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

1. JAPANESE LONG-TERM CARE SYSTEM IN DEMOGRAPHIC TRANSITION

孝 介護・看護 療養保護 老年護理 長期照護

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.

2. MUNICIPALITY’S PROSPECTS: CASE OF FUKUOKA-CITY

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

4. CAPACITY BUILDING OF CARE WORKERS FOR THE INTEGRATED COMMUNITY CARE SYSTEM

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

Japanese Qualification Framework of Long-term Care Competency

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