Disease Management Reporter in Japan
Nov. 2009 No.16
Long-Term Care Support Volunteer System of the Elderly Welfare Division, Welfare Department, Inagi City, Japan - Efforts to Improve the Sustainability of Long-Term Care Insurance and Create Lively Local Communities -
Inagi City, located in southwestern Tokyo, is implementing a program called "Long-Term Care Support Volunteer System" in order to promote social participation activities by the elderly, aged 65 or older.
The program aims to motivate the elderly to participate in volunteer activities to support long-term care in order for them to maintain their own health, as well as improving the sustainability of the National Long-Term Care Insurance System and creating lively local communities. Among various devices introduced to motivate the elderly to participate in volunteer activities, the most noteworthy is the issuing of a "Long-Term Care Support Volunteer Notebook." Elderly peo- ple who participate in volunteer activities are provided with the notebook, which is stamped every time they participate in volunteer activities. The stamps represent points that can be exchanged for money, which is defined in the system as funds to be used to pay part of their own long-term care insurance premium. This system promotes continuous participa- tion of the elderly in these activities, since the participants have their notebooks showing their activity records and they can feel pride and satisfaction when they show their records to their family members. Mr. Mitsuhiro Ishida, the Head of the Welfare Department in Inagi City, calls this type of system a "program to reward the healthy elderly people."
Inagi City’s goal was the participation of 1% of the elderly, i.e. one in 100 elderly people, and currently 2.7% of the eld- erly are conducting activities as long-term care support volunteers. This system, first introduced by Inagi City, has already been adopted by 25 other local governments as of October 2009. The city will continue releasing detailed information on their website so that other local governments can refer to the information when they introduce the system.
In this issue, we will feature efforts for introducing the Long-Term Care Support Volunteer System, the outline of the system, the current status, future challenges, etc. based on interviews with Mr. Mitsuhiro Ishida and Ms. Eriko Kudo who is the Chief of the Long-Term Care Insurance Section, Elderly Welfare Division of the Welfare Department.
Contents History and Background ...... 2 Long-Term Care Support Volunteer System ...... 2 Future Challenges ...... 6 Inagi City’s Advanced Activities for the Long-Term Care Insurance System ...... 6
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History and Background A variety of other activities have also been conducted with the goal of raising awareness about measures to pre- vent disability and dependence on long-term care. For 1. Overview of Inagi City example, the "Long-Term Care Prevention Exercise with the Inagi Hanjo Song" was invented so that elderly people can Inagi City in Tokyo is situated at the eastern end of enjoy exercising to this popular tune. Inagi City is promot- Minami-tama District, some 25 km southwest from Shinjuku ing the exercise program by producing a video and manual, which is in the center of Tokyo. The city has an area of and distributing them to clubs for the elderly, 17.97 km2 and is 5.3 km from east to west and 5.3 km from Communication Centers, local voluntary groups, etc. A north to south. Its population is 83,009 (42,225 males and "Convention for the Prevention of Dependence on Long- 40,784 females) with 35,045 households as of September 1, Term Care" was also organized and has been held once a 20091 and the percentage of the population aged 65 or older year since 2005. This provides an opportunity for groups was 16.5% as of November 1, 2009. involved in the prevention of disability to present their activ- ities. The number of participants at the first convention in The population of Inagi City grew rapidly in the 1950s and 2005 was 220 but groups making presentations at the con- 1960s due to an increased housing supply followed by the vention must now be selected, because the number of migration of young people and through the development of groups wishing to take part has increased. the Hirao housing complex in the city, and the Tama New Town. Although the proportion of those aged 65 or older in Inagi City is lower than the national average of 22.6% (as of Long-Term Care Support Volunteer System August 1, 20092), it is expected that the aging of the popula- tion will