Towards Integrated Community Care System in Fukuoka-city, Japan
Takeo Ogawa, Ph.D.
President
Asian Aging Business Center (NPO)
ESCAP, 6-7 Nov. 2015, United Nations University Sharing Knowledge and Experiences Toward Sustainable Ageing Societies in
North-East Asia: The 1st Meeting of the North-East Asian Forum on Population Ageing
Contents
1. Japanese Long-term Care System in Demographic Transition
2. Municipality’s Prospects: Case of Fukuoka-city
3. Reorganization of Medical and Long-term Care into the Integrated Community Care System: Case of Fukuoka-city
4. Capacity Building of Care Workers for the Integrated Community Care System
Japanese Age-Population Change
National Institute of Population and Social Security Research Population & Household Projection: 2011-2060
thousand
Demographic Transition in Japan (Change of Dependency Ratio)
Demographic Bonus Demographic Onus
%
National Institute of Population and Social Security Research. 2012. Population Projection for Japan: 2011-2060
Status Quo of LTC in Japan
• Decentralized Social Insurance System Public Long-term Care Insurance System is based on national & local governmental budget, premium by aged 40-64 (Health Insurance), and premium by aged 65+ (Pension).
• De-hospitalization Japanese LTC is differentiated from the medical cure and the nursing care. Japanese LTC has its own domain.
Regional Disparities of Medical/LTC Services
1 Poor
2 3 4 Average
5 6 7 Abundant
1 Poor
Tokyo Central
2 Nemuro Depopulated
Fukuoka Wide Area
3
4 Average
Oume Suburb
5 Tokyo Island
Omuta Local City
6 Beppu Local City
7 Abundant
Miyoshi Depopulated
LTC
Fac
iliti
es
Acute Hospitals
Yasushi Takahashi, 2015 http://www.policycouncil.jp/pdf/prop04/prop04_3_150702.pdf
• National Qualification of Service Providers and LTC workers Socialization of LTC from homework to quasi-Labor market. Various service providers including private corporations and non-profit organizations. Qualification of certified care workers.
• How can we sustain the public long-term care system in a demographic onus era.
Estimated LTC-recognized Elderly
11 19
27 9
16
24
7
12
18
6
11
17
5
10
15
0
20
40
60
80
100
120
2014 2025 2040
LTC Level 5
LTC Level 4
LTC Level 3
LTC Level 2
LTC level 1
thousand
Fukuoka-city, 2014. A Comprehensive Vison of Health and Welfare for the Elderly
Estimated LTC Budget of Fukuoka-city
198 345 500 118
200
290
105
182
263
233
349
442
174
331
550
0
500
1000
1500
2000
2500
2014 2025 2040
Premium of Aged 65+
Premium of Aged 40-64
Municipality Budget
Prefecture Budget
National Budget
Fukuoka-city, 2014. A Comprehensive Vison of Health and Welfare for the Elderly
hundred million
The Citizen’s Will of Stable Settlement
84.2
88.5
90.4 90.7 90.1
96.8
89.2
88.1
93.9 94.6
92.9 94.3
76
78
80
82
84
86
88
90
92
94
96
98
20s 30s 40s 50s 60s 70s
Male
Female
Fukuoka-city, 2014. Opinion Poll for Municipality
Age Group
%
Migration Rate in Fukuoka-city Ageing in Place?
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85
Census, 2010. Fukuoka-city.
