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Daily Living Support Techniques (Seikatsu Shien Gijutsu)

National Exam for Certified Care Workers 介護福祉士 · 介護福祉士国家試験(筆記) · Written by Tokutei Pass based on the official study texts; not copied verbatim.

Principles of Daily Living Support, Indoor Environment, and Recreation

The foundation of Daily Living Support Techniques lies in grasping the user's 'holistic picture'—including physical/mental functions, life history, and values—and utilizing residual functions to support independent living and QOL.

For a comfortable indoor environment, adjust room temperature to 25–28°C in summer and 18–22°C in winter with 40–60% humidity, ensuring air conditioner airflow does not blow directly onto the user's body.

For ventilation, opening two windows located diagonally across from each other creates an efficient airflow. Lighting should account for age-related vision decline while using indirect lighting to prevent direct glare.

In group activities and recreation, incorporate 'ice-breaking' (simple hand games or greeting activities) at the start to ease tension, while respecting self-determination rather than forcing participation.

Key points


  • Indoor environment: Diagonal two-window ventilation and lighting arrangements that prevent glare

  • Use 'ice-breaking' to ease tension at the start of recreation and respect self-determination in participation
WordMeaning
Grasping the holistic picture and utilizing residual functions
Preventing glare
Diagonal ventilation and temperature/humidity control
Ice-breaking activities

Home Environment Modification Tailored to Diseases and Disabilities

Effective home modifications for fall prevention and independence include eliminating floor steps (ramps or threshold removal), changing to non-slip flooring, and replacing hinged doors with 'sliding doors' (Hikido) that open with minimal force.

Handrails include 'horizontal handrails' (installed at about 75–80 cm high, around the greater trochanter level, to support walking) and 'vertical handrails' (supporting standing up, sitting down, and stepping over thresholds).

For users with Parkinson's disease experiencing 'freezing of gait' (difficulty taking the first step), placing horizontal marker tapes at regular intervals on the floor utilizes 'paradoxical kinesia' via visual cues to facilitate stepping.

For users with 'rheumatoid arthritis' who have finger joint deformity or pain, select 'flat handrails' (platform handrails supported by resting the forearm without gripping) and lever-type door handles or faucets operable without twisting the wrist.

Key points


  • Horizontal handrails assist walking (greater trochanter height); vertical handrails assist standing/sitting and stepping motions

  • Floor marker tapes help freezing of gait in Parkinson's disease; flat handrails and lever faucets help rheumatoid arthritis
WordMeaning
Horizontal handrails (greater trochanter height) and Vertical handrails
Sliding doors (Hikido) and step elimination
Floor marker tapes for freezing of gait (visual cues)
Rheumatoid arthritis with flat handrails and lever handles

Body Mechanics, No-Lifting Care, and Bed Repositioning

To prevent lower-back pain and ensure safe assistance, apply 'Body Mechanics principles': spread feet front-to-back and side-to-side for a 'wide base of support,' bend knees to 'lower the center of gravity,' and 'move your center of gravity close' to the user.

Fold the user's arms and bend their knees to 'make their body compact,' 'slide horizontally' across the bed rather than lifting vertically, point your toes toward the direction of movement without twisting the waist, and use leverage and large muscle groups.

Under 'No-Lifting Care' (avoiding manual lifting alone), actively use friction-reducing 'sliding sheets,' seated transfer 'sliding boards,' and mobile floor lifts.

When raising the backrest (Fowler's position) on a Gatch bed, 'raise the knee section first before raising the backrest' to prevent the body from sliding down toward the foot of the bed, and perform 'back pressure relief' (Haibu no Atsunuki) afterward.

Key points


  • Body Mechanics: Wide base of support, low and close center of gravity, compact posture, horizontal sliding without twisting the waist

  • Gatch bed backrest elevation follows 'Knee elevation first → Backrest elevation,' followed by 'back pressure relief'
WordMeaning
Base of support and Center of gravity
8 Principles of Body Mechanics
No-Lifting Care (Sliding boards and Sliding sheets)
Knee-first elevation and Back pressure relief on Gatch beds

Transfers in Hemiplegia, Wheelchair Operation, Cane Walking, and Guiding Visually Impaired Users

When a person with hemiplegia sits up from supine, they first roll onto their 'sound (unaffected) side' and push up with the sound elbow and hand into a seated position. For bed-to-wheelchair transfers, place the wheelchair on the 'sound side at a 20–30 degree angle.'