accelerate rapidly due to the baby boomers who 1. Description of the System migrated to the city following the New Town development and will turn 65 or older by 20153. It is in this context that (1) Outline Inagi City is emphasizing measures to prevent people from After a trial period from September 2007, Inagi City becoming disabled and in need of long-term care, with the fully launched the Inagi City Long-Term Care Support recognition that it is important to take measures now to Volunteer System in April 2008. Figure 1 and Table 1 maintain the health of currently healthy elderly people, in show the overview of this system. The program targets order to keep the future costs for the long-term care of the the elderly aged 65 or older. Elderly people who wish to elderly stable. conduct activities as long-term care support volunteers register with the Inagi City Council of Social Welfare and 2. Past Developments in Long-Term Care are given the Long-Term Care Support Volunteer Prevention Projects Notebook called the "No Problem with Health Notebook,"
Inagi City participated in the "Tokyo Metropolitan Priority 01 "The Latest Population and the Number of Households," the website of Inagi Support Program for Model Districts to Promote the City (visited on November 14, 2009)
of 941 people who received checkups were deemed eligible Inagi City Council ①Issue a notebook and introduce for the disability prevention program through Otassha 21 of Social Welfare host organizations for activities. Volunteers screening. Whereas only 26 people out of 941 were found to 2nd floor of the ④Receive credit points. Welfare Center be eligible for the disability prevention program using the ⑥Money is paid to the account in "Basic Checklist." Inagi City continues to use "Otasshi 21" as accordance with the points. a screening tool for the disability prevention programs to (Source) "Pamphlet on the Inagi City Long-Term Care Support Volunteer System," a material distributed at the 56th supplement the Basic Checklist. National Convention of the Japanese Society for the Study of Social Welfare (oral presentation) (October 2008).
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Table 1 Description of the Long-Term Care Support Volunteer System Article 115-38 (i) of the Long-Term Care Insurance Act; 1 (2) b (b) 3 of the Separate Paragraph of the Implementation Guidelines for Community Support Projects; Article 15-6 of the Inagi City Long-Term （1） Basis for the program Care Insurance Ordinance; the Implementation Guidelines for the Inagi City Long-Term Care Support Volunteer System Long-term care support "Primary Insured Persons" with Long-Term Care Insurance in Inagi City Registration with the managing （2） volunteers agency is needed prior to their activities. Long-term care support volunteer projects and activities designated by the Mayor of Inagi City Projects Activities (1) Facilities subject to Long-Term (1) Guidance on recreation, etc. and helping users to par- Care Support Insurance ticipate in the activities (2) Community Support Projects con- (2) Assisting in the serving of tea, setting and clearing the ducted on behalf of Inagi City tables in dining rooms (Long-Term Care Prevention (3) Assisting in the operation of a cafe, etc. Projects) (4) Assisting users in going for a walk, going out and mov- Long-term care support ´ （3） (3) Communication Centers ing around inside the building volunteer activities (4) Dining parties for the elderly (5) Helping at events such as assisting at refreshment (5) Others booths, setting up venues, assisting users in moving around and helping with presentations of the perform- ing arts (6) Serving as a companion (7) Other minor and supplementary activities conduced with facility staff (e.g. mowing, sorting laundry, chang- ing sheets, etc.)
The Long-Term Care Support Volunteer Notebook which the volunteer brings with him/her is stamped （4） Records on activities as a proof of their activities. Maximum 5,000 credit points are given in accordance with the number of stamps on the Long-Term （5） Giving credit points Care Support Volunteer Notebook. The volunteer submits the Long-Term Care Support Volunteer Notebook and applies for usage of the Award provided in exchange （6） credit points. for credit points The award is a maximum of 5,000 yen annually. The award is not disbursed when the volunteer has not paid or falls behind in the payment of the （7） Others Long-Term Care Insurance premium. (Source) "Report on the Implementation of the Inagi City Long-Term Care Support Volunteer System: Operational Status after the Full Implementation of the System" (March 2009).
