[Home medical care and long-term care insurance]

The difference in medical care at home before and after the introduction of the Long-term Care Insurance is discussed and reported on the basis of my 20 years of experience in the home medical care. I appreciate the introduction of the Long-term Care Insurance in terms of its effect in making the general public interested in nursing as well as in those who need care. On the other hand, since emphasis was placed only on the degree of demand for the care in evaluating the qualification of the users of nursing facilities under the Long-term Care Insurance, public interest was focused simply on the degree of demand for the care. In the meantime, the fundamental problem of how to institute medical care at home appears to be neglected. As a result, many of those whose demand for the care have been assessed low make claims and request re-assessment, which results in a lot of personnel and financial waste in office procedures. Moreover, the families of those with the care necessity grade of 1 or more tend to falsely feel that they have been given the right to use the facilities, which decreases their motivation toward the home care. In reality, most facilities are crowded with users and improvement of the facility does not catch up with the rapid increase of users. Needless to say, the present situation is attributed to the inadequate governmental policies taken at the time of introduction of the Long-term Care Insurance. Immediate measures for improving the situation are required. In the case of elderly insurance facilities, in particular, in addition to evaluation of the conditions for using the facility solely on the basis of the degree of demand for the care, their positioning as the rehabilitation facilities aiming at achievement of home care should be clarified like before the introduction of the Long-term Care Insurance. A certain limitation is necessary regarding the duration of the use of the facility. Other than that, various problems have been proposed. We hope to examine these problems as well and report the results. We believe the most important thing is to exercise our ingenuity in creating a system enabling medical care at home in each community.