When assisting standing up, draw the user's 'sound foot slightly back,' support the 'affected knee to prevent buckling,' and guide the user to lean forward like bowing to shift their center of gravity forward.

In wheelchair mobility, move forward uphill, but 'move backward down steep slopes'; when ascending a step, step on the tipping lever to lift the front casters; when descending a step, go backward and lower the rear wheels first.

Three-point cane walking on flat ground follows: '(1) Cane → (2) Affected leg → (3) Sound leg.' When 'climbing stairs,' the order is 'Cane → Sound leg → Affected leg'; when 'descending stairs,' it is 'Cane → Affected leg → Sound leg.'

When guiding a person with visual impairment, the care worker stands 'half a step ahead' on the side opposite the white cane, allowing the user to lightly hold just above the worker's elbow.

Transfers in Hemiplegia, Wheelchair Operation, Cane Walking, and Guiding Visually Impaired Users

Key points


  • Place the wheelchair on the 'sound side'; move 'backward' when descending steep slopes or steps in a wheelchair

  • Cane walking: Flat ground and descending stairs follow 'Cane → Affected → Sound'; ascending stairs follows 'Cane → Sound → Affected'; guide visually impaired users from 'half a step ahead'
WordMeaning
Transfer from the sound side and preventing affected knee buckling
Tipping lever and backward descent on slopes
Three-point cane gait (Cane → Affected → Sound) and stair navigation
Half-step-ahead guidance for visually impaired persons

Grooming, Oral Care, and Dressing / Undressing (Dakken Chakkan)

'Grooming' (washing the face, hair styling, shaving, makeup) not only maintains hygiene but boosts vitality and motivation for social participation. Move electric razors against the grain while stretching the skin.

Clip nails after bathing when soft, using a 'Square Cut' (cutting straight across and filing corners) to prevent ingrown nails. If redness, swelling, pus, or severe deformity is present around the nail, refer to medical staff without cutting.

In oral care, maintain a 'slightly forward-leaning posture with the chin tucked' to prevent aspiration, holding the toothbrush in a pen grip to brush 1–2 teeth at a time. Move tongue brushes gently 'from back to front' to avoid the gag reflex.

Full dentures are 'removed from the lower jaw first and inserted into the upper jaw first,' and removed dentures must be stored 'in water' (or denture cleanser solution) to prevent warping from drying (never use boiling water).

When dressing or undressing a person with hemiplegia, the golden rule to protect joints is 'Dakken Chakkan'—'undress from the sound side first, and dress from the affected (paralyzed) side first.'

Key points


  • Use Square Cut for nails, brush the tongue 'from back to front,' and store dentures 'in water' to prevent warping

  • Follow 'Dakken Chakkan' (undress sound side first, dress affected side first) for clothing assistance
WordMeaning
Square Cut (nail clipping method)
Pen grip and tongue brushing (from back to front)
Full denture insertion/removal and storage in water
Dakken Chakkan (undress sound side, dress affected side)

Meal Assistance, Aspiration Prevention, and Disease-Specific Nutrition / Hydration

A safe eating posture involves sitting deeply in a chair with 'both soles flat on the floor,' leaning the trunk slightly forward, and 'lightly tucking the chin' (cervical flexion). Tilting the chin up opens the airway and increases aspiration risk.

Sit at eye level with the user, moisten the mouth first with tea or soup, place about one teaspoonful onto the 'tongue on the sound side,' and confirm complete swallowing before offering the next bite.

For snacks in dysphagia, avoid crumbly sponge cake or sticky mochi, monaka wafers, and konjac jelly; choose smooth, cohesive foods such as 'pudding, mousse, or soft jelly.'