in which their volunteer activities will be recorded. The "Insurance Premium Deduction System for Long- Mayor designates the long-term care facilities or other Term Care Support Volunteers" where contributions locations at which they will conduct their volunteer to volunteer activities are reflected in a deduction to activities (the "host organizations") in accordance with the long-term care Insurance premium. In July 2005, their requests. When the elderly participants conduct the Mayor Ryoichi Ishikawa made a request for the volunteer activities such as giving guidance on recre- establishment of the system to the Health and Welfare ation and helping the facility users to participate in Bureau for the Elderly of the Ministry of Health, recreation, they can have their notebook stamped. Labour and Welfare (MHLW). After going through the Credit points are given in accordance with the number of procedure including soliciting the opinions of long- stamps and money is paid into the volunteers' accounts term care insurers nationwide (i.e. municipalities), in accordance with the number of credit points. The vol- the MHLW issued a notice in May 2007 that enabled unteers can obtain a maximum of 5,000 points in a year the introduction of a system to essentially reduce the and the maximum grant is 5,000 yen (about US$50 at insurance premium payments of the elderly in accor- 100 yen per US dollar). This grant is defined in the sys- dance with the amount of their volunteer social par- tem as funds to be used to pay part of their own Long- ticipation activities. More specifically, the notice Term Care Insurance premium. issued by the Heads of the Insurance Division and the There were 360 participants in the system as of Promotion Division, the Health and Welfare Bureau August 31, 2009 and the number of new registrants in for the Elderly of the MHLW stated that the "Grants 2009 was 61. The number of host organizations was 185. for Supporting Community Support Projects6" which are provided based on the Long-Term Care Insurance (2) Background and Objectives for Introduction of the Act can be used for the operation of the award sys- System tem. This made it possible to introduce the system In 2005 when a long-term care support volunteer devised by Inagi City. system was first considered, many healthy elderly The objectives of the Long-Term Care Support people made complaints about the high cost of the mandatory national long-term care insurance premi- 05 "Current Status of the host organizations, registration and the issuing of credit points in the Inagi City Long-term Care Support Volunteer System," the web- um. At the same time, the city recognized the need to site of Inagi City (visited on September 14, 2009) < http://www.city.inagi. take steps to maintain the health of the currently- tokyo.jp/kurashi/fukushi/kaigohoken/kaigosien/touroku/index.html> 06 Community Support Projects refer to Long-term Care Prevention Projects, healthy elderly in order to mitigate the high cost of Comprehensive Support Projects and voluntary projects. The Long-term Care the aging population, whose numbers are expected to Support Volunteer System was defined as one of the community support proj- increase in the near future. Discussions about meas- ects for activities to prevent dependence on long-term care targeting all elder- ly people and became subject to the Grants for Supporting Community ures to meet both needs resulted in devising an Support Projects.
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Volunteer System are: to promote the prevention of Figure2 Activities by a Long-Term Care Support disability and dependence on long-term care through Volunteer at the Momura, Higashi-naganuma and elderly people’s participation in social activities; and Omura Communication Center to improve the sustainability of Long-Term Care Insurance and create lively local communities, by maintaining the health of healthy elderly people.
3) Effects of the Introduction of the Long-Term Care Support Volunteer System Prior to the full launch of the Inagi City Long-Term Care Support Volunteer System in April 2008, a pilot project was implemented from September 2007 on a trial basis in order to examine the possibility of full implementation. A survey for measuring the effects of the system was conducted on the pilot project in January 2008. The survey results show that the majority of respondents gave a positive response to the system, with 70.5% of those surveyed agreeing with the statement, "I think it is a good system". The (Note)The lady in the center is long-term care support volunteer Ms. Imai. (Source) photo taken by the editorial staff at the interview site on survey also measured the quality of life (QOL) of August 28, 2009. long-term care support volunteers using SF-367 and compared the results with national standard values. lishment. According to the survey, the scores of long-term care According to Ms. Imai, the activities at the Momura, support volunteers in Inagi City were higher than the Higashi-Naganuma and Omura Communication Center national standard values for ages 60-69 and ages 70- are characterized by the concept that participants can 80 in six out of eight scales of SF-36, namely "physical do anything they like. The coordinators do not decide function," "physical role," "emotional role," "social activity content, except for karaoke on Monday morn- function," "vitality" and "mental