Is nursing care insurance making nursing care recipients worse?

June 15th, 2012 by Philip Brasor & Masako Tsubuku

Killing with kindness? Caregiver helps elderly woman into her apartment

Ever since the government launched the kaigo hoken system in 2000 to provide nursing care services for seniors, the health ministry reviews revenues and expenditures every year and adjusts them accordingly. What this means is that every year premiums go up, which makes sense since the number of seniors is increasing while the population in general remains static or shrinks. In 2000, 15.6 percent of the population was 65 or older. In 2011 the same demographic accounted for 21.4 percent of the population.

Starting at age 40, every resident of Japan pays kaigo hoken premiums, the amount determined by age and income. Even seniors who are eligible for and receive kaigo (nursing care) services pay premiums. They also bear 10 percent of the cost of their care. As each year passes, the burden gets heavier. In 2000, the average monthly premium for people 65 and older was ¥2,911. This past April, that amount breached ¥5,000, and it’s sure to go up. The baby boom generation will turn 75 in 2025, when it is estimated that the cost of kaigo hoken services, including the 10 percent that seniors bear, will total somewhere between ¥19 and ¥23 trillion. That’s twice the cost of such services in 2012. Consequently, average premiums for seniors will be more than ¥8,000.

Local governments administering the system say that most seniors are not able to pay more than ¥5,000 a month when taking into consideration their national pension benefits. Tokyo Shimbun recently reported on a woman in her 80s living in Nagoya, where average monthly payments this year increased from ¥4,149 to¥5,440. She lives alone and receives ¥100,000 in pension benefits a month. Last year she paid ¥2,000 a month in kaigo premiums. It just increased to ¥2,400. With the 10 percent she has to pay for her nursing and medical care, it amounts to about ¥20,000 a month, a good chunk of her fixed income. Consequently, some experts are saying that the government’s solution of hiking the consumption tax to help pay for social security will not be enough to pay for the steep increase in the number of people who will apply for kaigo services. The system itself must be overhauled on an ongoing basis.

Tokyo Shimbun reporter Nobuyuki Suzuki compared Japan’s nursing care system to Germany’s and France’s and found one glaring difference. Japan’s system comprises seven categories of care: two for yoshien (support) and five for yokaigo (nursing care). Support care level 1 is for seniors who can feed and bathe themselves and use the toilet without assistance — basically the caregiver provides housekeeping services. Support care level 2 is the same but may also involve a minimal amount of body contact.  France and Germany do not provide services that are equivalent to yoshien 1 and 2, and thus their expenditures are manageable. The cost of yoshien 1 support is about ¥50,000 a month; for yoshien 2, it’s ¥100,000. According to the finance ministry, even the care provided at yokaigo levels 1 and 2 is mostly outside the realm of nursing: 64 percent involves housekeeping, 16 percent shopping or picking up prescriptions, 11 percent cooking and serving.

Suzuki concludes that yoshien support services may actually contribute to a recipient’s declining health situation since it allows the recipient to become dependent on assistance even if the recipient is able-bodied. This is likely to be the case, because if the recipient weren’t able-bodied, the category of care would be yokaigo 1 or higher. The very fact that these support services are available and recipients may think they have already paid for them through premiums means that they may expect them, especially in the case of elderly single men, who, if they are widowed, are used to being taken care of. In a sense, the support system encourages a more sedentary lifestyle and thus exacerbates the nursing care crisis. Nobody wants to deny seniors care they really need, but there will have to be a fiscal reckoning someday.

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