Section 2. Establishment of the Long-Term Care Insurance System and the Development of Long-Term Care Service Supply System

While anticipating the arrival of super aged society in the 21st Century right in front of us, it is critical that long-term care services are available "at anytime, anywhere, and to anybody" to respond to the greatest concerns of long-term care in old age and to realize the society where all people can live their lives in old age with the feeling of security. To achieve this goal, the Ministry of Health and Welfare is promoting the New Ten-Year Strategy to Promote Health Care and Welfare for the Elderly (The New Gold Plan) that is the compilation of health and welfare plans for the elderly formulated by all local governments in Japan.

The New Gold Plan presents the basic framework for the measures to point out the directions for the development of various services by indicating that it is urgent to develop the infrastructure for long-term care service for the elderly. It determines the basic concept as 1 user-orientation and self-sufficiency support, 2 universalism, 3 provision of comprehensive services, and 4 localism. For smooth implementation of the long-term care insurance system in April 2000, it is critically important to develop the long-term care service supply system in an orderly manner based on the New Gold Plan.

According to the progress with the New Gold Plan, overall projects are making sound progress, but there are some gaps in the progress between regions and service types, and some regions are behind the schedule for developing the service supply system for in-home care services. While many elderly people wish to live at their own home and community as long as possible, some must move to special nursing homes for the elderly even though they are in the condition well enough to live at home because the development of in-home service supply system is insufficient. Or, some of them who moved into a special nursing home for the elderly cannot be released from the facility even when their conditions have improved to require no more care. Thus, there are excessive demands for institutional services.

Table 2-2-1. Progress of the New Ten-Year Strategy to Promote Health Care and Welfare for the Elderly
(The New Gold Plan)

Figure 2-2-2. Fiscal 1997 Edition of the Service Usage Map for Health and Welfare Services for the Elderly
(Health and Welfare Service Map for the Elderly)
- Use of In-home Welfare Services and the Ratio of Admission Capacity for Special Nursing Homes for the Elderly -

Table 2-2-3. Conditions of Using In-Home Services

In contrary, metropolitan areas are behind the schedule to develop care facilities due to the high price of land. Because of this problem, following promotions measures are applied when service facilities are to be built in urban areas: 1 Allowing social welfare foundations to rent property from owners other than national or local government bodies, 2 Additional land area to the standard area for the state subsidy when constructing tall facility buildings (Not more than 8% of the standard area for subsidy), and 3 Additional unit cost for the standard cost for state subsidy (Additional 10% to the unit price of non-urban area).

2. Actions for Achieving the Goals of the New Gold Plan

(1) Securing necessary budget

Based on the understanding of the progress with the New Gold Plan, necessary budgets are secured every year to achieve the goals. In fiscal 1999, required funds to achieve the target values for the New Gold Plan were budgeted for all items, except for economical nursing homes for the elderly (Care houses). Particularly for special nursing homes for the elderly and home-visit care providers (home helpers), the budget required for 300,000 users and 178,500 home helpers have been secured. These values are higher than the target values for the end of fiscal 1999 in the New Gold Plan (For 290,000 users and 170,000 home helpers in the plan).

(2) Deployment of measures in accordance with the conditions of individual regions

To facilitate for the deployment of measures for long-term care services in accordance with the conditions of individual regions, the following actions have been in place:

1 Entry of various business entities for in-home services

In order to adequately respond to the increasing demands for long-term care services and to ensure service users opportunities to select services, it is important to provide long-term care services through a variety of business entities in addition to social welfare foundations such as private-sector companies, agricultural cooperatives, consumers' cooperatives, silver human resources centers, non-profit organizations in which community residents participate, etc. Particularly for in-home services, the long-term care insurance system basically allows any organizations, regardless of public or private entities, to enter the business by meeting a certain requirement, and the efforts must be carried on to this direction from now.

Municipalities have been promoting the efforts to contract with a variety of organizations including private-sector companies for home-visit care (home help services), and in February 1998 they were permitted to contract with private-sector companies for commuting care service facilities (day services) and for short-term stay care facilities (Short-stay).

In addition, to understand the issues and problems in the utilization of private-sector companies, agricultural cooperative associations, etc. in depopulated areas, "A trial project to promote in-home health and welfare services in depopulated areas" was implemented in fiscal 1997, and to understand the issues and problems in the utilization of private-sector non-profit organizations in urban areas, "A trial project to promote in-home health and welfare services in which residents can participate in urban area" has been implemented since fiscal 1998.