health." ing. They leave the choice of activities to the partici- One year after the launch of the system, a survey pants because determining the activity content may was conducted once again in January 2009. The sur- limit the participants to those who like specific activi- vey results showed that the number of positive ties. People can participate in the activities at any responses to the system increased from the January time between 10:00 and 15:00. The center takes into 2008 survey, with 77.5% agreeing with the statement consideration the fact that the participants include "I think it is a good system". The results of SF-36 also those who have disabilities and the elderly aged 90 or showed that the scores of long-term care support vol- older, by, for example, having sofas so that the partic- unteers in Inagi City were higher than the national ipants who do not feel well during the activities can standard values for ages 60-69 and ages 70-80 in take a rest (see Figure 2). seven out of eight scales of SF-36, adding "general Ms. Imai was not particularly involved in communi- health" to the six scales mentioned as improved in the ty activities when she was working, but she started 2008 survey. getting interested in participating in the community Inagi City’s goal was the social participation of 1% and helping people after her retirement. Ms. Imai of the elderly, i.e. one in 100 elderly people, and, as of said, "Serving as a volunteer is worthwhile and it has the end of October 2009, 2.7% of the elderly are become my source of energy." indeed conducting activities as long-term care sup- port volunteers. 2. Properly Understanding the Residents’ Needs and Taking Measures 4) Example of the Activities of Long-Term Care Support Volunteers: Activities at the Momura, Higashi-Naganuma Mr. Ishida, the Head of Inagi City Welfare Department, and Omura Communication Center says that it is important to properly understand the target Inagi City operates "Communication Centers" at six residents’ needs and design a system which will meet those sites in the city that are used as socializing places needs. Participants in the Long-Term Care Support where any elderly person can participate. The centers Volunteer System are not those who receive long-term care. are open three days a week and various activities are The system needs to be designed to meet the volunteers’ conducted such as fitness exercises, karaoke competi- needs. Their need is their wish to "conduct volunteer activi- tions and tea parties. ties" and therefore the system should not use volunteers to At the Momura, Higashi-Naganuma and Omura perform long-term care delivery itself. The system defines Communication Center, which is one of the six cen- what are acceptable volunteer activities. Several types of ters, some 15 people are participating in every event. activities have been selected while taking into account vol- There are 15 registered long-term care support volun- teers at the center and two of them take turns manag- 07 SF-36 (MOS Short-Form 36-Item Health Survey) is an internationally used ing events as coordinators. Regular monthly meetings scale to measure health-related QOL which can be used for patients with vari- ous diseases and healthy people. SF-36 has national standard values obtained are held to exchange opinions, discuss improvement through a national survey which was conducted by taking samples to reflect measures, etc. the distributions of the national population regarding sex, ages, regions, city sizes, etc. Health status of a certain population can be evaluated against the Ms. Michie Imai, who is a long-term care support standards. SF-36 consists of multiple items to measure eight health concepts, volunteer, has been involved in the operation of the namely: (1) physical function; (2) role physical; (3) role emotional; (4) general Communication Center as a volunteer since 2001 health; (5) social function; (6) bodily pain; (7) vitality; and (8) mental health. Source: "What is SF-36?" (visited on October 20, 2009)
4 Disease Management Reporter in Japan Nov. 2009 No.16 unteers’ needs. Volunteers can choose their desired volun- Figure 3 The Health Notebook (the Long-Term Care teer duties from among the acceptable activities. Support Volunteer Notebook): the Cover, the Stamping Section and the Credit Point Register 3. Operational Framework: Division of Roles between Involved Organizations
When establishing the volunteer system, Mr. Ishida felt that it was better to minimize the need for a direct relation- ship between the volunteers and the local government. If the local government has direct relationships with volun- teers, the volunteers sometimes feel that suggestions, etc. from the local government are effectively imposed from above. This is why the Council of Social Welfare, and not a government office, conducts operations which involve direct contact with the volunteers such as the registration of long- term care support volunteers, the issuing of the notebook, giving and managing credit points, etc. The Elderly Welfare Division of Inagi City does plan and coordinate the entire (Note)The sheet for stamping is shown on the left. One stamp is given for one hour of activities and the date is recorded. A maximum operation of the system. During preparations for the estab- of two stamps can be obtained per day. The figure on the right lishment of the system, a small number of responsible per- shows the