Document

The Long-Time Care
President of The Gambia
Insurance
in Japan
c/o Minister of System
Foreign Affairs
International Cooperation and Gambians
And a glimpse
Abroad of what we are struggling to go forth,
toMamburay
support the
Mr.
Njiepeople of dementia.
Ministry of Foreign Affairs
4, Marina Parade
Banjul, TheKentaro
Gambia HORIBE
Senior Specialist for Dementia
Office for Dementia and Elder Abuse Prevention
Health and Welfare Bureau for Elderly
Ministry of Health, Labour and Welfare (MHLW)
Japan
Contents for Today
 Introduction
 Long-Term Care Insurance (LTCI)
 Changeing the word
 Programmes and Services specialized
for Dementia in Japan
Proportion of People Aged 65 and over
(%)
Growing Number of People with Dementia
Comparison of several previous estimates
(thousand)
The Place where People with Dementia
hope to lead a life for the years to come:
Intention Survey
Definitely
Home
Home,
if possible
Other
Places
No definite
answer
2.0%
3.4%
9.2%
26.1%
16.0%
70.5%
Toyama Pref., 2001
72.8%
Tokyo, 2009
Estimation of Future Forms of the
Elderly Households
(10,000 households)
2005
2010
General
Householder
aged 65 or
over
4,904
5,014 5,048 5,027 4,964
1,338
1,541 1,762 1,847 1,843
Single
386
28.9%
471
566
635
680
30.6% 32.2% 34.4% 36.9%
Couple
only
470
35.1%
542
614
631
609
35.2% 34.8% 34.2% 33.1%
(percentage)
(percentage)
2015
2020
2025
Note: Percentages show the ratio to the households of which a householder is 65 and over
Source: Estimation of the number of households in Japan (estimation in October 2003),
National Institute of Population and Social Security Research
Long-Time Care Insurance
2000
1st April
Establishment of the public LTC Insurance System
Long-Term Care Insurance System
Aimed
1. to support those who are facing the need of
LTC as a whole,
2. to clarify the relationship between benefits
and burdens, by way of introducing a social
insurance approach,
3. to enable service users receive
comprehensive services from a variety of
institutions of their choice,
4. to separate LTC from coverage of health care
insurance
Long-Term Care Insurance System
Insurers (Municipalities)
Nation
25
Prefecture
12.5
Municipality
12.5
50%
premiums
Insured
Participants
10%
Service
Providers
90%
Service
Certified
The insured
Category 2 Insured
Category
2
40
Category
1
65
age
Municipality's window for application
Doctor's opinion
Investigation for certification
LCT requirement certification
(Certification Committee)
Self-supporting
Support Level 1,2
Preventive Care Plan
Community
Support
Programme
Preventive
 In-Home Service
 Community-based
Service
Care Level 1-5
Care Plan
 In-Home Service
 Community-based
Service
In-facility
Service
Image of Physical Abilities by Care Level
Support
level 1
Support Care
level 2 level 1
Standing up
Care level 2
 Sitting up
Care level 3
Care level 4
Care level 5
 Standing on one leg
Characteristic of Physical
Abilities by Care Level
Walking Body washing Money management Nail clipping
 Putting on and taking off pants, etc.  Moving
around
 Decision making involved in daily life
Facial washing  Hair dressing
Mouth cleaning  Urination and
defecation
Transfer from/to bed
Support level 2 and
care level 1 are
classified based on the
stability of conditions
or the possibility of
improvement.
Dietary intake
Communication
Swallowing
Memorizing and
understanding
Increase of Service users
(thousand)
Three-year cycles of LTCI Scheme
Operation period
(JFY)
2000
2001 1st Phase
2002
2003
2004 2nd Phase
2005
Service plan
Benefits
Insurance premiums
(National average)
2,911 Yen
($ 37)
3,293 Yen
($ 42)
2006
2007 3rd Phase
2008
4,090 Yen
2009
2010 4th Phase
2011
4,160 Yen
2012
2013 5th Phase
2014
4,972 Yen
($ 52)
($ 53)
($ 63)
LTCI Services
Home-visit Services
Home-visit Care, Home-visit
Nursing, Home-visit Bathing
Service, In-home Care Support
etc.
Day Services
Day Care, Day Rehabilitation
Service etc.
Short-stay Service
Short-stay Daily Life Services etc.
Care Manager
Residential Services
Day Care Services for the Elderly
at Fee-charging Homes and People
with Dementia etc.
In-facility service
Special Nursing Homes for the
Elderly, Health Care Facilities etc.
Financial trend of the LTCI
Total cost: LTC benefit and 10% copayment by users
(Trillion Yen)
4.6
5.2
5.7
6.2
6.4
6.4
6.9
7.2
7.7
7.9
8.3
3.6
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
(JFY)
Evaluation of the LTCI among
the general public
Opinion Survey on LTCI, 2010
Changing the word
2004
The day before Christmas
Replacement of the word for "Dementia"
Changeing the Word
Another Word-Hunting?
痴
呆
Idiocy
Stupidity
Chihō
Public opinion
n=6,333
Ratio of people who feel the word "Chihō"
unpleasant or insulting
56.2%
as an administrative term
48.9%
as a medical term
Candidates for the alternative term
 認知障害
Cognitive Impairment
22.6%
 認知症
Cognitive Disorder
18.4%
 記憶障害
Memory Impairment
13.6%
 アルツハイマー症
Alzheimer's Disorder
11.4%
 もの忘れ症
Forgetfulness Disorder 11.3%
 記憶症
Memory Disorder
7.5%
 痴呆の方がまし
rather remain chihō
5.4%
The New word was expected to;
 be easily understandable to the general
public. Short, if possible.
 avoid evoking unpleasant, insulting, nor
gloomy feelings.
 be unmistakably interpreted to be the
identical concept of the former word.