By condition: users on 'hemodialysis' require restrictions on water, salt, potassium (abundant in raw vegetables/fruit; reduce by boiling vegetables and discarding the water), and phosphorus; users with 'gastroesophageal reflux disease' should avoid fatty foods and remain upright after meals.

For users with 'left unilateral spatial neglect,' place dishes toward the right side or verbally cue attention to the left; during sweating, diarrhea, or fever, replenish fluids frequently with 'oral rehydration solution' (ORS) or warm water.

Key points


  • Eating posture: 'Soles flat on the floor, slight forward lean, chin tucked'; place food on the 'sound side' and confirm swallowing

  • Hemodialysis restricts water, salt, potassium (boil and discard water), and phosphorus; avoid lying down immediately after meals in reflux
WordMeaning
Eating posture (soles flat on floor and chin tuck)
Placing food on the sound side and confirming swallowing
Hemodialysis diet (potassium, phosphorus, salt, and fluid restriction)
Tray placement for left spatial neglect and Oral Rehydration Solution (ORS)

Bathing, Partial Baths, Full-Body Bed Bath, and Perineal Wash

Bathing provides thermal, hydrostatic pressure, and buoyancy effects; to prevent blood pressure spikes from temperature differences (heat shock) and indigestion, pre-warm the changing room and bathroom and avoid bathing within 1 hour after meals.

When a person with hemiplegia steps over the bathtub rim, to support their center of gravity safely, the basic rule is to 'step in with the sound leg first AND step out with the sound leg first' (using a bath board is also effective).

When regular bathing is difficult, provide 'special mechanical baths' (stretcher baths), 'foot or hand baths' to promote circulation and sleep, bed hair washing using a Kelly pad, or a 'full-body bed bath' (Zenshin Seishiki).

In a full-body bed bath, wring towels in hot water at 50–55°C (about 40°C when touching the skin), minimize exposure, and wipe in the order: 'Face → Upper limbs → Chest/Abdomen → Back → Lower limbs → Perineum.'

Wipe the eyes in one direction 'from the inner corner to the outer corner,' wipe limbs 'from distal (extremities) to proximal (toward the heart)' to aid venous return, and wipe the abdomen 'clockwise in a circular motion around the navel' following the colon.

For perineal washing, use warm water at 38–39°C and always wash and pat dry in one direction 'from front (pubic/urethral side) to back (anal side)' to prevent urinary tract infections.

Bathing, Partial Baths, Full-Body Bed Bath, and Perineal Wash

Key points


  • Hemiplegia bathtub entry/exit: 'Step in with the sound leg first and step out with the sound leg first'; avoid bathing right after meals

  • Full-body bed bath: Eyes 'inner to outer corner,' abdomen 'clockwise,' limbs 'distal to proximal,' perineum 'front to back'
WordMeaning
3 physiological effects of bathing and Heat shock prevention
Bathtub entry and exit in hemiplegia (sound leg first both ways)
Full-body bed bath directions (inner-to-outer eye, clockwise abdomen, distal-to-proximal limbs)
Perineal wash (38–39°C, front to back)

Excretion Care, Suppositories, Glycerin Enemas, and Stoma Care

In excretion care, prioritize privacy and sensitivity to embarrassment; utilize the 'gastrocolic reflex' occurring after breakfast and encourage natural defecation in a forward-leaning posture on the toilet or portable toilet.

During diaper changes, layering multiple pads creates gaps that cause leakage, dampness, and pressure ulcers; choose pads matching body size and urine volume, and raise the leg gathers snugly along the groin.

When assisting with 'suppositories' (non-laxative suppositories require prior defecation), position the user in the 'left lateral position' and insert from the 'thick (pointed) tip first' while the user exhales through the mouth.

When assisting with a disposable 'glycerin enema,' warm the solution to '39–40°C' and position the user in the 'left lateral position'; never insert in a standing position due to the risk of rectal perforation.

Because an intestinal 'stoma' (colostomy/ileostomy) lacks sphincter muscles, bowel movements cannot be controlled; empty the pouch when stool fills 'one-third to one-half' of the bag, and peel the skin barrier slowly while pressing down the skin.