sheet on which the annual total points are recorded. (Source) Same as Table 1. sonnel from the municipal government had continuous dis- cussions with the Council of Social Welfare. The documenta- the notebook at a glance, which they find more satisfying tion forms to be used were also decided on one by one (see the Stamping Section of Figure 3) . The paper note- through discussions between the two parties. book was adopted for this reason. According to the Mr. Ishida points out that a suitable division of roles needs Welfare Department, many volunteers set a target num- to be considered in accordance with the situation in each ber of stamps and are motivated by watching the num- local area, although the operation of the system is conduct- ber of stamps increase. Before the notebook was distrib- ed by the Council of Social Welfare in Inagi City. uted, many elderly people marked the dates for their vol- unteer activities on a calendar, but calendars are often 4. Efforts to Ensure the Sustainability of the discarded after the yearend. On the other hand, a note- Long-Term Care Support Volunteer System book can be kept easily and the record of their activities accumulates year after year. The Welfare Department (1) Utilization of Existing Resources says that the notebook serves as an incentive for elderly The program has been developed based on existing people to continue participating in the long-term care activities in order to make the system easily acceptable support volunteer activities. for local communities. The Volunteer Center of the Council of Social Welfare, which was assisting with vol- (3) Schemes which Provide "Enjoyment" unteer activities by the elderly before the introduction of Mr. Ishida says that in order to maintain the system, it the system, became the managing agency for the opera- is important to continuously plan activities which pro- tion of the Long-Term Care Support Volunteer System. vide entertainment for long-term care support volun- Long-term care facilities, etc. which had been hosting teers and residents, in general, and keep them interest- the elderly as volunteers through the Volunteer Center ed. In one such example, Inagi City established the "Test were designated as the organizations in which the long- on the Inagi City Long-Term Care Support Volunteer term care support volunteers would conduct their activi- System8" on the first anniversary of the launch of the ties. When the system was introduced, many elderly vol- system and released it on the Internet. It contained a unteers aged 65 and older who had already been con- total of 25 multiple-choice questions (three choices ducting volunteer activities registered for the system. "I each) for the beginners’ level (3rd Grade Questions), the think that the main reason for the smooth introduction advanced level (2nd Grade Questions) and the highly of the system was because we utilized the existing advanced level (1st Grade Questions), as a tool for peo- scheme which had supported volunteer activities rather ple to study the Long-Term Care Support Volunteer than developing a new system from scratch," Mr. Ishida System while having fun. The Welfare Department says explained. that this quiz contains the element of a game show so that residents can become interested in the system by (2) Making a Mechanism which Rewards Healthy Elderly taking advantage of Japan’s "official test boom" and at People the same time serving as a tool to expand and continue The Long-Term Care Support Volunteer System is a usage of the system. system to increase the motivation of the elderly to con- With the sponsorship of Tokyo Verdy, a local soccer tinue their volunteer activities. In order to reward the team, the city also held a campaign to present team elderly participants and to provide them with an incen- goods and other prizes to the volunteer participants in tive, the system adopted a mechanism for issuing points FY 2007 who attained a certain numbers of credit points for participation in volunteer activities which can then by July 31, 20089. More specifically, the volunteer activi- be exchanged for a financial award. A notebook is used for the recording and management of the points. The use 08 "Test on the Inagi City Long-term Care Support Volunteer System," the web- site of the Inagi City (visited on September 18, 2009)
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ty participants who obtained 5,000 (50 hours) points, 2. The Idea of Equalization and Standardization and up to four family members, were invited to watch a for Regional Implementation Tokyo Verdy soccer match held at the Ajinomoto Stadium, free of charge. Twelve families (41 people in In the current system, credit points are not given to Inagi total) watched the game on November 9, 2008 through citizens who are conducting volunteer activities outside this special plan. Team memorabilia and pedometers Inagi City. Similarly, volunteers from other areas who con- were also presented to all of the volunteers who duct volunteer activities in Inagi City cannot obtain points. obtained 1,000 points or more. Therefore, Mr. Ishida is considering the possibility of intro- ducing a system to give points to volunteers who conduct 5. Ensuring Both Consistency of the System and activities outside their municipalities, by equalizing and Local Originality standardizing the systems in different municipalities through cooperation between the cities that