The number of elderly people who are suffering from senile dementia or whose health is so bad that they cannot receive nursing care services at home has been on the increase as the graying of Japan’s population progresses. The government needs to help establish a sufficient number of critical care nursing homes for the aged (tokubetsu yogo rojin homu, or tokuyo for short) in a systematic way.

Demand for government-subsidized tokuyo homes is strong because residents in tokuyo homes can receive a wide range of nursing care services, including help with eating, going to the bathroom and bathing for relatively low charges.

Some applicants have to wait two years before being accepted by tokuyo homes. According to the health and welfare ministry’s survey, as of Oct. 1, 2013, some 524,000 people nationwide were on a waiting list after applying for admission into tokuyo homes — an increase of some 103,000 from four years before.

Even if that number includes those who applied for more than one tokuyo homes and whose conditions are not so severe, it is safe to say that tokuyo homes are in considerably short supply. The survey shows that people with fairly severe to extremely severe conditions account for about 70 percent of the applicants for tokuyo homes.

There are several reasons for the shortage. Construction of such facilities in urban areas are often hampered by the high costs involved. The central and local governments are less enthusiastic than before about helping open tokuyo homes because they want to slow the rise in total spending for services under the nursing care insurance system.

To make up for the shortage of tokuyo homes, specially-designed residences for the aged — mainly those who do not have serious physical conditions — are being constructed in large numbers. In principle, services provided at these facilities are not covered by the nursing care insurance system, although staff at such houses regularly watch over the conditions of the residents and give advice on their daily lives.

But when the conditions of residents of these houses worsen, they need to move to tokuyo homes or to medical institutions that provide nursing care services.

Because the number of elderly people with serious conditions is steadily increasing, the need for tokuyo homes as people’s last abode is increasing. But building more tokuyo homes without a well thought-out plan will place an undue financial burden on the nursing care insurance system because the services provided at tokuyo homes are costly. Therefore it is imperative that the number of tokuyo homes be increased with due attention paid to the financial conditions of the nursing care insurance system and people’s needs.

The central government is now pushing a plan to create a community-based system in which medical and nursing care services for the elderly will be efficiently coordinated by 2025, when all remaining postwar baby boomers will be age 75 or older. It should realize that the planned system will not work properly without a sufficient number of tokuyo homes.

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