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Independent Living Becomes New Focus of Attention

January 11, 2001
Care workers help a man to go outside. (PANA)

Less than a year has passed since the Long-Term Care Insurance system was introduced. The new scheme, which was launched in April 2000, covers part of the costs of caring for elderly people as social insurance. Since its institution, however, problems relating to its management have arisen, such as the gap between insurance premiums and available services and the lack of objective standards for assessing the need for care. Concerns have also been raised that the growing number of elderly people and inevitable increase in demand for services will necessitate premium hikes and may even threaten the system's fiscal viability. Faced with this situation, the Ministry of Health, Labor and Welfare has decided to implement a program to encourage older people in good health to continue living at home without outside help. Scheduled to take effect in fiscal 2001 (April 2001 to March 2002), the program covers the formulation of "care-prevention plans" by local in-home care support centers for up to one million people, mainly those who have been classified as "independent" in the assessment process.

The Core of the Care-Prevention Program
The Long-Term Care Insurance system was designed to relieve the heavy burden on families that are faced with the task of caring for elderly members. The problem has been exacerbated by a number of trends, including the growing number of elderly people who are bedridden or have dementia, burgeoning care needs due to the growing length of time services are required and other factors, the rapid rise in the ratio of nuclear families, and the aging of the adult children who serve as caregivers. The introduction of the system reflects the realization that caring for the elderly is not a problem confined to specific individuals but one facing society as a whole.

Meanwhile, the number of people assessed as requiring care is expected to increase as the population ages, and the use of services will further expand from the present 40% to 50% of the maximum benefits allowed. Currently, half the revenues for care insurance benefits are covered by premiums and the remaining half comes from public funds, with the central government contributing 25% and prefectures and municipalities each providing 12.5%. If more people begin taking advantage of the system, premiums will have to be hiked and the burden borne by the country's fiscally strapped municipalities will grow.

Such a prospect led the Health, Labor and Welfare Ministry to allocate 37.0 billion yen (336.4 million U.S. dollars at 110 yen to the dollar) in its fiscal 2000 budget for care and living support services. The ministry told municipalities that it would subsidize half the cost of programs that aim at preventing elderly people from becoming bedridden or passing their days at home alone and fall into three categories: 1) living support services, such as meal deliveries and assistance on walks, 2) care prevention, including classes on avoiding falls that can cause broken bones and guidance on dietary improvements, and 3) sports and leisure activities. Because of their lack of know-how, however, municipalities failed to make much progress establishing such services.

Nevertheless, some places came up with innovative strategies for formulating care-prevention plans, and the ministry says that it will make these the foundation of its new program. The town of Sanbongicho in Miyagi Prefecture, for example, began using computers to prepare prevention plans, and the city of Higashikurume in Tokyo drew up and undertook a survey on its own to find out how many of its elderly live with their families and such aspects of their lifestyle as financial stability.

The Contents of the Care-Prevention Plans
The ministry has put the roughly 6,000 local in-home care support centers around Japan, which were established to respond to inquiries on Long-Term Care Insurance and other matters, in charge of preparing the care-prevention plans. These centers are classified either as "primary types" that serve as a core facility in municipalities or "regional types" that are run by municipalities themselves or commercial service providers appointed by government offices.

Under the ministry's plan, local care conferences will be organized at the primary centers or in municipalities for health, medical, and welfare officials, and information on conditions in a particular area will be collected for the purpose of drawing up a list of the elderly people who are likely to require care. Individuals who are classified as "independent" or who have not requested care services, as well as a number who qualify for support services, will be the targets of the care-prevention plans.

Local officials will subsequently meet with these people and prepare individual care-prevention plans covering such topics as meal deliveries, health consultations, participation in classes on preventing falls and broken bones, and assistance for taking walks. The cost of drawing up a single plan is estimated at 2,000 yen (18.2 dollars), half of which will be covered by central government funds and the remaining half of which will be covered by prefectural and municipal funds. The ministry hopes to make the care-prevention program one of the two pillars of support services for the elderly, the other being Long-Term Care Insurance.

The ministry is also in the process of putting together a manual on care prevention written by experts in the field, which it hopes to issue by the spring of 2001. It also plans to begin training people who can serve as leaders in care prevention programs at the prefectural level in fiscal 2001.

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Trends in JapanCopyright (c) 2001 Japan Information Network. Edited by Japan Echo Inc. based on domestic Japanese news sources. Articles presented here are offered for reference purposes and do not necessarily represent the policy or views of the Japanese Government.