Be careful cutting nursing services

The health ministry is weighing cuts to some services provided under the public nursing care insurance system to people with less than serious conditions — a measure intended to reign in the ballooning costs of nursing care for a rapidly aging population and to focus on services for the elderly with more severe health problems.

The government should carefully consider the impact that such a step will have on the people needing help. A deterioration in the care recipients’ health as a result of the cutoff in services will defeat the purpose of the planned measure. It needs to take adequate steps to mitigate the physical and financial problems that these people could face.

Under the nursing care insurance program, people entitled to care services are classified into five categories in ascending stages depending on the severity of their conditions. The Health, Labor and Welfare Ministry is thinking of excluding from the program’s coverage some services that people in the first and second categories — the least serious — receive at home, and instead making them pay the full cost if they want to continue receiving them. The ministry plans to submit the relevant bills to the Diet next year based on discussions by its Social Security Council.

Currently care recipients in the first and second categories are entitled to daily living support services at home — such as help with shopping, cooking, cleaning and washing — as are those in the higher categories. The planned change may deprive them of these services under the insurance program, although physical services such as assistance with taking bath or going to the bathroom will likely be maintained.

Behind the move are the mushrooming expenses of nursing care for the nation’s aging population — which rose from ¥4 trillion in fiscal 2000 to ¥10 trillion in 2015. Through the planned measure, the ministry hopes to secure sufficient benefits under the insurance system for people with more serious conditions.

Recently, the use of such services as shopping, cooking and cleaning by people with less serious conditions has become so conspicuous that some experts have complained that helpers provided by the nursing care insurance program are being used like housekeepers. It has been reported that people with first-category disabilities use the daily living support services in more than half of the home-visit care services they ask for. Last year, the Finance Ministry proposed that benefits under the nursing care insurance program focus on people in categories three to five.

But the proposed change will inevitably put more financial strain on people with less serious conditions and their relatives who truly need such services. At present, they can have access to daily living aid services by paying 10 to 20 percent of the cost under the insurance scheme, but their burden will increase by five- to tenfold if the services are no longer covered by the program. A unilateral cutoff of such services under the insurance program might leave those truly in need of care isolated from their local community.

As a long-term policy, the health ministry is thinking of putting municipalities in charge of nursing care for elderly people whose health conditions are not so serious. As for the support services for daily living, it is mulling providing only limited financial help to care recipients while in principle getting the recipients to pay the full cost of such services. One possible way the government is considering is to increase subsidies for domestic chores services provided by municipalities so that the care recipients’ burden will be mitigated.

But there is no guarantee that this idea will work since the financial footing differs among municipalities. Fiscally strong local governments may be able to provide sufficient services for their residents, but others may not. The national government needs to provide sufficient support to the municipalities so care recipients in some areas won’t be left without needed services.

In the first place, the health ministry needs to carefully weigh the consequences of withholding some services for people with less severe health conditions under the care insurance program. It should consider whether the use of daily living support services by these people is so large as to put a great financial strain on the program, how large a financial burden these people can bear and how the plan would increase their relatives’ burden — physical and otherwise. Depriving a segment of elderly people of the services they use today might lead to a worsening of their health conditions, possibly pushing up the nation’s total nursing care cost.