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Under a revision of the nursing-care insurance law, the nation’s care system for the elderly (people aged 65 or older) entered a new stage on April 1, the first day of fiscal 2006. This stage boosts efforts to prevent the health of senior citizens from deteriorating to the point that they need expensive care. The revision is aimed at holding down insurance-system costs, which have been rising as Japanese society ages.

The individual municipalities or associations of municipalities that have been operating the insurance system will play an important role in the new approach. Efforts and creative thinking are called for in order to provide easy-to-use services that will be welcomed by the elderly members of local communities.

At present, some 4 million out of Japan’s 25 million people aged 65 or older are designated as beneficiaries who need the system’s care, double the corresponding figure of when it was inaugurated in fiscal 2000. Such a significant increase suggests that the services provided by the system are being used not only by people who really need intensive care but also by those whose conditions are not so serious.

An increase in services available has also spawned a number of problems. Some people have begun to use wheelchairs even though they can still walk, and others have come to completely rely on helpers for household chores, including preparation of meals, even though in reality they are still capable of doing some housework themselves. Such unnecessary practices increase the financial burden placed on the insurance system. Total spending of the nursing-care insurance system is expected to climb from the 3.6 trillion yen in fiscal 2000 to 7.1 trillion yen in fiscal 2006.

To correct the situation, the government has created two new “needing support” categories in addition to the five “needing care” categories for beneficiaries of traditional nursing-care services. Some beneficiaries whose conditions are not serious will be reclassified from the “needing care” categories into one of the “needing support” categories. Those in the “needing support” categories will not receive certain services of traditional nursing care. For example, they will not be provided with wheelchairs or automated beds under the insurance system. Instead they will receive “preventive” services that are aimed at keeping elderly people healthy. The hoped-for final result is an increase in healthy elderly people and a reduction in the insurance system’s total spending, which would in turn create surplus funds that can be used to provide better care for those elderly people suffering from serious health problems.

The newly-created preventive services include exercise training to strengthen muscles, training to increase masticatory strength and nutritional counseling. Services are provided depending on the conditions of individual beneficiaries. Household-chore help is now limited to elderly people who live alone, and those who receive it will have to participate in meal preparation and housework with the helpers. There is a cap on the cost of these new services — either about 50,000 yen or 100,000 yen a month, depending on the beneficiary’s conditions and needs, and beneficiaries will also have to pay 10 percent of the cost. The Health, Welfare and Labor Ministry estimates that 1.6 million people will start receiving the new services.

Municipalities have established or will establish support centers as the hubs of preventive services. They are expected to number 5,000 to 6,000. Public-health workers will draw up care plans for those who receive the new services. Because the new services have just started, municipalities need to give full explanations to beneficiaries and their family members to avoid confusion. They also need to listen to their opinions with an eye on improving the quality of services.

As the graying of the population progresses, steps are being taken to ensure the nursing-care insurance system remains financially viable, including raising the premium from April 1. For people aged 65 or older, the monthly premium increased 24 percent to 4,090 yen. For people in the age bracket of 40 to 64 it rose 5.6 percent to 1,982 yen. The survival of the system is all the more important now because postwar baby boomers will reach the age bracket of 65 to 74 in 2015. The number of those 65 years in age or older will peak at 35 million in 2025. It is expected that households consisting of just one person or a married couple will account for 60 percent of all elderly households in 2015. The number of elderly people with senile dementia is projected to reach 2.5 million the same year, double the current figure.

It is becoming imperative for both the government and the private sector to engage in debate and try to reach a consensus on what kinds of services should be provided under the nursing-care insurance system as well as who should pay and how much.

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