Time to review nursing care fees for household chore assistance

The Yomiuri ShimbunAssist self-support by the elderly through high-quality nursing care services, thus preventing them from needing more critical care. And to this end, make more efficient use of limited financial resources and manpower. These are the kind of efforts that are essential for sustaining a nursing care system in a super-aged society.

The discussion on revising remunerations for nursing care services for fiscal 2018 is proceeding in earnest. This time, the triennial revision of nursing care fees is being done simultaneously with the revision of medical treatment fees, the first time they have coincided in six years.

The highest priority challenge is to beef up the cooperation between medical treatment and nursing care services, creating a system that can seamlessly offer services suited to the needs of the elderly.

The nursing care fees are official prices to be paid to nursing care business operators under the nursing care insurance program. From now to 2025, when postwar baby-boomers will be 75 or older, the total cost of nursing care will rise sharply. Nursing care insurance premiums for those 65 or older are also expected to increase from the current average of ¥5,500 to over ¥8,000.

While curbing the increase in nursing care costs by having services offered more efficiently and based on priority, the treatment of nursing care workers should be improved to alleviate the manpower shortage. To make these challenges compatible, it is important to revise the nursing care fees with proper modulation.

Fees to be reviewed are for “daily life assistance services,” including household chores such as cleaning and cooking, undertaken through home-visit care. As it costs recipients only about ¥300 per hour out of pocket, it has been said that daily life assistance services are being used as a substitute for housemaids. Also, overuse of such services is conspicuous, with cases of the service being used tens of times in a month.

Clarify roles of caregivers

Using these services more often than necessary might hinder the self-support of the elderly. It is also highly problematic when considered from the viewpoint of making effective use of financial and human resources.

The Health, Labor and Welfare Ministry plans to ease qualification requirements for those who can offer assistance with household chores, thus lowering the service fees. It is understandable that this will enable the ministry to achieve its aim of concentrating people with highly specialized skills in the areas of physical nursing care and others, thus clarifying the division of roles of caregivers while holding down costs.

Should it become easier for people to obtain qualifications, a new source of manpower that includes healthy older people is expected to join the nursing care service sector. A regional pool of this kind of manpower, including volunteers, should be increased. Further down the road, study might be required of the notion of putting local governments in control of services that feature assistance with household chores for people in need of a relatively light level of care.

Promoting the efforts to assist self-support by the elderly and to prevent the level of care they need from becoming more critical is also a challenge.

Under the present nursing care service fee system, the more critically a person requires nursing care, the higher the fees are set, in principle. Should the needed level of care be lowered, thanks to the positive effects of rehabilitation exercises, dietary advice and so forth, care-service providers will see their earnings decline. As a countermeasure, the ministry is studying the idea of increasing the remunerations to business operators that have achieved results in the assistance of self-support for the elderly.

It is necessary to highly rate operators that actively improve their services. But if attention is paid simply to the changes in the level of nursing care needed, it might lead to the exclusion of those who are critically in need of nursing care but have no hope for improvement. Appropriate barometers that also include self-support efforts, such as the degree to which rehabilitation exercises are implemented, should be worked out.

(From The Yomiuri Shimbun, Nov. 8, 2017)Speech


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