Strategies for Integrated Case Questions: Reading Cases like a Care Worker

Integrated case questions（総合問題）· Material

総合問題 · Updated 30 October 2026

総合問題 are case-based questions （事例）: one user’s story is read to answer several questions that mix many fields at once — dementia, life support, medical care, family, and community services. This field adds no new theory; what is tested is assessment （アセスメント） and priority-setting （優先順位）, just like a real care worker.

The anatomy of a case question

Each case presents a complete profile: age and sex, illnesses and their history, the level of ADL independence, family and living conditions, services currently in use, and the wishes of the user and their family. Details that seem trivial — for example “lives alone”, “children live far away”, “just discharged from hospital” — are almost always the key to the answer.

The questions then ask about things across fields from the same case: the right communication response, risks that must be prevented, service support that needs to be added, and how to respond when the user’s wishes conflict with the family’s wishes.

• Read the case profile as one whole, not question by question
• Family and living-arrangement details are almost always relevant
• One case tests many fields at once

How to read: mark four things

Get into the habit of marking four things as you read: (1) medical conditions and medications that affect risk, (2) ADL abilities — what the person can and cannot still do, (3) the user’s own wishes, stated clearly, and (4) the resources around them — family, neighbours, and formal services already running.

Then match each answer option against those marks. Options that ignore the user’s written wishes, skip over medical risks, or mobilize services that do not exist in the case are usually not the answer being looked for.

• Mark: medical, ADL, the user’s wishes, resources
• Eliminate options that clash with the case content
• The user’s explicitly stated wishes carry great weight

Setting answer priorities

When a question asks for the most appropriate or highest-priority response, the order of thinking is: safety of life and prevention of urgent danger first, then basic needs (eating, toileting, cleanliness), then comfort and social relationships. But this priority is always weighed against dignity: an action that is safe but demeaning, or forced without explanation, is rarely the best answer.

The answer pattern the exam favours: involve the user in decisions, use community resources and the interprofessional team （多職種連携）, choose the method that restricts freedom the least, and pass matters outside your authority to the right profession — for example, new medical symptoms are reported to a nurse or doctor, not handled alone.

• Priority: safety → basic needs → social
• Safety without dignity is rarely the best answer
• Outside your authority? Bring in the right profession

Recurring case themes

A few themes appear almost every time: an older adult with dementia who refuses care (testing communication and acceptance of feelings), a single older adult discharged from hospital (testing 退院支援 and the home-service network), end-of-life care at home （看取り） testing support for the wishes of the user and family, and an exhausted family caregiver (testing caregiver support and respite services).

For these themes, remember the fixed framework: listen to the user’s wishes, assess the risks concretely, assemble support from the available services （地域資源）, and evaluate together with the team. Answers that leave everything to the family, or conversely ignore the family, are usually the wrong choice.

• Favourite themes: dementia, hospital discharge, 看取り, tired caregiver
• Framework: wishes → risks → resources → team evaluation
• The family is a partner, not a substitute for services

Key terms

Frequently tested points

• Read the whole case before answering — later questions often use early details.
• Extreme options (“always”, “never”, forcing) are almost certainly wrong.
• The best answers balance safety with the user’s wishes.
• New medical matters outside kaigo’s authority are passed to a nurse or doctor.

Independent study material for the Japanese national Certified Care Worker exam (介護福祉士国家試験). Official terms and rules may change — always cross-check with the latest official sources.