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Editorial: Regional communities should play bigger role in improving nursing care

The Diet is set to pass a bill to amend the Long-Term Care Insurance Act, which provides for rules on the public nursing care system, and bring the amendment and other relevant legislation into law during the current Diet session.

The total amount of benefits provided under the nursing care insurance system, which stood at 3.6 trillion yen when the system was launched in fiscal 2000, is currently at 10.4 trillion yen, and is expected to snowball to 21 trillion yen by fiscal 2025.

Under the reform proposal, local governments would be urged to reduce the level of nursing care needed among elderly people and resolve problems in regional communities under their jurisdictions. The move is designed to trim nursing-care benefits, and improve the quality of life not only of only senior citizens but of other residents in the community.

We agree with the direction of the reform. However, questions remain as to how the system would ensure that local bodies and residents are self-reliant.

Municipal governments, which operate the nursing care system, are tasked with the important role of helping elderly people stay healthy to avoid relying on nursing care services and maintaining a certain level of wellness among those who do use care services. Under the new bill, each local body would be required to analyze data on the number of care workers and the extent of care service use to clarify the challenges each regional community faces, and to specify concrete measures to prevent the conditions of elderly people receiving care from deteriorating as well as goals in their long-term nursing care plan. The national government would release information on how much progress each local government has made toward achieving their respective goals and extend financial assistance to local bodies that have been effective.

In Oita Prefecture and the Saitama Prefecture city of Wako, people in various professions have successfully cooperated in reducing the ratio of those certificated as needing long-term care. The reform of the nursing care system is aimed partly at spreading such examples throughout the country.

However, it is feared the reform could spur some local governments to divert elderly people whose nursing care levels are high and those who have no hope of getting better to medical institutions to reduce the ratio of people certified as needing nursing care. Such a move would push up medical costs while slashing nursing care costs, which is the wrong way to go about the issue.

Under the reform plan, the central government would decide whether to extend financial assistance to local governments for their care services after examining not only changes to the ratio of those certified as needing long-term care but also the process taken toward that end, such as changes in the frequency or content of regional nursing care meetings. But it remains to be seen whether local governments' efforts will be reflected accurately in the financial assistance given to them.

Furthermore, the bill aims to ease regulations to allow facilities that assist disabled people to provide nursing care services to elderly people. There are examples in which elderly people's conditions have improved by working after receiving job placement assistance, which is not covered by the long-term care program -- making them less reliant on nursing care services. The reform is expected to encourage businesses in a wider variety of sectors to enter the nursing care market.

The Social Welfare Act will be revised simultaneously with the Long-Term Care Insurance Act to obligate municipal governments to create a system to resolve livelihood-related challenges by small regional communities. The move is aimed at promoting local resident-oriented welfare services and preventing senior citizens from becoming isolated.

The central government has so far managed to maintain the long-term care insurance system by reducing care services provided to senior citizens and increasing the financial burden on the public. The success of the ongoing reform, which is aimed at improving the quality of nursing care services, hinges on how seriously and enthusiastically local governments and residents will undertake the challenges.

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