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20% of special nursing homes refusing elderly people requiring level 3 care: survey

Roughly 20 percent of Japan's special nursing homes for the aged have declined to accommodate elderly people with nursing care level 3 -- those who cannot stand up or walk and need full support to go to the toilet -- according to a Mainichi Shimbun survey.

The primary reason was that many of these facilities prefer to accept patients with higher nursing care levels -- 4 and 5 -- to be eligible for higher compensation from the public nursing care program.

In 2015, the government limited special nursing home accommodation to elderly people requiring nursing care level 3 or higher. However, over 20 percent of the facilities are believed to have vacancies, while there are requests that they accept dementia patients with a nursing care level of 1 or 2. The finding is expected to prompt the government to review its accommodation restrictions at these facilities.

The Mainichi Shimbun queried 1,000 special nursing homes for the aged in Tokyo and Osaka Prefecture as well as 20 government ordinance-designated cities this past February. Of those, 359 facilities responded.

When asked if they decline to accommodate elderly people with nursing care level 3 while considering the possibility that these patients would leave the facility in the future, 66 facilities, or 18.4 percent of respondents, answered in the affirmative. Among these, about 60 percent said they decline such patients if their nursing care level is likely to decline to 2 in the next screening.

The central government provides a higher supplementary subsidy to facilities where at least 70 percent of new patients accommodated over the past six to 12 months require level 4 or 5 care. About 30 percent of the respondents that decline to accept those with care level 3 said losing the extra compensation would be financially difficult.

Moreover, numerous respondents said there are many patients with nursing care level 1 and 2 who should be accommodated in special nursing facilities, such as those with dementia who tend to wander, as well as those being cared for by other elderly family members.

Moreover, 13.6 percent of the facilities have trouble filling all their beds, as the number of people on waiting lists is less than half the number of actual places.

A 2016 survey commissioned by the Health, Labor and Welfare Ministry and carried out by Mizuho Information & Research Institute Inc. shows that 26 percent of special nursing care homes had vacancies. Of these, 9.8 percent said the vacancies were due to low applicant numbers.

The national government has enforced restrictions on accommodations at special care homes for the elderly even though some of these facilities have vacancies and can easily accommodate new patients.

"We can't say it's wrong that such facilities accommodate only those with nursing care level 4 and 5 at their own discretion. But the national government can't adopt a policy of refusing accommodation at such facilities to those with care level 3," a health ministry official said, urging the homes to take in level 3 patients.

Shuhei Ito, professor at Kagoshima University Faculty of Law, Economics and the Humanities and an expert on the public nursing care insurance system, told the Mainichi, "The survey has clarified that the national government is tightly restricting accommodation at these facilities. However, the policy isn't effective in decreasing the number of those cut off from nursing care services, raising concerns among patients and their families.

"Superficial government policy measures have reached their limit. The government should fundamentally review the system by spending more public funds on the expansion of these facilities," he added.

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