Issues of Long Term Care from the IFA Meeting

Dr. M F Leung

Some of the issues discussed

Financing of Long Term Care Workforce for Long Term Care

The Reform of Long Term Care Insurance Scheme in Japan

Long Term Care Scheme in Japan Launched in 2000 A bill to make partial amendment to Long

Term Care Insurance Law Approved in June 2005 To be implemented in June, October 05 or April

2006

Achievements of the Long Term Care Insurance Scheme in Japan Rapid Expansion of community care services Expansion of services provided by profit-

making agencies and new types of nonprofit agencies

Changes in the attitudes of Japanese citizens towards the utilization of Long Term Care services

Increase in voluntary activities

Problems of the Long Term Care Insurance Scheme in Japan Long waiting lists for admission into care

facilities Defects in the quality of care, particularly in

group homes for the demented elderly Shortage of skilled and experienced care

managers Lack of effective co-ordination and liaison

among different agencies and professionals

Problems of the Long Term Care Insurance Scheme in Japan Decline in the planning and co-ordinating fun

ction of municipalities Increase in the improper claim of benefits by

profit making agencies

Strong pressures to include effective measures for containing the benefit expenditure Growth in benefit expenditures seen as a

‘problem’ Goal of ‘small government’ Need to facilitate the reconstruction of the

state finance

Reform of the Long Term Care Insurance in Japan Measures to contain the benefit expenditure

Increase in charges in institutional care Control mechanism of the amount of care services

for some community care services The reorganization and expansion of ‘preventive’

services Targeting of service provision

Reform of the Long Term Care Insurance in Japan New Service Programs

Small-scale geriatric health care facilities Nightime home care services ‘small-scale multi-functional home care’

A new schedule of the payment of remuneration

Reform of the Long Term Care Insurance in Japan Measures to solve the problems

Obligatory disclosure of information Measures to improve the quality of care

management ‘community total care support centre’ ‘locally-based services’ – transfer of authorities to

municipalities Regulatory power of municipalities strengthened System of renewal of accreditation

Significance and prospects of reform New service programs and measures for the

improvement in the quality of care Increase in the supply of accommodation for

the aged and the replacement of large-scale care institutions by smaller one are needed

It is not easy to predict the extent to which a ‘prevention’ centered approach will achieve its goal of reducing the needs of long term care services

Significance and prospects of reform A new understanding of the central role that

municipalities play in the planning and co-ordination of long term care services

The extent to which municipalities will actively engage in the improvement of the functioning of the community total care system yet remains to be seen

It is debatable whether this reform has greatly enhanced the mid and long term financial sustainability of the LTCI scheme

Plan to reduce the lower age limit of the insured from 40 to 20 The most effective method to enhance the financi

al sustainability of the Long Term Care Insurance scheme

Manpower issues in Long Term Care

AARP

OECD long term care survey found ‘staff shortages and staff qualifications’ were by far the most frequent mentioned concerns

Nurses shortages are predicted worldwide in almost all developed countries

Many African countries have <20 nurses per 100,000 (>1,000 in Norway and Finland)

Disproportionate numbers of migrating health care workers are in LTC settings

Brain Drain

Philippines lost 25,000 nurses to migration in 2003, three times the number of nursing school graduates

Africa bears 25% of the world’s disease burden but has only 0.6% of health professionals

Every year 8% of nurses leave Jamaica, 5% per year from Fiji and Samoa

Conclusion

Financing of long term care is key concern in all ageing societies in the world – preparation should commence in Hong Kong

Planning of services and monitoring of quality are essential elements of a good Long Term Care

Manpower for Long Term Care especially nursing shortage are key concerns – Do we have any solutions locally?

Thank you