1. The Long-Time Care Insurance System in Japan Kentaro 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 And a glimpse of what we are struggling to go forth, to support the people of dementia. President of The Gambia c/o Minister of Foreign Affairs International Cooperation and Gambians Abroad Mr. Mamburay Njie Ministry of Foreign Affairs 4, Marina Parade Banjul, The Gambia

2. Introduction Long-Term Care Insurance (LTCI) Changeing the word Programmes and Services specialized for Dementia in Japan Contents for Today

3. Proportion of People Aged 65 and over (%)

4. Growing Number of People with Dementia Comparison of several previous estimates (thousand)

5. The Place where People with Dementia hope to lead a life for the years to come: Intention Survey Tokyo, 2009 Toyama Pref., 2001 Home, if possible Other Places No definite answer Definitely Home

6. 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 (10,000 households) 20052010201520202025 General4,9045,0145,0485,0274,964 Householder aged 65 or over 1,3381,5411,7621,8471,843 Single (percentage) 386 28.9% 471 30.6% 566 32.2% 635 34.4% 680 36.9% Couple only (percentage) 470 35.1% 542 35.2% 614 34.8% 631 34.2% 609 33.1% Estimation of Future Forms of the Elderly Households

7. Long-Time Care Insurance

8. 2000 Establishment of the public LTC Insurance System 1 st April

9. Long-Term Care Insurance System 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 Aimed

10. Long-Term Care Insurance System 50% Insurers (Municipalities) premiums Service Providers 25 Nation 12.5 Prefecture 12.5 Municipality Certified copayment Service Insured Participants

11. The insured 4065 age Category 2 Category 1

12. Doctor's opinionInvestigation for certification In-facility Service In-Home Service Community-based Service Preventive In-Home Service Community-based Service Community Support Programme Support Level 1,2Care Level 1-5 Self-supporting Care Plan Preventive Care Plan LCT requirement certification (Certification Committee) Municipality's window for application

13. Support level 1 Care level 2 Care level 3 Care level 4 Care level 5 Standing up Sitting up Standing on one leg Walking Body washing Money management Nail clipping Dietary intake Communication Swallowing Memorizing and understanding Characteristic of PhysicalAbilities by Care Level Support level 2 Care level 1 Support level 2 and care level 1 are classified based on the stability of conditions or the possibility of improvement. 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 Image of Physical Abilities by Care Level

14. Increase of Service users (thousand)

15. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 3,293 Yen ($ 42) 4,090 Yen ($ 52) 2,911 Yen ($ 37) Operation period (JFY) BenefitsService planInsurance premiums (National average) 4,160 Yen ($ 53) Three-year cycles of LTCI Scheme 4,972 Yen ($ 63) 1 st Phase 2 nd Phase 3 rd Phase 4 th Phase 5 th Phase

16. In-facility service Special Nursing Homes for the Elderly, Health Care Facilities etc. In-facility service Special Nursing Homes for the Elderly, Health Care Facilities etc. Residential Services Day Care Services for the Elderly at Fee-charging Homes and People with Dementia etc. Residential Services Day Care Services for the Elderly at Fee-charging Homes and People with Dementia etc. Short-stay Service Short-stay Daily Life Services etc. Short-stay Service Short-stay Daily Life Services etc. Day Services Day Care, Day Rehabilitation Service etc. Day Services Day Care, Day Rehabilitation Service etc. Home-visit Services Home-visit Care, Home-visit Nursing, Home-visit Bathing Service, In-home Care Support etc. Home-visit Services Home-visit Care, Home-visit Nursing, Home-visit Bathing Service, In-home Care Support etc. LTCI Services Care Manager

17. Total cost: LTC benefit and 10% copayment by users (Trillion Yen) Financial trend of the LTCI 2001 2002 2003 2004 2005 2006 2007 2008 2009 2000 2011 3.6 5.7 4.6 5.2 6.2 6.4 6.9 7.2 7.7 7.9 8.3 2010 (JFY)

18. Evaluation of the LTCI among the general public Opinion Survey on LTCI, 2010

19. Changing the word

20. 2004 Replacement of the word for "Dementia" The day before Christmas

21. Changeing the Word Chihō Another Word-Hunting? Idiocy Stupidity

22. Public opinion as an administrative term as a medical term 56.2% 48.9% Ratio of people who feel the word "Chihō" unpleasant or insulting n=6,333

