The Long-Time Care President of The Gambia Insurance in Japan c/o Minister of System Foreign Affairs International Cooperation and Gambians And a glimpse Abroad of what we are struggling to go forth, toMamburay support the Mr. Njiepeople of dementia. Ministry of Foreign Affairs 4, Marina Parade Banjul, TheKentaro Gambia 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 Contents for Today Introduction Long-Term Care Insurance (LTCI) Changeing the word Programmes and Services specialized for Dementia in Japan Proportion of People Aged 65 and over (%) Growing Number of People with Dementia Comparison of several previous estimates (thousand) The Place where People with Dementia hope to lead a life for the years to come: Intention Survey Definitely Home Home, if possible Other Places No definite answer 2.0% 3.4% 9.2% 26.1% 16.0% 70.5% Toyama Pref., 2001 72.8% Tokyo, 2009 Estimation of Future Forms of the Elderly Households (10,000 households) 2005 2010 General Householder aged 65 or over 4,904 5,014 5,048 5,027 4,964 1,338 1,541 1,762 1,847 1,843 Single 386 28.9% 471 566 635 680 30.6% 32.2% 34.4% 36.9% Couple only 470 35.1% 542 614 631 609 35.2% 34.8% 34.2% 33.1% (percentage) (percentage) 2015 2020 2025 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 Long-Time Care Insurance 2000 1st April Establishment of the public LTC Insurance System Long-Term Care Insurance System Aimed 1. to support those who are facing the need of LTC as a whole, 2. to clarify the relationship between benefits and burdens, by way of introducing a social insurance approach, 3. to enable service users receive comprehensive services from a variety of institutions of their choice, 4. to separate LTC from coverage of health care insurance Long-Term Care Insurance System Insurers (Municipalities) Nation 25 Prefecture 12.5 Municipality 12.5 50% premiums Insured Participants 10% Service Providers 90% Service Certified The insured Category 2 Insured Category 2 40 Category 1 65 age Municipality's window for application Doctor's opinion Investigation for certification LCT requirement certification (Certification Committee) Self-supporting Support Level 1,2 Preventive Care Plan Community Support Programme Preventive In-Home Service Community-based Service Care Level 1-5 Care Plan In-Home Service Community-based Service In-facility Service Image of Physical Abilities by Care Level Support level 1 Support Care level 2 level 1 Standing up Care level 2 Sitting up Care level 3 Care level 4 Care level 5 Standing on one leg Characteristic of Physical Abilities by Care Level Walking Body washing Money management Nail clipping 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 Support level 2 and care level 1 are classified based on the stability of conditions or the possibility of improvement. Dietary intake Communication Swallowing Memorizing and understanding Increase of Service users (thousand) Three-year cycles of LTCI Scheme Operation period (JFY) 2000 2001 1st Phase 2002 2003 2004 2nd Phase 2005 Service plan Benefits Insurance premiums (National average) 2,911 Yen ($ 37) 3,293 Yen ($ 42) 2006 2007 3rd Phase 2008 4,090 Yen 2009 2010 4th Phase 2011 4,160 Yen 2012 2013 5th Phase 2014 4,972 Yen ($ 52) ($ 53) ($ 63) 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. Care Manager Residential Services Day Care Services for the Elderly at Fee-charging Homes and People with Dementia etc. In-facility service Special Nursing Homes for the Elderly, Health Care Facilities etc. Financial trend of the LTCI Total cost: LTC benefit and 10% copayment by users (Trillion Yen) 4.6 5.2 5.7 6.2 6.4 6.4 6.9 7.2 7.7 7.9 8.3 3.6 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 (JFY) Evaluation of the LTCI among the general public Opinion Survey on LTCI, 2010 Changing the word 2004 The day before Christmas Replacement of the word for "Dementia" Changeing the Word Another Word-Hunting? 痴 呆 Idiocy Stupidity Chihō 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 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% 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. Changeing the Word Another Word-Hunting? Chihō 痴 呆 Idiocy Stupidity Ninchishō 認知 症 Cognition Disorder In 2004, the Japanese Government replaced the word for "Dementia" 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. 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 and names… ......the notion of kotodama presupposes that sounds can magically affect objects, and that ritual usages can influence our environment, body, mind, and soul.... Programmes specialized for Dementia "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 Training Doctors Seminar for PCP to Upskill Dementia Practice (250min) Specialists 26,000 Support Doctors for Dementia 1,700 PCP (Primary Care Physician) Caregivers, Communities Services specialized for Dementia Conceptional Image People Living with Dementia Medical Care Community Long-Term Care 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) In-Home Services Home-Visit Care Service Day Care Service Community-Based LTC Services (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) Community-Based LTC 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. Small-scale Multifunctional in-Home Care To support living in their own homes. 1. Outpatient Day Care Inclusive copayment! 3. Short-stay Care (when necessary) All with Same Caregivers! 2. Home Visit (When necessary) Small-scale Multifunctional in-Home Care To support living in their own homes. Designed to support "life" of the elderly as a whole. Group Home To live communally in homely environment. Bath W.C. Public Space (Kitchen, Dining, etc.) Daily intercourse with neighbourhood is mandatory. Steering Committee involving neighbour representative. In-Facility Services Sanatorium Medical Facility for the Elderly Requiring LTC Intensive Care Home for the Elderly Others (ex. ordinary care homes) Medical Need Long-Term Health Care Facility More like Hospital More like Home In-Facility Services Sanatorium Medical Facility for the Elderly Requiring LTC Intensive Care Home for the Elderly Others (ex. ordinary care homes) Medical Need Long-Term Health Care Facility More like Hospital More like Home "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 Community General Support Centre For seamless, continuous support for the elderly Located in every municipalities, planned for every junior high school district. General, Continuous Care Management Support Preventive LTC Management Certified Social Worker Chief Care Manager Public Health Nurses Coordinate Cross-system Support Global Consulting Advocacy, Prevention of Elder Abuse (Volunteers, Medical Service, LTC Services, LTC counselors, Social Workers, Regional advocacies, Health Services, Guardianship, Abuse Prevention, etc.) 1. Epidemiologic Survey 2. Research Causes, Risk reduction, Drugs, … 3. Medical Care Early 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 Minamisanriku Town, Iwate Pref. 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.
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