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New Nursing Fees Hit Elderly / Revised Law Increases Cost Burden Ongeriatric Patients
By Yoko Harihara and Takeharu Yasuda, The Daily Yomiuri
Japan
July 26, 2005
A key element in the revised Nursing Care Insurance Law--the abolition of government spending on accommodation and meals for geriatric nursing care--has caused disquiet among nursing care facility operators because the revision will be implemented quickly to take effect in October.
With the revision having been approved in June during the current Diet session, nursing caregivers will need to collect money for accommodation and meals from the elderly at their facilities from autumn.
Before the implementation of the amended law, the government this month revealed the revised benefits that will be available to nursing care facilities and the resulting cost burden on the elderly receiving nursing care at the facilities.
In the coming months, nursing home operators are expected to begin explaining the impact of the revised law to residents and their families. But the operators themselves appear bewildered by the large increase in costs for the elderly and the hasty implementation of the revision.
Koichi Atsumi, director of Oshika Seishinen, a public facility that provides around-the-clock nursing care, is concerned that the revised law could discourage residents at his facility from staying there.
"About 10 percent of 50 residents might leave this facility, even if we count low-income earners who would be eligible for a reduced service fee and exemption measures," Atsumi said.
Oshika Seishinen in Ishinomaki, Miyagi Prefecture, is a new type of public nursing home that provides individual rooms and staff care for a small number of residents in units.
Such facilities have already been allowed to charge residents accommodation and meals fees, but Oshika Seishinen has not charged its residents accommodation fees. The facility's residents only pay 10 percent of the cost of nursing care services they receive and meal fees. Currently, residents pay between 25,000 yen and 53,000 yen a month.
However, when the revised law comes into effect in October, residents will face a fee increase of up to 80,000 yen a month.
Families of the residents also have grumbled about the revised law, saying that the new financial burden is tough and the October implementation too soon.
Despite a backlash from residents' families, Atsumi has to make a difficult decision soon. "The only way to prevent the quality of our services deteriorating is ask our residents to pay the same amount of money to make up for the benefits that the government will cut," he said.
Providers angry at revision
Ariyoshi Hospital, a type of nursing care facility where residents also receive medical care, was refurbished three years ago to become the first facility of its kind equipped with 90 individual rooms. After pouring 150 million yen of its own funds into the refurbishment, the hospital found it necessary to make its residents contribute to nursing care costs.
But with the revised law, the hospital will have to charge each resident nearly 80,000 yen more each month.
Hospital director Michiyasu Ariyoshi was angry about the government's move. "We made efforts to improve the medical services on our own, but the efforts haven't been appreciated [by the government]. Instead, we're now suffering a big cut in benefits. This doesn't make sense at all," he said.
Like Ariyoshi Hospital, nursing care facilities that provide medical services are divided over the use of the state-run nursing care insurance system.
Recently, an administrative manager with 25 years of nursing care home experience in Kanagawa Prefecture was asked for advice from several hospitals as to whether they should return to the government-run medical insurance system.
Under the medical insurance scheme, costs for accommodation and meals are covered.
"It's not rare [for nursing care hospitals] in the prefecture that the payment by an individual resident exceeds 200,000 yen a month. Thus, many facilities are considering switching to the medical insurance system," the manager said.
"But patients likely will pay for accommodation and meals, currently covered under the medical insurance system, in the near future. So, we need to tread carefully," the manager added.
Private facilities unconcerned
Meanwhile, operators of private nursing homes where their residents pay for rooms and meals on their own have viewed the government's measure more calmly.
Masahiro Takeda, head of Benesse Style Care Co. compliance department, said: "So far, special nursing care facilities were given preferential treatment in terms of financial assistance for building the facilities. Therefore, it's natural that facility users bear some costs."
The discontinuance of government spending on accommodation and meals is aimed at curbing increases in nursing care-related benefits.
Government-paid benefits currently total 5.5 trillion yen and have increased by more than 10 percent annually.
With the new measure, the Health, Labor and Welfare Ministry aims to cut the 300 billion yen it spends on nursing care benefits each year. Insurance subscriber benefits will be cut by about 200 yen a month.
Some observers also have called for a system in which nursing care patients shoulder the cost of the service, arguing that the current system is unfair because the elderly staying at home pay for rent and meals on their own, while those at nursing home do not.
The elderly have access to rent assistance under the pension insurance system, and this has raised questions over duplicate payments for those staying at nursing homes.
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