Key points


  • Promote natural defecation using the post-breakfast 'gastrocolic reflex' and forward-leaning posture; avoid double-layering diapers

  • Glycerin enema: '39–40°C in left lateral position (standing strictly prohibited)'; empty stoma pouches at 1/3 to 1/2 full
WordMeaning
Gastrocolic reflex and forward-leaning defecation posture
Suppository insertion (pointed/thick end first)
Glycerin enema (39–40°C, left lateral position)
Stoma (colostomy / urostomy) and pouch management

Housework Support (Cooking 'Sa-Shi-Su-Se-So,' Food Safety, Laundry, Consumer Protection)

In cooking support, the basic seasoning order 'Sa-Shi-Su-Se-So' stands for 'Sa = Sugar, Shi = Salt, Su = Vinegar, Se = Soy sauce, So = Miso'; add sugar before salt because its larger molecules penetrate more slowly, and add soy sauce and miso last to preserve aroma.

On food labels, 'Use-by Date' (Shouhi Kigen) indicates the 'safety limit' for perishable foods, whereas 'Best-before Date' (Shoumi Kigen) indicates the 'quality/taste limit' for shelf-stable foods.

The 3 principles of food poisoning prevention are 'Do not attach, Do not multiply, Destroy'; bivalves or foods at risk of Norovirus must be heated to a core temperature of '85–90°C for 90 seconds or longer.'

In clothing care, check laundry symbols, remove plastic covers after dry cleaning to prevent moisture buildup and residual solvents, and place 'mothballs (insect repellents) on top of clothing' because their gas is heavier than air.

In shopping and money management support for older adults living alone or with dementia, if suspicious door-to-door sales or excessive contracts are found, connect promptly with the cooling-off system, the Consumer Hotline ('188'), or the Community General Support Center.

Key points


  • Seasoning order 'Sa-Shi-Su-Se-So (Sugar → Salt → Vinegar → Soy sauce → Miso)' and Norovirus heating (85–90°C for ≥90 seconds)

  • Place mothballs 'on top of clothing' (gas is heavier than air), and report consumer fraud to Consumer Hotline '188'
WordMeaning
Sa-Shi-Su-Se-So seasoning order
Use-by Date (safety limit) and Best-before Date (taste limit)
Placement of mothballs (on top of clothes)
Consumer Hotline (188) and Cooling-off system

Sleep Support, End-of-Life Care, and Utilization of Assistive Devices

To promote quality sleep, get morning sunlight to reset the biological clock, stay moderately active during the day, and take a warm bath or foot bath 1–2 hours before bed. In bed-making, pull sheets taut without wrinkles to prevent pressure ulcers.

In end-of-life (terminal) care, gently explain natural physical changes—such as decreased food/fluid intake, mandibular breathing, and 'Cheyne-Stokes respiration' (alternating deep breathing and apnea)—to alleviate family anxiety.

After a physician confirms death, perform 'Angel Care' (post-mortem care preserving dignity and a peaceful appearance), 'Grief Care' (supporting bereaved family members), and a 'Death Conference' (team reflection to improve future care).

For mobility aids, select 'Lofstrand crutches' (supported at two points by forearm cuff and grip) for users with weak grip strength or rheumatoid arthritis, 'multi-point canes' for high stability, or 'reciprocal walkers' matched to physical function.

Additionally, utilize self-help devices (Jijogu) and daily living aids such as 'sock aids,' 'button hooks,' portable conversation aids, and Braille slates, while continuously monitoring their fit after introduction.

Sleep Support, End-of-Life Care, and Utilization of Assistive Devices

Key points


  • Understand Cheyne-Stokes respiration in terminal stages and the purposes of Angel Care, Grief Care, and Death Conferences

  • Select appropriate assistive devices: Lofstrand crutches (forearm support), multi-point canes, bath boards, and sock aids
WordMeaning
Cheyne-Stokes respiration and Mandibular breathing
Angel Care, Grief Care, and Death Conference
Lofstrand crutches, Multi-point canes, and Walkers
Self-help devices (Sock aid, Button hook)

Daily Living Support Skills

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Official references