Status Quo of LTC in Fukuoka-city
• Residential Care Facilities 75
• Community-based Multi-Functional Small-size Facilities 24
• Community-based Day Care Services 506
• Community-based Visiting Services 723
• Population 1,500,000
• Aged 65+ 297,000
• Recognized LTC 38,000
Service Demand-Supply Balance in Fukuoka-city
Aged20-64 932,000
Aged 75+ 150,000
LTC needed 57,200
Life-Support
41,000
Dementia 29,300
Patients in Home
3,800
Medical Doctors
5,600
Nurses
17,000
Care Workers
17,000
Aged 75+ 284,000
Aged20-64 869,000
Fukuoka-city 2040
Demand
Supply
Health & LTC for the Elderly Fukuoka-city Status Quo
Population
3. REORGANIZATION OF MEDICAL AND LONG-TERM CARE INTO THE INTEGRATED COMMUNITY CARE SYSTEM: CASE OF FUKUOKA-CITY
Integrated Community Care System
Nation
Prefecture
(Wide Area)
Municipality
School District
Emergency /Specialized
Hospitals Rehabilitation
Hospitals Long-term Care
Facilities
Group Homes for Dementia
Advanced Medical Hospitals
Area Comprehensive Support Centre
Community-based small-scale multi-
functional Care
Community Hospitals
In-home Care Services
Clinics Home Doctor
Home Nursing
Housing for the Elderly with Supportive
Services
Private Houses
Dementia- Supporters
Life-support Coordinators
Volunteers, Neighbor & NPO
Family Caregivers
Medical Insurance
Long-term Care Insurance
Aging in Place Integrated Community Care System
Health Care Long-term Care
Life-Support & Preventive Care
Aging-in-Place
Integrated Community Support Center
Fukuoka-city Challenging Strategies for 2040
1. Mind Set! Citizen’s Awareness Orienting preventive care & health promotion Community involvement
2. System transform! Reconstruction of service providing system Securing “Ageing in Place!”
3. Town Design! Urban planning for hyper aged society Constructing age-friendly city! Enhancing active ageing
1. Mind Set!
• Enhancing 4 dimensions of independent citizen
• Health: Prolonging healthy life expectancy Preventive long-term care
• Latter Life: Self-management of health, One who should be helped well
• Income: Not only depend on pension and social security but also gain wage/income/interest.
• Decision of the end of life: Living will.
1 Mind Set!
• Sharing: From “Live alone” to community involvement Community café Social participation
2. System Transform
• Combining between the health care and the long-term care into an Integrated community care system Harmonizing formal care and informal care Social inclusion
• Applying Information & Communication Technologies, and Robotics Disclosing big data
3. Town Design
• Global action: Constructing an active ageing city Fukuoka Capacity building of international care workers
Estimated Volume of Health and Long-term Care Services in 2025
2011 2025
Beds in Hospitals, Average Hospitalization Period
1,070,000 Beds 19~20 days
High Acute 220,000beds 15~16 days Middle Acute 460,000 beds 9days Low Acute 350,000 60days
Medical Doctors 290,000 320,000~340,000
Nurses 1,410,000 1,950,000~2,050,000
Clients of LTC 4,260,000 6,410,000
In-home Care 3,040,000 4,490,000
Community-based Care 310,000 610,000
Long-term care Facilities
Nursing Home 480,000 老健440,000
特養720,000 老健590,000
LTC staffs 1,400,000 2,320,000~2,440,000
Visiting Nurse(/day) 280,000 490,000
Japan Cabinet,2011. Integrated Reform of Social Security and Tax
Structural Transformation of Long-term Care Workforce
Unclear Profession Mixed role
Little Future Outlook Impenetrable Career Path
Women during child-rearing Young age
Middle and old age
Turn over Turn over
Status quo
Women during and after child-rearing, Other occupations, Young age,
The disabled, Middle and old age
Latent Certified Care
Workers
Ideal Structure in 2015
Enhancing Entry to Care Work Improvement of Working Conditions Quality improvement
準看護師
認定看護師
看護師
準看護師
無資格介護者
International Harmonization of Qualification of LTC
介護職員初任者研修
介護職員 現任者研修
介護福祉士 受験資格者
介護福祉士
専門介護福祉士
専門
看護師
無資格介護者
看病人
家族療養保護士
日本 韓国
レベル 1
レベル2
レベル3
レベル4
レベル5
レベル6
レベル7
専門
看護師
認定看護師
看護師
療養保護士
資格統合
技能実習生
Brain Circulation
• Win-win-win through capacity development
Foreign nurse/caregiver
Knowledge, skill and experience in caregiving Theories and legal framework in caregiving
Japanese care facilities
Quality workforce Cross-cultural learning experience
Foreign Community Care
Utilization of returnees Raise in standard of care promoting active aging
Reiko Ogawa, Kyushu University
International Training Centre for Long-term Care for the Elderly
• Living Lab for LTC
• Information Platform
• Developing Programs for Training of Trainers
• Comparative Researches of Long-term Care on Multi-cultural Contexts
• Evaluation Research and Consulting
• Collaboration Approaches to Ageing Communities
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