5. The development of the long-term care system until now and future issues

(1) Development until now

1) Nov. 1999	�@	'Special measures for the smooth implementation of the long-term care insurance system' Special measures for insurance premiums of the elderly, etc.
2) Apr. 2000		The Long-term care insurance law was enforced. Indications that the short-stay service is hard to use because of the limits of usage. (Enforced 'replacement' of home-visit outpatient services with short-stay services) At first, it started as a provisional care plan. Indications regarding the evaluation of senile elderly persons in primary screening(screening by computer) of long-term care requirement certification.
3) Sep. 2000		'Improvement measures for the fixation of the long-term care insurance system' (Agreed by the three government parties) The ideal way of home-visit long-term care (Within the range of housework assistance as insurance benefits) Short stay service (Unification of limits of benefit payments with home-visit outpatient service) Measures for persons with low income (Reduction of user's cost sharing by social welfare foundations) Adjustment of the foundation for long-term care Improvement in the nature of care managers
4) Oct. 2000		Receipt of 50% of insurance premiums by elderly persons begins Rate of receipt 98.6% (premiums for FY 2000)
5) Oct. 2001		Receipt of original amount of insurance premiums by elderly persons begins

(2) Future issues and schedule

�@1)	Improvement of the Quality of Long-term care services

• One of the biggest future issues for the long-term care insurance in the middle to long run, is the improvement in the quality of long-term care services. For the moment, emphasis will be put on the following issues.

  (a)	Professional training for the improvement of long-term care for senile patients, study on long-term care for senile patients, other measurements for senile patients
  (b)	Promotion of the 'No Physical Restraint Campaign'
  (c)	Evaluation of long-term care services
  (d)	Increase single rooms and grou-care units at special nursing homes for the elderly
  (e)	Further assistance for care managers

�@2)	Preparation of the basis for provision of long-term care services

• Preparation of the basis for provision of long-term care services is steadily promoted along with the Gold Plan 21.
• Also, in the proposal for the FY2002 budget, the following two items have been included..

  (1)	In terms of special nursing homes for the elderly, construction of new-type homes characterized by all single rooms and group-care units shall be promoted. Along with this promotion, a scheme shall be made in which residents in the new-type homes pay a certain amount of accommodation fees, though there are some considerations for people with low income. ( from FY2003)
  (2)	In terms of "Care houses," constructed for the purpose of promoting assisted living, the category of entities that are permitted to run those care houses shall be expanded to for-profit private companies and other entities, and construction of those houses shall be promoted, in the style of public ownership and private management, through the use of PFI (Private Finance Initiative) scheme.

�@3)	Preparation for the second-stage planning for long-term care service from FY2003

• There is a need for preparation for revising municipal planning for long-term care service provision, as well as for revising the premium table.
• There is a need for preparation of revising the long-term care insurance fee table. It is planned to establish the Committee on Long-term Care Service Fee in the Social Security Council and examine the issues in the Committee. Also, a survey on the financial situations of service providers shall be conducted.