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In a bid to lower insurance costs while improving the quality of life for elderly patients, some municipal authorities have introduced incentive programs that reward greater independence for residents of nursing care homes.

Keizanso, a nursing care home in Tsuruga, Fukui Prefecture, received ¥120,000 ($1,040) from the prefectural government in April after a 77-year-old bedridden male patient regained the ability to go to the toilet independently. As a result, the graded level of nursing care required under the public nursing care insurance system for the patient was lowered from 4 to 3.

In 2010, Keizanso began removing residents’ diapers in the daytime, while its staff began helping patients use the toilet. In addition, dentists have been consulted to help residents, some of whom have been fed through tubes, to eat more solid foods.

If the level of care required for a patient is lowered from 4 to 3, as in the case of the 77-year-old resident, compensation paid to the welfare facility by the patient or their family will decline by ¥250,000.

However, Yoshii Kubota of Keizanso downplayed the seriousness of the drop in revenue.

“What is important is the fact that our efforts to make the patient more self-reliant are supported by society,” said Kubota, adding that the morale of nursing staff has also risen.

Fukui Prefecture introduced the incentive program in response to a surge in insurance money paid to nursing homes under the public nursing care system.

Also behind the move was a two-fold increase in monthly premiums paid by patients, to an average ¥5,903 per person from 2000 when the insurance system started.

As premiums are deducted from elderly people’s pensions, an increase will impact their livelihoods, a prefectural official said.

In introducing the incentive program, the prefectural government set aside some ¥15 million in annual payments. In fiscal 2015, 145 nursing care homes participated in the program. Consequently, the degree of nursing care required dropped for 192 patients, accounting for 12 percent of the 1,548 residents at these nursing homes.

In fiscal 2015, the Okayama Municipal Assembly started paying up to ¥1 million in incentives to day care service providers recognized as having offered higher-quality services, measured by the degree of improvement in patients’ conditions.

Similar programs have also been launched by Tokyo’s Shinagawa and Edogawa wards, as well as Kawasaki and Nagoya.

The central government, meanwhile, is studying ways to support municipalities if patient conditions at welfare facilities under their jurisdiction improve.

A potential shortcoming of the incentive program is that it may encourage care staff to prioritize patients whose conditions are expected to improve easily.

To address this problem, the city of Okayama takes into account not only short-term changes of patient conditions but also whether staff have devised broader schemes that will lead to patients’ self-reliance.

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