,null,null,null,"キーパーソンである長男が在宅生活の支援を継続していきたいとの意向はあるが，長男には癌が見つかり，入退院を繰り返している状況。長男家族も長男の支援のため，常時の支援は難しい。身体状況の変化から常時見守りが必要だが，本人は自分でできることは自分でしたいという思いが強く，今までの生活を送ろうと特に夜間に１人で動こうとしてしまう。本人の意向を尊重し，なるべく在宅での生活を維持するため，継続して利用し慣れているショートステイの日数を増やし対応する。"]
[]
[]
[]
[]
[null,null,"今後の方針\n及び\n施設等申込状況",null,null,null,null,null,"主治医からは施設入所の検討も視野に入れるよう話もあったが，現在は本人の意向通り少しでも在宅生活を維持できるように支援していく。長男の入院中は，長男家族の支援が可能である週末のみ自宅に帰り，入浴などは訪問介護，訪問看護等を利用しながら支援。長男が退院すれば，ショートステイの日数は減らすが，入院が長期化した場合は小規模多機能型居宅介護や定期巡回・随時対応型訪問介護看護等の利用も提案していく。"]
[]
[]
[]
[]
[null,null,"利用状況",null,null,null,null,null,"有効期間の半数を超える月",null,null,null,null,null,null,null,null,"令和",null,4,"年",6,null,"月　　","提出月末までの利用日数計",null,null,null,null,null,null,null,27,null,null,null,"日"]
[null,null,"直近の\n短期入所\nサービス\n利用",null,null,null,"利用（予定）月",null,null,null,null,null,null,10,"月",11,"月",12,"月",1,"月",2,"月",3,"月",4,"月",5,"月",6,"月",7,"月",8,"月",9,"月"]
[null,null,null,null,null,null,"利用（予定）日数",null,null,null,null,null,null,2,"日",25,"日",24,"日",25,"日",23,"日",25,"日",25,"日",25,"日",24,"日",25,"日",25,"日",24,"日"]
[null,null,null,null,null,null,null,"うち連続利用制限",null,null,null,null,null,0,"日",0,"日",0,"日",0,"日",0,"日",0,"日",0,"日",0,"日",0,"日",0,"日",0,"日",0,"日"]
[null,null,null,null,null,null,null,"うち限度額超過",null,null,null,null,null,0,"日",3,"日",2,"日",3,"日",1,"日",3,"日",3,"日",3,"日",2,"日",3,"日",3,"日",2,"日"]
[null,null,null,null,null,null,null,"当該月までの累計日数",null,null,null,null,null,2,"日",{"$f":"N34+P31","v":27},"日",{"$f":"P34+R31","v":51},"日",{"$f":"R34+T31","v":76},"日",{"$f":"T34+V31","v":99},"日",{"$f":"V34+X31","v":124},"日",{"$f":"X34+Z31","v":149},"日",{"$f":"Z34+AB31","v":174},"日",{"$f":"AB34+AD31","v":198},"日",{"$f":"AD34+AF31","v":223},"日",{"$f":"AF34+AH31","v":248},"日",{"$f":"AH34+AJ31","v":272},"日"]
[]
[null,null,null,"　上記の理由により，短期入所サービス利用日数が認定有効期間の半数を超える計画を作成しましたので届け出ます。"]
[]
[]
[null,null,null,"事業所名",null,null,null,"ケアプランセンターあしや",null,null,null,null,null,null,null,null,null,null,null,null,null,"電　話",null,null,null,"0797-38-○○△△"]
[null,null,null,"担 当 者",null,null,null,"芦屋　花子"]
[]
[null,null,null,"【芦屋市確認欄】"]
[null,null,null,"承認日",null,null,null,"／",null,null,null,"備考"]