Fee structure for elderly care needs comprehensive review

The Asahi Shimbun, November 5, 2001

A 72-year-old Hyogo Prefecture man who lives alone has been receiving home care services for the past six months from the Coop Kobe. He is visited for two hours a day, six days a week by a home care worker. Weakened by the combined effects of age, cardiac infarction and high blood pressure, the partly senile man has been certified by the municipal government as being in need of moderate care. 
The home care worker encourages the man to go out shopping with him as often as possible as a form of mild exercise. The care provider's advice has helped the man develop a much healthier lifestyle by drinking less and watching his diet. His health has improved markedly as a result, to the extent that his senility is mild enough that he can enjoy phone conversations with his daughter, who lives overseas. The care worker hopes to see the man's condition improve so he will be able to benefit from adult day care services, which offer opportunities to socialize with others in his community. 
The man's remarkable improvement is a result of dedication and appropriate help from the caregiver, who provides hot, nutritious meals and cleans his rooms as part of quality at-home service. These home care services, combined with the man's own effort, have established the foundation for a healthier lifestyle and his health has improved accordingly. The lifestyle changes also contribute to the prevention of disease. 
Help with housework provided under the public nursing care insurance program is quite a bit different from ordinary home help services. The assistance is carefully planned and designed to meet the specific needs of individuals so they can live as independently as possible within their communities. It is a job that requires a great deal of devotion and skill. But the job is a very low-paying one - 1,530 yen an hour under the public care insurance system. That is poor remuneration when compared with 4,020 yen an hour for physical nursing care services. 
Most home health care providers have a tough time because demand is greatest for the cheaper housework-assistance part of the program, contrary to projections made by the Ministry of Health, Labor and Welfare. Home care workers bear the brunt of this policy miscalculation. Even full-time workers can only earn about 200,000 yen a month. But most service providers cannot afford to hire many full-time workers, even at the lower wage, and instead operate their businesses by drawing from a pool of registered part-time workers who are then paid by the hour. These part-timers are resigned to a paltry income under 100,000 yen a month. 
The Consumer Cooperative Chiba is one of the biggest providers of home care services among such cooperatives in Japan. But even this non-profit provider has trouble increasing the number of its full-time workers significantly from the current 10 percent, filling the other 90 percent of its positions with part-timers. 
Nursing care services are one of the few areas in which domestic employment rates could grow vigorously in the future. The future of the business is at stake, because, if supported with the right policies, it could become a thriving service industry that provides decent livelihoods for many workers as the aging population increases the demand for its services. Whether home health care becomes a profession that guarantees enough income for financial independence for its workers is an issue that will have an important effect on the nation's economic future. 
Service fees need review, but it would not be enough to just raise the government-set rate for housework help. A bigger problem is the difference between the rates paid for different kinds of services. This complicates things for users who want a combination of household assistance and physical care. 
There is no good reason to distinguish between these two types of service, since they are usually interwoven. One uniform fee for both kinds of service makes more sense from the financial as well as operational perspective. It would also help simplify paperwork. 
The government has begun reviewing the fees for home service to take effect in 2003. The review should focus on ways to unify fees and price services accordingly, while paying proper attention to the circumstances of low-income users. 
Before such review, a better training program is needed to help care workers get the proper skills and develop expertise. Users will not want to pay higher fees unless they are sure they will get value in the services they receive for the money.