A revision in the nursing-care insurance law, which passed the Diet in late June, will go into effect in April 2006, representing a significant turn in the direction of the government’s approach since the insurance system was introduced in fiscal 2000.

The new approach will emphasize care for the elderly (people at least 65 years old) that helps prevent their condition from deteriorating to the extent that they require intensive and expensive care under the system.

The government’s thinking is understandable in view of the steady rise in spending. But some current beneficiaries and their families may feel uneasy about proposed changes in services they are now receiving, such as assistance in meal preparation and house-cleaning. Explanations must ease their concerns and help them adjust to the new approach. Individual cases may demand flexible judgment.

Total spending in the nursing-care insurance system has increased by more than 10 percent annually as the size of the budget, which was 3.6 trillion yen in the first year of the insurance system, has jumped to 6.8 trillion yen for fiscal 2005.

The number of people designated as needing care under the system has gone up from 2.18 million in the first year to the current 4.06 million. In particular, the number of people requiring “light” assistance has shot up from 840,000 to 2 million.

While spending has increased, legislation has postponed discussion of the basic system framework — whether to lower the age of people paying premiums from the current 40 and whether the system should cover disabled people younger than 65.

The new preventive-care services to be introduced under the revision are aimed at improving elderly people’s physical and mental conditions or, at least, keeping them from deteriorating. The services include routines to train or strengthen muscles that have weakened from disuse, nutritional counseling, and guidance on how to keep one’s teeth and mouth clean. Elderly people will be free to choose which service to receive.

As for assistance with house chores, beneficiaries will be encouraged to exercise by participating in meal preparation, house-cleaning, taking in the wash, etc., rather than letting helpers do everything. About 1.6 million elderly people are expected to receive the new services.

In addition, for about 1.2 million elderly people (5 percent of the nation’s elderly population) not designated as beneficiaries under the insurance system, local governments will carry out their own preventive-care services, such as guidance on how to prevent falls, keep from withdrawing into oneself, prepare healthful meals and cope with depression and senile dementia.

Support centers will be set up within communities to advise on health problems and to serve as day-care facilities. People with senile dementia can visit or stay for long periods to receive continual care from the same staffers.

One big question about new services such as muscle training is whether they will have a meaningful effect. According to a report submitted by the Health and Labor Ministry to the Diet, among the 98 elderly people from 44 municipalities who received muscle training in a model project, conditions improved for 43.9 percent of them, leveled off for 39.8 percent and worsened for 16.3 percent.

At this stage, the need for such training is generally accepted, but nobody knows what actual effect the new care services will have. It is acknowledged that, if one grudgingly receives training or guidance, there is little likelihood of it having a beneficial effect. The results of the new services will be reviewed after three years.

While local governments are required to offer new services, it is clear that they do not have enough time to prepare and organize them. Some local governments may feel that the central government has just dumped new tasks on them. A grace period is given until the end of March 2008.

A clear improvement in the revised law is the requirement that care managers receive training every five years and renew their license. Nursing-care providers will have to disclose information about their businesses on the Internet and by other means. These measures will serve as a check against providing superfluous services that waste insurance-system funds.

As part of the revision, starting in October, elderly people staying at public nursing homes will have to shoulder all costs for accommodations and meals — translating into an increase of around 30,000 yen per month. The government should work out special measures to reduce this burden on low-income people as quickly as possible.

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