The Diet is debating a bill that would integrate welfare services for those who are physically, intellectually or mentally disabled. Currently, facilities and services for these people are regulated by different laws. The proposed legislation would provide better support for the disabled by creating a single support system.
The bill, however, raises a number of issues. For example, it would require beneficiaries to pay a flat 10 percent of the expenses incurred. A final decision on this should not be made until after the wishes of patients and their families are fully taken into account. The same goes for other issues, such as how to share food and utility costs.
At present, support services are available under four different laws, which cover people with physical, intellectual or mental disabilities, as well as juvenile delinquents. Under a unified system, facilities and services would be provided according to the degree of disability.
That would open the way for the “mutual use” of welfare institutions, with patients at one facility using another that could have been originally intended for a different group of patients. In addition, they would be able to receive services either at or near their homes.
More specifically, if one wanted to receive nursing services at home under the bill, he or she would first file an application with the local office in charge, regardless of the type of disability. The office would examine the application, then submit it to the review board, which would determine the degree of disability. (The same procedure is required to commence nursing care for the elderly).
However, a decision on the degree of disability would not automatically mean that services would be provided. This is an important difference from the nursing-care insurance system, under which care-giving begins once the degree of care required is determined. A final decision would be made after related factors were considered, such as physical conditions at home, family relationships and the willingness to work.
Another advantage, for the government, under the bill is that the cost-sharing formula would ease fund shortages. For patients, the chances of returning to work would improve through hands-on functional training, although the door to employment is not as open as it should be.
On the other hand, the proposed 10-percent charge for welfare services would be a big concern to those who receive those services, as well as to organizations who run welfare facilities. To this flat-rate fee would be added utility expenses, or “hotel costs,” and food expenses.
According to the Ministry of Health, Labor and Welfare, “standard” hotel costs and food expenses would be up to 10,000 yen and 48,000 yen a month, respectively. The ministry says that actual amounts would depend on contracts between individual patients and institutions.
Those payments would deal a double blow, financially, to patients and their families. For many of these people, basic disability pensions are the only source of income. Although the ministry plans to set ceilings on payments according to household incomes, a fundamental question remains: Is it appropriate to impose a flat-rate fee burden on the recipients of disability-welfare services?
Currently, payments vary with the incomes of those obliged to support disabled persons. Under the new system, payments would be based on the incomes of patients’ families — a change that the ministry says is needed to maintain symmetry with medical and nursing-care insurance systems. As a result, payments from patients who have spouses, parents and siblings might increase.
All this indicates strongly that the real aim of the support bill is to integrate measures for the disabled with the nursing-care insurance system. In the background looms a dire shortage of public funding for expanding disability-welfare services. While the proposed cost-sharing would help reduce the deficit, some of the funding for nursing-care services could be diverted for disability welfare.
The Upper House is now debating a bill to amend the nursing-care insurance system, but no integration plan is incorporated in the measure, due to opposition by the ruling parties. The health and welfare ministry may be counting on passage of the disability support bill as a way toward integration, but the very purpose of that legislation — supporting the efforts of the disabled toward self-reliance — will be compromised unless the anxiety felt by patients and their families is removed.
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