the long-time care insurance system in japan kentaro horibe senior specialist for dementia office...
TRANSCRIPT
The Long-Time Care Insurance System in Japan
Kentaro HORIBESenior Specialist for Dementia
Office for Dementia and Elder Abuse PreventionHealth and Welfare Bureau for Elderly
Ministry of Health, Labour and Welfare (MHLW)Japan
And a glimpse of what we are struggling to go forth,to support the people of dementia.
President of The Gambiac/o Minister of Foreign AffairsInternational Cooperation and Gambians AbroadMr. Mamburay NjieMinistry of Foreign Affairs4, Marina ParadeBanjul, The Gambia
IntroductionLong-Term Care Insurance (LTCI)Changeing the wordProgrammes and Services specialized
for Dementia in Japan
Contents for Today
Proportion of People Aged 65 and over(%)
Growing Number of People with DementiaComparison of several previous estimates
(thousand)
The Place where People with Dementiahope to lead a life for the years to come:
Intention Survey
Tokyo, 2009Toyama Pref., 2001
Home,if possible
OtherPlaces
No definiteanswer
DefinitelyHome
Note: Percentages show the ratio to the households of which a householder is 65 and overSource: Estimation of the number of households in Japan (estimation in October 2003), National Institute of Population and Social Security Research
(10,000 households)
2005 2010 2015 2020 2025
General 4,904 5,014 5,048 5,027 4,964
Householder aged 65 or over
1,338 1,541 1,762 1,847 1,843
Single (percentage)
38628.9%
47130.6%
56632.2%
63534.4%
68036.9%
Couple only
(percentage)
47035.1%
54235.2%
61434.8%
63134.2%
60933.1%
Estimation of Future Forms of the Elderly Households
Long-Time Care Insurance
2000
Establishment of the public LTC Insurance System
1st April
Long-Term Care Insurance System
1. to support those who are facing the need of LTC as a whole,
2. to clarify the relationship between benefits and burdens, by way of introducing a social insurance approach,
3. to enable service users receive comprehensive services from a variety of institutions of their choice,
4. to separate LTC from coverage of health care insurance
Aimed
Long-Term Care Insurance System
Insurers (Municipalities)
premiums
Service Providers
25Nation
12.5Prefecture
12.5Municipality
Certified
copayment
Service
InsuredParticipants
The insured
40 65age
Category 2
Category1
Doctor's opinion Investigation for certification
In-facility Service
In-Home ServiceCommunity-
basedService
PreventiveIn-Home ServiceCommunity-based Service
CommunitySupport
Programme
Support Level 1,2 Care Level 1-5Self-supporting
Care PlanPreventive Care Plan
LCT requirement certification (Certification Committee)
Municipality's window for application
Support
level 1Care level 2 Care level 3 Care level 4 Care level 5
Standing up Sitting up Standing on one leg
Walking Body washing Money management Nail clipping
Dietary intakeCommunication
SwallowingMemorizing and
understandingCh
ara
cteri
stic
of
Ph
ysi
cal
Ab
iliti
es
by C
are
Level
Support level 2
Care level 1
Support level 2 and care level 1 are classified based on the stability of conditions or the possibility of improvement.
Putting on and taking off pants, etc. Moving around Decision making involved in daily life
Facial washing Hair dressingMouth cleaning Urination and defecationTransfer from/to bed
Image of Physical Abilities by Care Level
Increase of Service users(thousand)
200020012002
200320042005
200620072008
200920102011
201220132014
3,293 Yen
($ 42)
4,090 Yen
($ 52)
2,911 Yen
($ 37)
Operation period (JFY)
BenefitsService plan Insurance premiums(National average)
4,160 Yen
($ 53)
Three-year cycles of LTCI Scheme
4,972 Yen
($ 63)
1st Phase
2nd Phase
3rd Phase
4th Phase
5th Phase
In-facility service
Special Nursing Homes for the Elderly, Health Care Facilities etc.
In-facility service
Special Nursing Homes for the Elderly, Health Care Facilities etc.
Residential Services
Day Care Services for the Elderly at Fee-charging Homes and People with Dementia etc.
Residential Services
Day Care Services for the Elderly at Fee-charging Homes and People with Dementia etc.
Short-stay Service
Short-stay Daily Life Services etc.
Short-stay Service
Short-stay Daily Life Services etc.
Day Services
Day Care, Day Rehabilitation Service etc.
Day Services
Day Care, Day Rehabilitation Service etc.
Home-visit Services
Home-visit Care, Home-visit Nursing, Home-visit Bathing Service, In-home Care Support etc.
Home-visit Services
Home-visit Care, Home-visit Nursing, Home-visit Bathing Service, In-home Care Support etc.
LTCI Services
Care Manager
Total cost: LTC benefit and 10% copayment by users
(Trillion Yen)
Financial trend of the LTCI
2001
2002
2003
2004
2005
2006
2007
2008
2009
2000
2011
3.6
5.7
4.65.2
6.2 6.4 6.46.9 7.2
7.7 7.98.3
2010
(JFY)
Evaluation of the LTCI among the general public
Opinion Survey on LTCI, 2010
Changing the word
2004
Replacement of the word for "Dementia"
The day before Christmas
Changeing the Word
Chihō
Another Word-Hunting?
