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Nursing Care Insurance Over-assistance Can
Weaken the Elderly
The Asahi Shimbun,
Tokyo, Japan
June 16, 2004
Photo By Judith Farber
Since the nursing care insurance system was implemented four years ago, the number of people receiving care services has nearly doubled in as many years. This indicates that society has accepted the system.
That is all well and good, but there are some disturbing indications. Care recipients fall under six categories, according to the degree of support or care they need. The two least-serious categories are for those who need minimal support.
What disturbs us is that many elderly people, once placed in these two categories, tend to quickly deteriorate physically after they start receiving services. One reason is a growing over-reliance on ``assistive technology'' products, such as wheelchairs and special beds for disabled and elderly people.
One in three home-care service recipients are using these expensive products, which users can rent or purchase at about one-tenth the market prices.
But some care service providers actually press these devices on their clients, emphasizing that they will make moving around and lying down and getting up on bed much easier.
As a result, even people who can walk or need only minimum support are relying on wheelchairs and sleeping in special beds.
Once a person who can still walk becomes dependent on a wheelchair and has someone else doing everyday tasks for them, they soon lose muscle strength. This makes them even more reluctant to walk and leads to a rapid overall decline in health.
The Ministry of Health, Welfare and Labor has announced a new policy of charging, in principle, the full price to anyone in the minimal support category who decides to rent or buy such products.
Ideally, such minimum-care receivers should also be taking part in regular exercise programs to maintain and strengthen their muscles.
The nursing care insurance system is being re-examined from all angles. We need to look closely at the nature of care services to ensure that they truly enable people to remain self-sufficient.
Rehabilitation programs should also be reviewed. A report compiled in January by a welfare ministry study panel on rehab programs for senior citizens offers good pointers.
The report insists that such programs, now offered mainly at hospitals, be redesigned and made more pertinent to people's daily lives.
Toru Sometani, a 65-year-old resident of Moriya, Ibaraki Prefecture, had a stroke when he was 53. He was confined to a bed for six months after surgery. At the time, his doctors told him he would be in a wheelchair for the rest of his life.
But Sometani was determined to stand up at his daughter's wedding. With the help of a rehab expert, Sometani learned to walk with a cane, using custom-made braces on his legs.
And rather than installing handrails all over his home, he used the walls and furniture for support whenever he was on his feet. This improved his overall physical condition and sped his recovery. He was in the level 4 category when he first entered his rehab program, but he is now at level 2-a seemingly miraculous improvement.
For people who love gardening, being able to get out and dig among their flowers should be the goal of their rehab. For those who wish to continue doing things around the house, performing such tasks on their feet should be the goal. In short, rehab should help people do what is most important to them.
Some people may think they need to get their money's worth out of any service offered.
But such an attitude toward rehab could result in people being confined to beds for the rest of their lives. Each person must be encouraged to exercise whatever faculties and abilities are left to him or her. The best goal is to live life to its fullest for all our remaining days.
At least, that is what we would like to believe all care givers and care receivers should think.
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