Complementary Currency B
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MEMORANDUM City of Delta Parks, Recreation & Culture Department To: Parks, Recreation & Culture Commission From: Ken Kuntz, Director of Parks, Recreation & Culture Date: April 27, 2018 Subject: Community Care for Seniors File No.: 14060-20 This memorandum is before the Parks, Recreation & Culture Commission (Commission) for information and discussion. At the direction of the Commission Chair, staff researched unique programs available to seniors at a local or regional level. This memo contains some of the findings and programs that are available in Japan and in Ontario. Over the past several years, articles and studies have been published on ways to empower and care for the elderly in Japan. Japan has the oldest population in the world. People over the age of 65 make up a quarter of Japan's population, and over the next several years will reach 40%. The top-heavy demographic creates huge challenges for local government and the overall economy on how to respond to caregiving challenges. Japan's government, businesses and society as a whole are facing challenges earlier than other countries, allowing the world to learn and benefit from their stumbles, innovations and experiments. Focusing on how to ensure an older population remains relevant in today's society and to stay ahead of the curve, Japan is tackling the issue with innovative programs including everything from comprehensive long-term care insurance introduced in 2000, to robotics. Historically adult children in Japan cared for their aging parents, now many are moving away. Not only are the adult children moving away, they are having less children due to an uncertain economic future. In order to overcome this enormous demographic challenge, Japan has developed some innovative ways to keep the aging population healthy, engaged and relevant. City of Delta Parks, Recreation & Culture Department Subject: Community Care for Seniors Page 2 of 5 File No: 14060-20 Examples of programs currently employed in Japan are as follows: • Community Time Banking (Fureai Kippu): Ticket for a Caring Relationship The program is a community based complimentary currency that was initiated in 1995 through the Sawayaka Welfare Foundation. It was widely embraced in China as well. By 2005, China had the largest complimentary currency system in the world. The Fureai Kippu system provides care for the elderly through an exchange of time credits. Members of the community donate their time by helping a senior and are issued tickets as payment which can then be used by a senior to "buy" services. Anyone can earn the tickets - seniors helping seniors, someone younger helping an older person in the community, etc. The tickets pay for things like a ride to a medical appointment, a trip to the grocery store or having someone come in and clean or cook. Adult children who moved away can earn tickets by helping seniors who live near them and then send the tickets they earned to their family members. They can also save the tickets for when they are older to pay for their own services. A surprising result of the program is that elderly tend to prefer the services provided by people paid in Fureai Kippu over those paid in yen. This may be due to the personal connection. Elders wishing to seek services, who do not have any time credits could pay a user fee to access the service, and/or buy a service at a reduced amount. In 2012, it was reported there were 391 operating branches/ centres of Fureai Kippu across Japan. Approximately 38% were new independent small grassroots agencies, and a further 21 % were operated by local government, with the remaining 41 % run by two non-profit organizations with wider networks. The largest operating Fureai Kippu organization in Japan is Nippon Active Life Club (NALC), operating since 1994. NALC identified one of the most pressing challenges is the number of persons requiring the care significantly outnumbers those providing the services. Volunteer recruitment has not kept pace with the number of care-dependent members. ~ ~.. ~~ City of Delta •Parks, Recreation & Culture Department Subject: Community Care for Seniors Page 3 of 5 File No: 14060-20 In addition, there is no one clearing house issuing comprehensive time credits that are transferable between all organizations; as a result, this may limit the types of services the credits can be used for depending on where the time credits are banked. Fureai Kuppu services supplement other care resources and they are more cost-effective, flexible and humane than expensive "top down" regulated and professional government care provisions. It represents the first "bottom-up" civil action to address local social problems, pushing government to take greater responsibility for the care of older people, which notably in Japan was the enactment of the Long-Term Care Insurance (LTCI) national social care reform. • Japan's Long-Term Care Insurance Model: In 2000, the Japanese government implemented LTCI in response to the skyrocketing caregiving burden on families. Under the system, all Japanese residents 40 years and older are required to pay into long-term care insurance premiums, which pay for about half of the long-term care services (corporate and personal taxes pay the rest). LTCI is a compulsory care system featuring mandatory contributions from everyone aged 40 years and older and offers uniform entitlements to individuals 65 and older. Seniors access the services, along with their caregiver, by attending an appointment at the community comprehensive care center. A case manager, along with a social worker, will assess the client. The client will then be categorized in one of seven categories that has an associated dollar amount attached to it from $55 to over $4,500 per month. Assessments are repeated every two years. Rather than providing cash, the funding can only be used for services. The client is advised of the type of services available in their community. Services will range from someone coming into the home to cook and clean, to having nightly nurse visits or 24 hour home care. Those providing the services range from volunteer-driven community organizations to for-profit nursing homes. A down-side to the program is that many seniors want assistance with cooking and cleaning services at the expense of utilizing nurse visits. A City of Delta Parks, Recreation & Culture Department Subject: Community Care for Seniors Page 4 of 5 File No: 14060-20 result is they miss out on preventative health care that ultimately reduces hospitalization. Many drop-in centres in Japan have activity rooms, a cafeteria, bathing facilities and a nurse on staff, in addition to support workers. A van travels around the community to pick up the clients and brings them to the centre. Studies found the day care use was associated with lower mortality in frail adults and lowered hospital admissions. The community focused model is not perfect. Because LTCI is separate from medical insurance, communication networks between home care and medical care providers suffer, as home helpers are not trained in medicine. The Japanese government is increasing training, and rolling out technologies in smartphones that prompt home caregivers to send reports of new symptoms to the client's health professionals. Canada is also facing an aging demographic, and it too will create issues for federal, provincial and local governments on how to manage the home and community care needs of an aging population. • Community Care Access Centre: In Ontario, there are similar offerings under the provincial Ministry of Health. Similar to Japan, people who need long-term care are referred to the local Community Care Access Centre (CCAC), where a care coordinator conducts a standardized assessment. Rather than choosing between a wide variety of services, the individual only has access to the services for which he or she meets the eligibility requirements for. This can be different between areas providing the services. A concern with the system is the fact that services an individual is eligible for, may be different than services the individual actually wants. An example is, one CCAC may say you are entitled to a bath, and the individual will say, "I don't need a bath my daughter bathes me, what I need is physiotherapy services", to which the CCAC responds, "you are not eligible for that". It is not the fault of the CCAC, it is a result of the rigid funding rules set by the Ministry. The Ontario Association of CCAC has raised alarms about the lack of flexibility in what services patients can access. City of Delta Parks, Recreation & Culture Department Subject: Community Care for Seniors Page 5 of 5 File No: 14060-20 Creating another challenge is the fact that many services provided through CCAC are contracted. This creates uncertainty for the coordinators who do not necessarily know what services are available. Furthermore, seniors must access these services separately. To many, the system is fragmented. Japan's single access point and flexibility for clients would address many of the Ontario systems shortcomings. Providing the power to seniors to choose services should be balanced by the ability of care coordinators to ensure that a care plan is appropriate for each client. The difference between Japan's LTIC and Ontario's CCAC is that the long term care services in Ontario are controlled by the province, while the services provided in Japan are controlled much more by municipalities. The local governments become the main coordinating institution to provide care, and mobilize communities, non-governmental organizations, and health care institutions to provide care. As noted, many of the long term care services needed are not health care. Delta already has many programs and services available for our aging population, including the Seniors Bus Program and the one on one service provided by our Seniors Support Coordinator.