2 Effective use of currently available facilities

To provide long-term care services efficiently, it is also important to use existing social resources effectively. Based on this concept, the asset disposal process is simplified when utilizing unused classrooms in public schools for day service facilities for the elderly (day service center for the elderly) or when remodeling abandoned school buildings to create welfare facilities for the elderly such as special nursing homes for the elderly. Furthermore, in fiscal 1997 day service project using existing facilities (satellite type day service) was implemented for active deployment of commuting care services (day services) using existing facilities such as community halls and public bathhouses.

3 Reconstruction of in-home care support centers

In-home care support centers are expected to take charges in consultation and support functions on comprehensive health and welfare services in local communities after the implementation of the long-term care insurance system. Considering this circumstance, in fiscal 1998 in-home care support centers were permitted to take various different forms with the requirement to form a communication support system to control all in-home care support centers within the responsible area. In addition to the conventional form, "Standard type", of staying side-by-side with special nursing homes for the elderly, "Single type" is also an option in which the support center can rent an office in an office building in a large city, or it can be developed in the form of "Main business type" which is residing next to a municipal facility such as health and welfare centers to control both management and support functions. Or, such functions can be contracted to private-sector companies.

1 Group homes for the senile elderly

One of major issues in health and welfare services for the elderly in the future is long-term care for the elderly with dementia. As a measure for this issue, the concept of group homes for the senile elderly is capturing attention. This is a small scale facility (A small group of people, about 8 persons, live together in a form of communal living) where elderly people share the tasks of preparing meals, cleaning, laundry, etc., and it aims to provide a living place for them to live in home-like atmosphere and to keep their mental condition stable. To test the efficacy of group homes for the senile elderly, a trial project was conducted and the result indicated various effects such as slow progress of dementia and stabilizing symptoms. Based on these results, financial aid was provided to the operation cost for fiscal 1997, and in the 3rd supplementary budget for fiscal 1998, financial aid was established for the facility development of social welfare foundations, etc. In addition, group homes for the senile elderly are already added to the services covered by the insurance benefit of the long-term care insurance. We need to take active efforts for further development of these homes.

2 Abolishing the regional limit for multipurpose senior centers

Multipurpose senior centers are small size facilities for multiple functions and consisting with facilities for day care services (day service center for the elderly) for about 10 users and residential section. They are facilities with comprehensive service functions for the elderly including support function, living function, and communication and exchange function. Previously, these centers were created only in depopulated areas and isolated islands, but considering the benefits of the centers such as relatively small burden on the users and the center can be used as residential place for the elderly people who are released from special nursing homes for the elderly when the center is placed adjacent to nursing homes, the regional limit was abolished with the 3rd supplementary budget for fiscal 1998 and all multipurpose senior centers in Japan including urban areas became eligible for financial aid for facility development cost and operation cost.

3 Promotion of measures to support livelihood support and fulfillment for the elderly

The goal of health and welfare service measures for the elderly is leading not only the elderly in the condition to require care but all elderly people to live with the sense of security and fulfillment. In the scheme of long-term care insurance system, it is also necessary to improve the measures for preventing the elderly becoming the condition from requiring care, so that the elderly feel fulfillment in life and promote health.

Considering these needs, municipalities as the insurers of the long-term care insurance are going to establish the "Support program to promote health and welfare of the elderly at home" to enable the comprehensive implementation of health and welfare measures including the view of fulfillment, health promotion and preventative health measures according to the conditions of individual communities. This program is for the national and prefectural governments to provide aid to municipalities when they implement various measures such as fulfillment measures to support the elderly to participate in sports and volunteer activities and prevention measures for bedridden elderly in accordance with the conditions of own region in addition to livelihood support measures of meal delivery services and transportation services for the elderly.

Furthermore, to respond to elderly people desiring to work, the "Program for supporting the employment of the elderly for the promotion of their fulfillment" will be implemented in fiscal 1999 in collaboration with the Ministry of Labor. This program is based on the consideration of survey conducted on the members of old people's club regarding their desire for employment, and the program supports temporary and short-term employment of the elderly for the purpose of promoting fulfillment in life through investigating the possibility of creating new job opportunities as well as developing a system to accept the elderly into work place in a joint effort with the Federation of Old People's Clubs, and the Federation of Organizations of Silver Human Resources Centers. For fiscal 1999 this program is scheduled for trial implementation in about 15 locations throughout Japan.

3. Developing the Long-Term Care Service Supply System under the Long-Term Care Insurance System

For the long-term care insurance system individual municipalities are assigned to create the business plan for the long-term care insurance with understanding of the actual conditions of long-term care needs, etc. by projecting the required long-term care services in the future. During fiscal 1999 all municipalities in Japan are expected to create the first phase of the five-year plan of fiscal 2000 to fiscal 2004, and the preparation for service supply system for the five year period will begin in accordance with the plan. The Ministry of Health and Welfare intends to actively provide necessary support to these efforts.