The Long-Time Care Insurance System in Japan Kentaro HORIBE Senior Specialist for Dementia Office for Dementia and Elder Abuse Prevention Health and Welfare.

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.