そもそも「介護」とは何か？
こみちは現場経験を積み、国家試験に合格した介護福祉士の有資格者です。
資格試験はいろいろあり、試験の難易度だけを比較すると介護福祉士の試験はしっかりと準備すればほぼ合格できるくらいの難しさです。
「難しくない」＝「誰にでも取れる」「有資格者に価値がない」と考えるのは、少し軽率です。
介護福祉士の一番難しいことは、「現場で３年以上働く」と言う、自身の時間と引き換えに得られる受験資格をクリアすることだからです。
頭がいい人なら、もしかすると半日も勉強しないで合格点以上が取れるかもしれません。
でも言ったように、雨の日も風の日も、施設に足を運んで利用者の世話を３年以上続けることは楽しくもあり、苦労もある時間です。
ではなぜ介護福祉士の受験資格に実務経験を課しているのでしょうか。
その理由はこうだと思います。
介護福祉士の担う業務は、主に生活に密接した行為です。
誰もが当たり前にしている食事や運動、お風呂や歯磨き、そしてトイレなど、どれもが日常的に行われるものです。
ただ重要なのは、「できること」ではなく、「どうしてできるのか」を知識に加えて経験としても学ぶことにあります。
なぜなら、「トイレを上手く使えず失敗してしまう」と言う状況で、「なんで失敗するの！こんな簡単なことで！」と言ってしまえば、介護にはなりません。
できない状況をどうフォローし、できるようにするか、できないなら他にどんな手段があるのかを考え実行することが介護です。
介護福祉士以外にも、介護系の資格には初任者研修や実務者研修があり、介護福祉士の後にはケアマネジャーの資格も目指せます。
初任者研修や実務者研修には、実務経験など必要なく、期間が異なりますが「介護技術や知識」を系統に従って学ぶことになります。
そして、その知識や技術を使い、現場での経験を加えて介護福祉士になるのです。
さらに言えば、そこからさらに５年の経験を経てケアマネジャーの受験ができるのですが、現場での振る舞いをベースに利用者それぞれの介護計画（ケアプラン）を作ることができるようになります。
と言うのも、介護は日常生活に密接していますが、一方で医療や機能回復などとも密接で、医師や看護師、理学療法士や社会福祉士など、いろいろな立場から介護に携わる専門家からも意見をもらい介護計画を立てなければいけません。
「〇〇させて欲しい」と言われても、それをそのまま計画書に書いても上手く機能しないので、介護現場でどう組み込むかを変換し、現場スタッフが理解できる作業に書き換えなければいけません。
そのためには現場経験がないとできないので、未経験でケアマネジャーには慣れませんし、介護福祉士になってから５年と言う期間が受験資格になっているのです。
なぜ父親はリハパンを拒むのか？
例えば現実にお漏らししてしまうとして、「お漏らしするからオムツね」と言われて、すぐに「分かりました」と現実を受け止められるでしょうか。
実際に介護現場でもオムツを使い始めたばかりの利用者は、「トイレに行きたい」と言います。
まだ経験が浅かった頃、本当にトイレに連れて行って、そこでオムツを脱がせて用を済ませました。
しかし、それを見ていた先輩に呼び出され、なんでトイレに連れて行ったのかと聞かれ、結果的に「オムツを使うこと」が介護計画に沿った介護だと言われたのです。
もちろん、理想的な介護ならこみちの行いが絶対にダメだとは今も思いません。
尿意を訴える意識は、その方の自尊心や生き方にも繋がるので、尊重されるべきことだからです。
しかし、現実的なことを言えば、もしもその方をトイレに誘導し、途中で転倒などで骨折、さらに入院や歩行レベルの低下が発生したら、介護スタッフにも過失責任が問われる可能性も否定できません。
もしも本当にトイレ誘導したいなら、現場の管理スタッフやケアマネジャーに相談し、立位や歩行など、「トイレに行きたい」を実現させる条件を再度検討しなければいけないからです。
つまり、「オムツで対処する」と計画書に書かれた背景は、それにまつわる様々な条件と照らした結果で、「トイレに行きたい」と言われて「じゃあ、行こう」と言う応対ではありません。
一方で、在宅介護の場合、介護計画が立てられる訳ではないので、その場での判断になることもたくさんあります。
父親がどんな理由でリハパンを拒むのかは置いておいて、実際に履かずに寝れば布団まで濡れてしまい、朝から大騒動になるかもしれません。
毎日それを家族が負担し続けるのも困難過ぎるので、結果的に夜間はリハパンを使って欲しいと言う選択が浮かびます。
しかし、リハパンを履く自分が少し惨めに思うと、やはり履きたくないと言うでしょう。
そして朝になってお漏らししていて「なんでお漏らしするの！」と事実を指摘してもそれは介護ではありません。
履かないことで、朝の貴重な時間が何時間も無駄になってしまう。
一緒に手伝ってくれるなら履かなくてもいいけれど、「それが嫌ならリハパンを履いて」と言う家族の苦痛も分かち合ってもらうしかないのです。
それこそ自立した大人なら、全ての選択が自由ですが、失敗も自己責任です。
しかし、介護を必要になる高齢者の場合、できなくなったことをまだ上手く受け止められず、できないのにその対策もせずにどんどん生活苦になってしまうことも少なくありません。
母親の場合、老いていく父親を受け止められていなくて、「なんで失敗するの」を毎朝繰り返しています。
「そうじゃなくて、どう対処するかなんだよ」と言われても、母親には何を考えることが求められているのかピンと来ないのです。
つまり、「自分はできる」でも「なぜできているか、失敗する原因がどこか」と言う介護の基本が理解できていません。
特に母親の場合、自分の価値観で判断しやすく、他人の立場で考えることができないタイプの人間なので、嫌なことも平気でしてくれる反面、些細なことでもやり方やルールを変えることができないのです。
What Is “Caregiving” in the First Place?