Changeing the Word
Another Word-Hunting?
Chihō
痴
呆
Idiocy
Stupidity
Ninchishō
認知症
Cognition
Disorder
In 2004, the Japanese Government replaced the word for "Dementia"
After the announcement
2004
Dec. 24 Announcement of the new word to the public
2005
Jun. 16 Japanese Psychogeriatric Society
determined to accept the new word.
Jun. 29 Revision of the laws to replace related
legal terms
(e.g. LTCI ACT, Elderly Welfare Law)
Oct. 1
Japan Society for Dementia Research
determined to accept the new word,
replacing the word within its title.
言霊
Kotodama –Wikipedia(en)
Kotodama or kototama (言霊 lit. "word spirit/soul") refers to the
Japanese belief that mystic powers dwell in words and names…
......the notion of kotodama presupposes that sounds can
magically affect objects, and that ritual usages can influence our
environment, body, mind, and soul....
Programmes specialized for
Dementia
"Dementia Supporters"
What are "Dementia Supporters"?
- Who,
with good knowledge of dementia,
support the people with dementia and their families,
with what they can do in their everyday life.
Seminar to train "Dementia Supporters" (90 min)
2,463,064 attendees as of 31 March, 2011
Workshop to train "Caravan Mates",
or lecturers for Dementia Supporters (6 h)
61,449 participants as of 31 March, 2011
Training Doctors
Seminar for PCP
to Upskill Dementia Practice
(250min)
Specialists
26,000
Support Doctors
for Dementia
1,700
PCP
(Primary Care Physician)
Caregivers,
Communities
Services specialized for
Dementia
Conceptional Image
People
Living
with
Dementia
Medical
Care
Community
Long-Term
Care
In-Home Services
 Home-Visit Care Service
 Day Care Service
(Outpatient Day Long-Term Care)
 Short Stay Care Service
(Short-Term Admission for Daily Life Long-Term Care)
 Small-scale Multifunctional in-Home Care
 Group Home
(Communal Daily Long-Term Care for a Dementia Patient)
In-Home Services
 Home-Visit Care Service
 Day Care Service
Community-Based
LTC Services
(Outpatient Day Long-Term Care)
 Short Stay Care Service
(Short-Term Admission for Daily Life Long-Term Care)
 Small-scale Multifunctional in-Home Care
 Group Home
(Communal Daily Long-Term Care for a Dementia Patient)
Community-Based
LTC Services
 Designed to support the elderly keep their
living in familiar environment.
 Municipalities are in charge to make the most
of its closeness with local communities within,
whilst most of other services are governed by
prefectures.
Small-scale Multifunctional in-Home Care
To support living in their own homes.
1. Outpatient Day Care
Inclusive
copayment!
3. Short-stay Care
(when necessary)
All with
Same
Caregivers!
2. Home Visit
(When necessary)
Small-scale Multifunctional in-Home Care
To support living in their own homes.
Designed to support "life" of the elderly as a whole.
Group Home
To live communally in homely environment.
Bath
W.C.
Public Space
(Kitchen, Dining, etc.)
Daily intercourse with neighbourhood is mandatory.
Steering Committee involving neighbour representative.
In-Facility Services
 Sanatorium Medical Facility
for the Elderly Requiring LTC
 Intensive Care Home for the Elderly
 Others (ex. ordinary care homes)
Medical Need
 Long-Term Health Care Facility
More like
Hospital
More like
Home
In-Facility Services
 Sanatorium Medical Facility
for the Elderly Requiring LTC
 Intensive Care Home for the Elderly
 Others (ex. ordinary care homes)
Medical Need
 Long-Term Health Care Facility
More like
Hospital
More like
Home
"Unit Care" in Intensive Care Homes
Admiring individuality and life rhythm of every single resident
Public Space
Numbers of "Unit type" Intensive Care Homes
27% of
all Intensive Care
Homes in Country
Community General Support Centre
For seamless, continuous support for the elderly
Located in every municipalities,
planned for every junior high school district.
General, Continuous
Care Management
Support
Preventive
LTC
Management
Certified
Social Worker
Chief
Care Manager
Public Health
Nurses
Coordinate Cross-system Support
Global
Consulting
Advocacy,
Prevention of
Elder Abuse
(Volunteers, Medical Service, LTC Services, LTC counselors, Social Workers,
Regional advocacies, Health Services, Guardianship, Abuse Prevention, etc.)
1. Epidemiologic Survey
2. Research
Causes, Risk reduction, Drugs, …
3. Medical Care
Early Diagnosis and Treatment
4. Long-Term Care (LTC) & Support
5.
Actions for
Young Onset Dementia
from : "The Urgent Project on Improving the Quality
of Medical Treatment and of Life with Dementia" 2008
Minamisanriku Town, Iwate Pref.
 LTC insurance system has
now become indispensable
in supporting the people in
need of LTC, including
dementia.
 Changeing the word have
worked well in Japan.
 Spreading good public
knowledge and designing
optimized services for
dementia may contribute
making our community
worthwhile to live in, even
after we suffer dementia.

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