The Long-Time Care Insurance System in Ja p an

1. The Long-Time Care Insurance System in Japan President of The Gambia c/o Minister of Foreign Affairs International Cooperation and Gambians Abroad Mr. Mamburay Njie Ministry of Foreign Affairs 4, Marina Parade Banjul, The Gambia And a glimpse of what we are struggling to go forth, to support the people of dementia. Kentaro 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

2. Contents for Today • Introduction • Long-Term Care Insurance (LTCI) • Changeing the word • Programmes and Services specialized for Dementia in Japan

3. Proportion of People Aged 65 and over (%)

4. Growing Number of People with Dementia Comparison of several previous estimates (thousand)

5. The Place where People with Dementiahope to lead a life for the years to come: Intention Survey Definitely Home Home, if possible Other Places No definite answer Toyama Pref., 2001 Tokyo, 2009

6. Estimation of Future Forms of the Elderly Households (10,000 households) 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

7. Long-Time Care Insurance

8. 2000 1st April Establishment of the public LTC Insurance System

9. Long-Term Care Insurance System Aimed to support those who are facing the need of LTC as a whole, to clarify the relationship between benefits and burdens, by way of introducing a social insurance approach, to enable service users receive comprehensive services from a variety of institutions of their choice, to separate LTC from coverage of health care insurance

10. Long-Term Care Insurance System Insurers (Municipalities) 25 Nation 50% Insured Participants premiums 12.5 Prefecture 12.5 Municipality copayment Service Providers Certified Service

11. The insured Category 2 Category 1 age 40 65

12. Municipality's window for application Doctor's opinion Investigation for certification LCT requirement certification (Certification Committee) Self-supporting Support Level 1,2 Care Level 1-5 Preventive Care Plan Care Plan • Preventive • In-Home Service • Community-based • Service • In-Home Service • Community-based • Service Community Support Programme In-facility Service

13. Image of Physical Abilities by Care Level Support level 1 Support level 2 Care level 1 Care level 4 Care level 2 Care level 3 Care level 5 Standing up  Sitting up  Standing on one leg WalkingBody washing Money management Nail clipping Characteristic of Physical Abilities by Care Level  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 Dietary intake Communication Support level 2 and care level 1 are classified based on the stability of conditions or the possibility of improvement. Swallowing Memorizing and understanding

14. Increase of Service users (thousand)

15. Three-year cycles of LTCI Scheme Operation period (JFY) Service plan Benefits Insurance premiums (National average) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2,911 Yen ($ 37) 1st Phase 3,293 Yen ($ 42) 2nd Phase 4,090 Yen ($ 52) 3rd Phase 4,160 Yen ($ 53) 4th Phase 4,972 Yen ($ 63) 5th Phase

16. 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. Residential Services Day Care Services for the Elderly at Fee-charging Homes and People with Dementia etc. Care Manager In-facility service Special Nursing Homes for the Elderly, Health Care Facilities etc.

17. Financial trend of the LTCI Total cost: LTC benefit and 10% copayment by users (Trillion Yen) 8.3 7.9 7.7 7.2 6.9 6.4 6.4 6.2 5.7 5.2 4.6 3.6 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 (JFY)

18. Evaluation of the LTCI among the general public Opinion Survey on LTCI, 2010

19. Changing the word

20. 2004 The day before Christmas Replacement of the word for "Dementia"

21. Changeing the Word Another Word-Hunting? 痴 呆 Idiocy Stupidity Chihō

22. 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

23. 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%

24. 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.

25. Changeing the Word Another Word-Hunting? Chihō Ninchishō 認知 症 痴 呆 Cognition Disorder Idiocy Stupidity In 2004, the Japanese Government replaced the word for "Dementia"

26. 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.

27. 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 andnames… ......the notion of kotodama presupposes that sounds can magically affect objects, and that ritual usages can influence our environment, body, mind, and soul....

28. Programmes specialized for Dementia

29. "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

30. Training Doctors Seminar for PCP to Upskill Dementia Practice (250min) 26,000 Specialists Support Doctors for Dementia 1,700 PCP Caregivers, Communities (Primary Care Physician)

31. Services specialized for Dementia

32. Conceptional Image People Living with Dementia Medical Care Long-Term Care Community

33. 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)

34. In-Home Services • Home-Visit Care Service Community-Based LTC Services • 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)

35. Community-BasedLTC 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.

36. Small-scale Multifunctional in-Home CareTo support living in their own homes. 3. Short-stay Care (when necessary) 1. Outpatient Day Care Inclusive copayment! All with Same Caregivers! 2. Home Visit (When necessary)

37. Small-scale Multifunctional in-Home CareTo support living in their own homes. Designed to support "life" of the elderly as a whole.

38. Group HomeTo live communally in homely environment. Bath W.C. Public Space (Kitchen, Dining, etc.) Daily intercourse with neighbourhood is mandatory. Steering Committee involving neighbour representative.

39. In-Facility Services More like Hospital • Sanatorium Medical Facility • for the Elderly Requiring LTC • Long-Term Health Care Facility Medical Need • Intensive Care Home for the Elderly More like Home • Others (ex. ordinary care homes)

40. In-Facility Services More like Hospital • Sanatorium Medical Facility • for the Elderly Requiring LTC • Long-Term Health Care Facility Medical Need • Intensive Care Home for the Elderly More like Home • Others (ex. ordinary care homes)

41. "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

42. Community General Support Centre For seamless, continuous support for the elderly Located in every municipalities, planned for every junior high school district. Certified Social Worker General, Continuous Care Management Support Global Consulting Chief Care Manager Public Health Nurses Advocacy, Prevention of Elder Abuse Preventive LTC Management Coordinate Cross-system Support (Volunteers, Medical Service, LTC Services, LTC counselors, Social Workers, Regional advocacies, Health Services, Guardianship, Abuse Prevention, etc.)

43. 1. Epidemiologic Survey 2. Research Causes, Risk reduction, Drugs, … 3. Medical CareEarly 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

44. Minamisanriku Town, Iwate Pref.

45. 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.