Komichi is a certified care worker (Certified Care Worker / Kaigo Fukushishi) who has accumulated hands-on experience in the field and passed the national examination.
There are various certification exams, and if you compare them purely by difficulty, the Care Worker national exam is not extremely hard—if you prepare properly, it is generally an exam you can pass.
However, to think that “not difficult” means “anyone can get it” or that “the qualification has no value” is a bit careless.
The most difficult part of becoming a certified care worker is meeting the eligibility requirement of “working in the field for at least three years,” which you obtain in exchange for a significant amount of your own time.
Someone who is academically gifted might be able to score well above the passing line with barely half a day of studying.
But as I said, continuing to go to a facility and care for users for over three years—rain or shine—is a period that is both rewarding and full of hardship.
So why is hands-on work experience required as a qualification to take the care worker exam?
I believe the reason is this.
The work performed by certified care workers consists mainly of actions that are closely tied to daily life.
Eating, exercising, bathing, brushing one’s teeth, and using the toilet—these are all everyday activities that everyone normally takes for granted.
What matters, however, is not just “being able to do them,” but learning, both through knowledge and experience, why they can be done.
Because if someone fails at using the toilet properly and you say, “Why can’t you do something this simple?” that is not caregiving.
Caregiving means thinking about how to support someone in a situation where they cannot do something, how to help them become able to do it, or—if they truly cannot—what other options are available, and then actually putting those ideas into practice.
In addition to the certified care worker qualification, there are other caregiving-related certifications such as the Initial Care Worker Training and the Practical Care Worker Training. After becoming a certified care worker, one can also aim to obtain the Care Manager (Care Manager / Kaigo Shien Senmon-in) qualification.
The initial and practical training programs do not require work experience. While their durations differ, they involve systematically learning caregiving skills and knowledge.
Then, by applying that knowledge and skill in the field and adding real-world experience, one becomes a certified care worker.
Furthermore, after an additional five years of experience, one becomes eligible to take the care manager exam. At that point, one is able to create individualized care plans based on actual behavior and realities observed in the field.
This is because caregiving is closely tied to daily life, but at the same time it is also deeply connected to medical care and functional rehabilitation. Care plans must be created while incorporating opinions from professionals in various roles—doctors, nurses, physical therapists, social workers, and others involved in care.
Even if a user says, “I want you to let me do ○○,” simply writing that request into the care plan will not work effectively. It must be translated into something that can realistically be incorporated into the caregiving setting and rewritten as tasks that on-site staff can understand and carry out.
This cannot be done without field experience. That is why someone with no experience cannot become a care manager, and why the requirement is five years after becoming a certified care worker.
Why Does My Father Refuse to Wear Rehabilitation Pants?
For example, if someone actually wets themselves and is told, “You wet yourself, so you’ll need to wear diapers,” would you really be able to immediately accept that reality and say, “I understand”?
In actual caregiving settings, users who have just started using diapers often say, “I want to go to the toilet.”
When I was still inexperienced, I took them at their word, brought them to the toilet, removed the diaper, and helped them relieve themselves there.
However, a senior staff member who saw this later called me aside and asked why I had taken them to the toilet. In the end, I was told that “using diapers” was the care aligned with the care plan.
Of course, even now I don’t think my actions were absolutely wrong from the perspective of ideal caregiving.
The awareness of needing to urinate is tied to a person’s dignity and way of living, and should be respected.
That said, realistically speaking, if I guided the person to the toilet and they fell on the way, suffered a fracture, were hospitalized, or experienced a decline in walking ability, it cannot be denied that caregiving staff might be held responsible.
If we truly want to guide someone to the toilet, we must consult with supervisory staff or the care manager and reassess the conditions—such as standing ability and walking ability—that would make “going to the toilet” feasible.
In other words, the background behind writing “manage with diapers” in the care plan is the result of weighing various related conditions. It is not a simple response of “You want to go? Okay, let’s go.”
On the other hand, in home care, there often is no formal care plan, so decisions must frequently be made on the spot.
Setting aside the reason why my father refuses to wear rehabilitation pants, if he sleeps without them and wets himself, the bedding will also get soaked, and the morning may turn into a major ordeal.
It is far too difficult for the family to shoulder that burden every single day, so the option of asking him to wear rehabilitation pants at night naturally comes up.
However, if he feels miserable wearing them, he will still say that he doesn’t want to.
And even if he wets himself by morning, pointing out the fact by saying, “Why did you wet yourself?” is not caregiving.
By not wearing them, hours of precious morning time are wasted.
If he is willing to help deal with the aftermath together, then not wearing them might be acceptable—but if not, he has to share in the family’s suffering and accept the request: “Then please wear the rehabilitation pants.”
A fully independent adult is free to make all their own choices—but failures are also their own responsibility.
However, in the case of elderly people who require care, it is not uncommon for them to be unable to fully accept what they can no longer do, and without taking countermeasures, their daily life gradually becomes more difficult.
In my mother’s case, she has not been able to accept my father’s aging, and she repeats “Why do you keep failing?” every morning.
Even when told, “That’s not the point—it’s about how to deal with it,” she cannot quite grasp what she is being asked to think about.
In other words, she understands “I can do it,” but does not understand the basics of caregiving: why something is possible, or where the causes of failure lie.
Especially in my mother’s case, she is the type of person who easily judges things based on her own values and cannot think from another person’s perspective. As a result, she may do unpleasant things without hesitation, yet at the same time she is unable to change her methods or rules—even over the smallest details.