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About 18 months have passed since the introduction of long-term care insurance based on the principle of the "socialization of care." From October, elderly people aged 65 and over have been paying the full insurance premium. This is an important period for solidifying the system. The Ministry of Health, Labor and Welfare has hailed the system's "smooth progress, almost without hitch." On average nationwide, however, only about 40 percent of usable funds are actually being used. This means that efforts must be made to improve the system, including a thorough review of the quality and use of services.
Problems to be tackled include the development and diffusion of "welfare equipment" that can be obtained through care insurance, such as spoons designed for deformed hands and mattresses that prevent bedsores. The expression "welfare equipment" refers to the "helping hand" that enables elderly and disabled people to lead independent lives. It also must be designed to reduce the burden on care providers.
Scandinavian countries are known for their generous distribution of welfare equipment designed to make the lives of the elderly more pleasant. In addition to having an abundant variety of equipment, suppliers have a meticulous attitude. Decentralization has made deep inroads in those countries, and local governments are obliged to set up special centers.
In Denmark, for example, there is a public welfare-equipment center in every county. Each of these centers has about 4,000 items, large and small, centering on electric-powered and ordinary wheelchairs. The staff includes work and physical therapists, visiting nurses, and welding and metal-plate experts.
When an elderly or disabled person visits the center, staff members select necessary equipment according to that person's wishes or disabilities and thoroughly instruct the person on usage. If they do not have appropriate equipment, they might make improvements on what they have. Simple additions and alterations are done on the spot.
Another particularly striking feature is the diffusion of wheelchairs. Renovations are made so that people can use their wheelchairs not only at home but also at work. People with severe disabilities, such as those who have suffered a stroke or are paralyzed from the waist down, can be helped into wheelchairs by apparatus using state-of-the-art technology. Both welfare equipment and home renovations are provided free of charge.
In addition to beautiful design and superb functionality that is matched to users' movements, self-help equipment in Denmark displays engineering considerations to ease the burden on care providers. Severely disabled people can hire two helpers (working 37 hours a week) at all times, with the municipality paying their wages.
Kyodo News quotes the director of one such center in the county of Storstrom in Denmark as saying: The basic policy is to guarantee a high quality of life and equal opportunities to all people at all times. We try to draw out the abilities that people still have and enable them to use these abilities as much as possible. Then the social system helps with what they cannot do.
Japan should introduce this approach to the development and supply of welfare equipment. According to the Ministry of Economy, Trade and Industry, the scale of the welfare equipment market topped ¥1 trillion in fiscal 1997, increasing from ¥773.1 billion in fiscal 1993 to about ¥1.15 trillion in fiscal 1999. Although the lease and purchase of welfare equipment have been permitted under care insurance, the figures fall well below forecasts before the system was launched. There are two main reasons for this: Municipalities have reduced subsidies for the purchase of welfare equipment and it is difficult to purchase expensive equipment within the limits set by care insurance. The annual International Home Care and Rehabilitation Exhibition was held in Ariake, Tokyo, at the end of October. About 630 companies from 14 countries and regions participated, and 25,000 items of the latest welfare equipment were on display. This year's show attracted 134,000 visitors, the highest ever.
There was a great variety of exhibits, from spoons to high-tech equipment and specially designed vehicles. The problem, however, is that all the equipment, both domestic and foreign, is just too expensive. Manufacturers should increase efforts to develop welfare equipment that is safe, of good quality and cheap. Accurate information on welfare equipment should also be supplied to elderly and disabled people, their families and the care managers who draw up care plans under the care insurance scheme.
The Japan Times: Nov. 8, 2001
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｢介護の社会化｣を目指して介護保険制度がスタートしてから18ヶ月になる。10月から65歳以上の高齢者も介護保険料を全額支払っている。今はこの制度を強化する重要な時期だ。厚生労働省によると制度の運営は順調だというが、給付限度額に対する利用率は全国平均で40%でしかない。これはサービスの質と利用の見直しを含め、制度の改善努力が必要なことを示す。
不自由な手でも使えるスプーンや、床ずれを防ぐマットレスなど、介護保険により入手できる｢福祉用具｣の開発と普及に努めることが必要だ。福祉用具は、高齢者や身体障害者が自立した生活を送るための補助手段であり、また介護者の負担を軽減するものでなくてはならない。
福祉用具を豊富に供給している北欧諸国では地方分権が浸透しており、地方自治体が福祉施設を設置する義務がある。デンマークでは各郡に福祉用具センターがあり、それぞれ4,000品目を備えている。スタッフは作業療法士、理学療法士、看護婦、溶接、金属メッキの専門家などだ。センターを訪れた高齢者や障害者の希望や障害に応じてスタッフが器具を選び、使い方を徹底的に指導する。適当な器具がない場合は既存の器具を改善する。もう一つ驚くべきことは車椅子の普及だ。家庭だけでなく仕事場も、車椅子が使えるように改造されている。重度の障害者もハイテク機器の補助で車椅子に乗れる。福祉用具も住宅改造も無料だ。ある福祉センターの基本方針は質の高い生活と平等な機会を全ての人に保証することであり、人々の能力を最大限に引き出すよう努めているという。
日本も福祉用具の開発と供給にこうした取組みをすべきだ。福祉用具市場の規模は1999年には1兆1,500億円に達している。福祉用具のリースと購入は介護保険制度の下で行われているが、実績は介護保険制度の開始前の予測よりかなり低い。これには二つの理由がある。地方自治体が福祉用具購入用の助成金を削減し、介護保険の制限内での購入が難しくなっていること。10月末に東京で開催された国際福祉用具展では、14の国と地域から630社が参加し、スプーン、ハイテク機器、特別設計の自動車など25,000品目が展示されたが、高価すぎるという問題がある。メーカーは安全で高品質、格安な福祉用具の開発に努めるべきだ。また、高齢者、身体障害者とその家族、介護プランを立案するケアマネージャーに対し、器具に関する正確な情報を提供していかなくてはならない。
The Japan Times Weekly
Nov. 17, 2001
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