have intro- Systems similar to the Long-Term Care Support Volunteer duced similar systems. System have currently implemented in 11 cities and wards in Tokyo and eight cities outside Tokyo. Eight additional 3. Utilization of the Principles of the Long-Term cities are also planning to implement similar systems (as of Care Support Volunteer System for Other July 23, 2009, according to Inagi City’s research). Inagi City Purposes also receives numerous visits and inquiries from other municipalities and it is actively releasing information about Inagi City is considering expanding the scope of the sys- its system on its website10, etc. so that they can refer to the tem to volunteer activities for childcare, people with disabil- information when they introduce similar systems. ities, etc. in addition to the field of long-term care for the With many local governments starting to introduce similar elderly. systems, Mr. Ishida comments that it is important to remem- Mr. Ishida thinks that because the system motivates and ber that each municipality has different concerns as well as supports volunteers it will be effective in promoting local resources. When implementing a system in each different volunteer activities in other welfare fields as well as in the municipality, one must take the perspective that the system field of long-term care. However, each field has different is one measure to solve problems which each municipality challenges and the participants’ needs also vary. The Long- faces, rather than having the establishment of the system Term Care Support Volunteer System was introduced in a itself as a goal. He points out that it is important to utilize way which would meet both the needs of the elderly, who the unique resources of each area and incorporate the origi- wished to reduce their long-term care Insurance premium, nality of each municipality, while taking advantage of the as well as the long-term care insurer’s need to maintain the basic framework of the Inagi City's system. health of the elderly in order to improve the sustainability of the long-term care insurance system. He explained that it is Future Challenges important to assess whether or not the volunteer system could serve as a means to solve the problems of the target fields if expanded to other groups. 1. Continuous Support for Long-Term Care Support Volunteers Aged 75 and Older Inagi City’s Advanced Activities for the Long- Term Care Insurance System Table 2 shows the age distribution of registered long-term care support volunteers (as of June 30, 2009). There are more than 120 registered volunteers in the age groups of 65- In parallel to these efforts to prevent disability and the 69 and 70-74, but the number drops to half for the age elderly’s dependence on long-term care, Inagi City is also group of 75-79. It is believed that this is because when they conducting advanced activities on the Long-Term Care turn 75 or older, many elderly people feel that they have Insurance System as described below. become physically and mentally weak. According to Ms. Kudo, the Chief of the Long-Term Care Insurance Section of 1. Confirmation Sheet for the Utilization of Inagi the Elderly Welfare Division, the eldest volunteers seem to City Long-Term Care Insurance Services worry that because of their advanced age, they may be both- ering or inconveniencing the participants. In light of this sit- Inagi City developed a "Confirmation Sheet for the uation, the Inagi City Council of Social Welfare as the man- Utilization of Inagi City Long-Term Care Insurance Services" aging agency responsible for the operation of the system that it distributes to each user of long term care together considers that one future challenge is how to encourage with a notice on the result of the Certification of Need or a people aged 75 or older to continue volunteering. notice on the result of the Certification’s renewal (see Figure 4). The sheet was developed based on a request from Table 2 Ages of Registered Long-Term Care Support the Inagy City's Certification Committee for Long-Term Volunteers (as of June 30, 2009) Care Need who wanted to give advice to long term care Age group Males Females Total % users rather than just notifying them about the results of 65 - 69 25 102 127 36.49 their assessment. 70 - 74 26 99 125 35.92 The sheet summarizes the status of the utilization of 75 - 79 20 41 61 17.53 Long-Term Care Insurance by the user for three periods 80 - 84 2 21 23 6.61 (the current period and the past two periods), including the 85 - 89 1 3 4 1.15 services that he/she is using and his/her physical condition. 90 - 95 1 2 3 0.86 The sheet also contains a section on which the Certification Loss of qualification （5） 010 Total 76 272 348 "Inagi City Long-term Care Support Volunteers," the website of Inagi City (visited on September 14, 2009)
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Figure 4 Confirmation Sheet for the Utilization of Inagi sheet also has graphs showing the number of people certi- City Long-Term Care Insurance Services fied for long-term care in Inagi City for each level of disabili- ty and care needed, so that the user can see immediately where he/she stands among all users in Inagi City. The sheet also contains information about the general services made use of by people needing the same level of care as the par- ticipant, providing an opportunity for individual comparison to the average in Inagi City.