23. Cognitive Impairment22.6% Cognitive Disorder18.4% Memory Impairment13.6% Alzheimer's Disorder11.4% Forgetfulness Disorder11.3% Memory Disorder7.5% rather remain chihō5.4% Candidates for the alternative term

24. 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. The New word was expected to;

25. Changeing the Word Chihō Ninchishō In 2004, the Japanese Government replaced the word for "Dementia" Another Word-Hunting? Idiocy Stupidity Cognition Disorder

26. After the announcement 2004 Dec. 24 2005 Oct. 1Japan Society for Dementia Research determined to accept the new word, replacing the word within its title. Japanese Psychogeriatric Society determined to accept the new word. Jun. 16 Jun. 29Revision of the laws to replace related legal terms (e.g. LTCI ACT, Elderly Welfare Law) Announcement of the new word to the public

27. Kotodama or kototama ( 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.... Kotodama – Wikipedia(en)

28. Programmes specialized for Dementia

29. Seminar to train "Dementia Supporters" (90 min) 2,463,064 attendees as of 31 March, 2011 "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. Workshop to train "Caravan Mates", or lecturers for Dementia Supporters (6 h) 61,449 participants as of 31 March, 2011

30. Caregivers, Communities Specialists Seminar for PCP to Upskill Dementia Practice (250min) 26,000 PCP (Primary Care Physician) Support Doctors for Dementia 1,700 Training Doctors

31. Services specialized for Dementia

32. Long-Term Care Medical Care Community People Living with Dementia Conceptional Image

33. Short Stay Care Service (Short-Term Admission for Daily Life Long-Term Care) Home-Visit Care Service Group Home (Communal Daily Long-Term Care for a Dementia Patient) In-Home Services Small-scale Multifunctional in-Home Care Day Care Service (Outpatient Day Long-Term Care)

34. In-Home Services Community-Based LTC Services Short Stay Care Service (Short-Term Admission for Daily Life Long-Term Care) Home-Visit Care Service Group Home (Communal Daily Long-Term Care for a Dementia Patient) Small-scale Multifunctional in-Home Care Day Care Service (Outpatient Day Long-Term Care)

35. 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.

36. Small-scale Multifunctional in-Home Care To support living in their own homes. 1. Outpatient Day Care 2. Home Visit (When necessary) 3. Short-stay Care (when necessary) Inclusive copayment! All with Same Caregivers!

37. Small-scale Multifunctional in-Home Care To support living in their own homes. Designed to support " life " of the elderly as a whole.

38. Group Home To live communally in homely environment. Bath W.C. Public Space (Kitchen, Dining, etc.) Steering Committee involving neighbour representative. Daily intercourse with neighbourhood is mandatory.

39. Intensive Care Home for the Elderly Long-Term Health Care Facility Sanatorium Medical Facility for the Elderly Requiring LTC In-Facility Services Medical Need More like Hospital More like Home Others (ex. ordinary care homes)

40. Intensive Care Home for the Elderly Long-Term Health Care Facility Sanatorium Medical Facility for the Elderly Requiring LTC In-Facility Services Medical Need More like Hospital More like Home Others (ex. ordinary care homes)

41. Numbers of "Unit type" Intensive Care Homes "Unit Care" in Intensive Care Homes Public Space Admiring individuality and life rhythm of every single resident 27% of all Intensive Care Homes in Country

42. Community General Support Centre Certified Social Worker Chief Care Manager Public Health Nurses Coordinate Cross-system Support (Volunteers, Medical Service, LTC Services, LTC counselors, Social Workers, Regional advocacies, Health Services, Guardianship, Abuse Prevention, etc.) Located in every municipalities, planned for every junior high school district. For seamless, continuous support for the elderly Global Consulting Preventive LTC Management General, Continuous Care Management Support Advocacy, Prevention of Elder Abuse

43. 3. Medical Care Early Diagnosis and Treatment 2. Research Causes, Risk reduction, Drugs, … 4. Long-Term Care (LTC) & Support 5. Actions for Young Onset Dementia 1. Epidemiologic Survey from : "The Urgent Project on Improving the Quality of Medical Treatment and of Life with Dementia" 2008

44. Minamisanriku Town, Iwate Pref.

45. 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.