Implementation process and challenges for the community-based integrated care system in Japan

Abstract

Background: Since 10 years ago, Japan has been creating a long-term vision to face its peak in the number of older people that will be reached in 2025 when baby boomers will turn 75 years of age. In 2003, the government set up a study group called "Caring for older people in 2015" which led to a first reform of the Long-Term Care Insurance System in 2006. This study group was the first to suggest the creation of a community-based integrated care system.

Cost of physician-led home visit care (Zaitaku care) compared with hospital care at the end of life in Japan

“…This system was implemented to promote socialization of care with the slogan “Transitioning From Care by Family to Care by Society” [4, 5]. Another goal of the LTCI is to support organized community-based integrated care [8, 9], especially for the increasing number of the frail elderly and home-bound patients with medical and nursing needs [5–7]. …”

“…Although home care services and programs have also been implemented in other countries [10–16], Zaitaku (“staying at home” in Japanese) care is unique in that primary care physicians lead home care teams consisting of nurses, rehabilitation staff, pharmacists, medical aides (helpers), care managers, and case managers using LTCI and public medical insurance including national health insurance (NHI) [8]. To be enrolled in Zaitaku care, patients must be unable to get to outpatient clinic and must reside within roughly 16 km of the hospital or clinic that provides these services.…”

“…Eighty three percent of the population died at home in 1951. Current literature on end of life care suggests that people still prefer to stay at home [17–21], but more Japanese citizens die in health care facilities (81.6% in 2003) than at home [8]. There are still some roadblocks such as deficiencies in patient and family knowledge regarding home care and support systems for caregivers, but the biggest barrier may be the lack of widespread medical systems that can adequately support patients’ wishes to spend their last days at home [22, 23].…”

Promoting the Use of Visiting Nurse Services for Patients Discharged From Hospital

“…To keep the health care system under the aging situation, the government facilitates the integrated health care system focusing on the home health care. 2 …”

Recommended Design and Direction of Development for Humanoid Nursing Robots Perspective from Nursing Researchers

“…This, and the declining birth rate associated with the aging society have caused an aging population demographic structure [2]. Moreover, along with societal changes such as the increase in unmarried people and single-person households or separated parent-child households, the number of elderly persons living alone has also increased [3]. Similarly, many high-income countries in Asia like Japan, in Europe, and in North America are facing a demographic "double whammy", i.e., with the aging population, they also have an aging nursing workforce who are caring for the increasing numbers of elderly persons [4] [5].…”