2. Disclosure of the Contribution Ratios of the Long-Term Care Insurance Premiums
Inagi City discloses data showing which benefits and other activities the Long-Term Care Insurance premiums are used for, how much the premium revenue contributes to these benefits and activities, and the trends in these numbers, in the Inagi City Long-Term Care Insurance Project Plan (the (Note)Information about the Certification of Needed Long-Term Care Fourth Term) (see Table 3). This information is disclosed for the current period is shown at the top left of the sheet, infor- mation for the last period is shown at the top center and infor- on the city’s website, the "PR Bulletin Inagi11" and is printed mation for the period before last is shown at the top right. Each on the back of the certificates of payments for long-term contains the Long-Term Care Insurance utilization status and advice from the Certification Committee to the individual user. care insurance premiums. The objectives for showing clearly The bottom section of the sheet has graphs which show the the contribution and expense ratios are to both promote the number of people certified to be disabled in Inagi City for each level of care needed. understanding of the system to those who pay the insurance (Source) Material provided by the Elderly Welfare Division, the Welfare premiums, as well as to enable analysis of the projects. Mr. Department, Inagi City Ishida says that he hopes that other municipalities will also Committee can write a brief message or advice for individual disclose the contribution ratios of the revenue from long- users, for example, "Please use the day-care service," "We 011 "The Special Number on Prevention of Dependence on Long-term Care (April recommend you to receive nutritional counseling" (for those 15, 2009)" of PR Bulletin Inagi (visited on September 16, 2009) who are overweight), and so on. The bottom section of the
Table 3 Contribution Ratios of Insurance Premiums Paid by Primary Insured Persons (Unit:yen) The Third Term Project Plan The Fourth Term Project Plan Com- (FY 2006-FY 2008) (FY 2009-FY 2011) parison Amount of Amount of Share Insurance Share Insurance insurance insurance of premium/ of premium/ B－A premiums premiums costs month (A) costs month (B) needed needed Standard benefit costs 1,416,341,160 3,284 1,839,263,812 3,654 370 Long-Term Care Benefit 1,218,510,829 2,825 1,548,393,583 3,076 251 costs Prevention Benefit costs 130,608,658 303 184,138,658 366 63 Costs of Allowances for High-Cost Long-Term Care 19% 19,412,069 45 20% 31,090,489 62 17 Services Costs of Allowances for Long-Term Care Services to 44,950,484 104 73,220,026 145 41 Persons Admitted to Specified Facilities Examination fees 2,859,120 7 2,421,056 5 －2 Costs of Community Support 19% 34,735,800 81 20% 55,104,740円 109 28 Profects Fiscal Stability Fund 2,291,174 5 0 0 －5 contribution Fiscal Stability Fund redemption 79,000,000 183 0 0 －183 money Adjusting Subsidies (5%) 365,349,358 847 458,435,953 911 64 surcharge The total amount of insurance 1,897,717,492 4,400 2,352,804,505 4,674 274 premiums needed
Appropriation from the Long- Term Care Benefit payment 109,357,097 －217 －217 reserve funds Expected amount of special 28,653,480 －57 －57 grants Base amount of insurance 4,400 4,400 0 premium fees (per month) (Source) The Inagi City Long-Term Care Insurance Project Plan (the Fourth Term), FY 2009-FY 2011 (March, 2009)
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term care insurance premiums in the future, so that the fig- ures between different municipalities can be compared.
Editorial Board Members of Disease Management Reporter in Japan: Gregg L. Mayer President, Gregg L. Mayer & Company, Inc. Shigeru Tanaka (Chief Editorial Board Member) Professor and Associate Dean, Graduate School of Business Michiko Moriyama Administration, Keio University Professor, Division of Nursing Science Graduate School of Health Sciences Hiroshima University Shinya Matsuda Professor, Department of Preventive Medicine and Hiroyuki Sakamaki Community Health, School of Medicine, University of Professor, Department of Clinical Economics, Faculty of Occupational and Environmental Health Pharmaceutical Science, Meijo University
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