Idiocy
痴 呆Stupidity
Public opinion
as an administrative term
as a medical term
56.2%
48.9%
Ratio of people who feel the word "Chihō"unpleasant or insulting
n=6,333
認知障害 Cognitive Impairment22.6%
認知症 Cognitive Disorder 18.4%
記憶障害 Memory Impairment13.6%
アルツハイマー症 Alzheimer's Disorder 11.4%
もの忘れ症 Forgetfulness Disorder 11.3%
記憶症 Memory Disorder 7.5%
痴呆の方がまし rather remain chihō5.4%
Candidates for the alternative term
be easily understandable to the general public. Short, if possible.
avoid evoking unpleasant, insulting, nor gloomy feelings.
be unmistakably interpreted to be the identical concept of the former word.
The New word was expected to;
Changeing the Word
Chihō Ninchishō
In 2004, the Japanese Government replaced the word for "Dementia"
Another Word-Hunting?
痴Idiocy
呆Stupidity
認知Cognition
症Disorder
After the announcement2004
Dec. 24
2005
Oct. 1 Japan Society for Dementia Researchdetermined to accept the new word,replacing the word within its title.
Japanese Psychogeriatric Societydetermined to accept the new word.
Jun. 16
Jun. 29 Revision of the laws to replace related legal terms(e.g. LTCI ACT, Elderly Welfare Law)
Announcement of the new word to the public
言霊
Kotodama or kototama ( 言霊 lit. "word spirit/soul") refers to the Japanese belief that mystic powers dwell in words and names…
......the notion of kotodama presupposes that sounds can magically affect objects, and that ritual usages can influence our environment, body, mind, and soul....
Kotodama –Wikipedia(en)
Programmes specialized for Dementia
Seminar to train "Dementia Supporters" (90 min)2,463,064 attendees as of 31 March, 2011
"Dementia Supporters"
What are "Dementia Supporters"?
- Who, with good knowledge of dementia, support the people with dementia and their families, with what they can do in their everyday life.
Workshop to train "Caravan Mates",or lecturers for Dementia Supporters (6 h)61,449 participants as of 31 March, 2011
Caregivers,Communities
Specialists
Seminar for PCPto Upskill Dementia Practice
(250min)26,000
PCP(Primary Care Physician)
Support Doctorsfor Dementia
1,700
Training Doctors
Services specialized for Dementia
Long-Term Care
MedicalCare Community
PeopleLivingwith
Dementia
Conceptional Image
Short Stay Care Service(Short-Term Admission for Daily Life Long-Term
Care)
Home-Visit Care Service
Group Home(Communal Daily Long-Term Care for a Dementia
Patient)
In-Home Services
Small-scale Multifunctional in-Home Care
Day Care Service(Outpatient Day Long-Term
Care)
In-Home Services
Community-BasedLTC Services
Short Stay Care Service(Short-Term Admission for Daily Life Long-Term
Care)
Home-Visit Care Service
Group Home(Communal Daily Long-Term Care for a Dementia
Patient)
Small-scale Multifunctional in-Home Care
Day Care Service(Outpatient Day Long-Term
Care)
Community-BasedLTC Services
Designed to support the elderly keep their living in familiar environment.
Municipalities are in charge to make the most of its closeness with local communities within, whilst most of other services are governed by prefectures.
Small-scale Multifunctional in-Home Care To support living in their own homes.
1. Outpatient Day Care
2. Home Visit(When necessary)
3. Short-stay Care(when necessary)
Inclusivecopayment! All with
Same Caregivers!
Small-scale Multifunctional in-Home Care To support living in their own homes.
Designed to support "life" of the elderly as a whole.
Group HomeTo live communally in homely environment.
Bath
W.C.
Public Space(Kitchen, Dining, etc.)
Steering Committee involving neighbour representative.
Daily intercourse with neighbourhood is mandatory.
Intensive Care Home for the Elderly
Long-Term Health Care Facility
Sanatorium Medical Facilityfor the Elderly Requiring LTC
In-Facility ServicesM
ed
ical N
eed
More likeHospital
More likeHome
Others (ex. ordinary care homes)
Intensive Care Home for the Elderly
Long-Term Health Care Facility
Sanatorium Medical Facilityfor the Elderly Requiring LTC
In-Facility ServicesM
ed
ical N
eed
More likeHospital
More likeHome
Others (ex. ordinary care homes)
Numbers of "Unit type" Intensive Care Homes
"Unit Care" in Intensive Care Homes
Public Space
Admiring individuality and life rhythm of every single resident
27% ofall Intensive Care Homes in Country
Community General Support Centre
CertifiedSocial Worker
ChiefCare Manager
Public HealthNurses
Coordinate Cross-system Support(Volunteers, Medical Service, LTC Services, LTC counselors, Social Workers, Regional advocacies, Health Services, Guardianship, Abuse Prevention, etc.)
Located in every municipalities,planned for every junior high school district.
For seamless, continuous support for the elderly
GlobalConsulting
Preventive LTC
Management
General, ContinuousCare Management
Support
Advocacy,Prevention of Elder Abuse
3. Medical Care Early Diagnosis and Treatment
2. Research Causes, Risk reduction, Drugs, …
4. Long-Term Care (LTC) & Support
5. Actions for Young Onset Dementia
1. Epidemiologic Survey
from : "The Urgent Project on Improving the Quality of Medical Treatment and of Life with Dementia" 2008
Minamisanriku Town, Iwate Pref.
LTC insurance system has now become indispensable in supporting the people in need of LTC, including dementia.
Changeing the word have worked well in Japan.
Spreading good public knowledge and designing optimized services for dementia may contribute making our community worthwhile to live in, even after we suffer dementia.