ASOURCE Navi

Many people may feel anxious or confused when faced with a situation where their family member requires nursing care, but there is no need to panic. By making effective use of the nursing care insurance system and using various services, it is possible to reduce the burden of nursing care. In this article, we will explain the procedures for nursing care insurance services.

In recent years, with the rapid aging of the population, the home environments of elderly people who require care have become more diverse. According to the 2022 Basic Survey on Living Conditions of the Japanese People conducted by the Ministry of Health, Labor and Welfare, 42.1% of households with people requiring care are nuclear families, accounting for the largest proportion overall. Next are single-person households at 30.7%. In the 2001 survey, single-person households accounted for 15.7% of households, and the proportion has increased since then, indicating that the number of elderly people living alone is also increasing. Looking at the age group of those requiring care, 87.1% are elderly people aged 75 or older, highlighting the reality that the need for care increases with age.

On the other hand, the caregivers are mostly in their 60s and 70s when living together, and in their 50s and 60s when living separately, with a high proportion of women in both cases. This shows that the family members who provide care for the elderly are often elderly and female.

The most common cause of the need for nursing care is dementia, followed by stroke and locomotor disorders such as fractures and falls. In either case, daily living activities and decision-making abilities decline, resulting in a state in which someone is constantly in need of care.

When you need nursing care, the nursing care insurance system plays a major role. First, consult with the local government office or the local comprehensive support center where you live. Consultations can be made by phone, in person, or at a local office. If, after consultation, it is determined that you need nursing care, you can apply for nursing care certification at the local government office. When applying, you will be required to present your nursing care insurance certificate. A nursing care certification investigator will then visit your home and conduct an interview survey regarding your physical and mental condition. In addition, they will ask your doctor to write a letter of opinion. If you do not have a doctor, you will need to undergo a medical examination designated by the local government. Based on the survey results and the doctor's opinion, the local government will make a final decision on the level of nursing care required after a first judgment by computer and a second judgment by the nursing care certification review board. In principle, the process from application to notification is completed within one month.

There are seven levels of care level: 1-2 assistance required, 1-5 care required, and 7 levels of care required. The types of services and the usage limit vary depending on the level of care required. If the level is mild, "care level 1," then home care services such as visiting care and day care will be the main focus, while if the level is severe, "care level 5," then admission to a facility such as a special nursing home will be permitted. After receiving care certification, the individual will meet with a care manager to create a care plan that combines the necessary services based on the individual and their family's wishes. Next, a request is made to an actual service provider based on the care plan. Finally, the user's share of the cost is confirmed and paid, and the system is in place to receive care services. The care certification is generally valid for one year.

There are various types of nursing care services, but the main ones include home visit care (dispatch of home helpers), day care, short stays (short-term admission), respite hospitalization (short-term admission to a medical institution), and the rental of welfare equipment.
The loan of welfare equipment is intended to help users live independently at home. Designated businesses select appropriate welfare equipment based on the user's needs and living environment, and install and adjust it. The main welfare equipment eligible for subsidies are 13 items: wheelchairs, special beds, pressure dispersion devices, body position changers, wandering detection devices, mobility lifts, walkers, canes, handrails, ramps, and automatic waste disposal devices. The items eligible for subsidies vary depending on the level of care required. A portion of the rental costs for welfare equipment is subsidized by nursing care insurance, but users are required to pay a certain amount. In principle, users are required to pay 10%, but those with incomes above a certain level are required to pay 20% or 30%. Costs vary depending on the item, and monthly upper limits are set for each level of care required, so users must consider combining the equipment with other services.
By making good use of the long-term care insurance system, it is possible to reduce the burden of caregiving and improve the quality of life of those in need of care and their families.