April 2012
Long-term Care Insurance System
The long-term care insurance
system supports the independence
of the elderly and aims at
establishing the community
that guarantees a secure life
to all the people.
Tokyo
Structure of the Long-Term
【Key Policies】
■The number of the elderly is going to increase rapidly to the year 2015, and the population of later stage elderly people (age 75 and over) is estimated to increase after the year 2015.
■In order to appropriately deal with nursing care issues peculiar to aging societies, the long-term care insurance system started in April 2000 so that people who need nursing care can have enough social support. After its launch, there was a fast increase in the use of nursing care, especially home care service. Now, the long-term care insurance system has come to have an important role as a system to assure a comfortable life for elderly people and their family members.
■The long-term care insurance system gives those in need of long-term care due to a disease caused by an old age or for other reasons necessary services in a comprehensive and uniform way so that they can lead an independent life as much as possible. It is a user-oriented system where you can use the service you choose yourself.
Source: Ministry of Internal Affairs and Communications “Census” (2000 to 2010)
National Institute of Population and Social Security Research “Population Projection for Japan Estimated as of May 2007” (2015 to 2035) 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 1,159 73,187 106,090 32,903 164,339 43,328 231,182 51,920 200,350 48,783 262,967 55,154 284,194 57,070 300,501 57,081 306,332 60,605 317,597 61,473 328,660 61,840 346,980 63,149 367,250 64,009 121,011 151,567 179,262 207,813 227,124 232,823 232,568 241,407 251,103 266,477 284,102 10,597 13,159 14,717 15,717 17,354 19,139 1,318 1,426 1,634 1,559 1,371 1,495 1,786 1,782 2,055 2,113 2,109 1,524 1,216 977 751 1,910 2,295 2,642 3,158 3,341 3,426 3,608 3,895 2000 2005 2010 2015 2020 2025 2030 2035
The population of elderly people in Tokyo
The Number of Those who Use the Long-term Care
Insurance System in Tokyo
Home care services Community-oriented services
Facility services
Early stage elderly people (age 65-74)
Thousand people
People
Later stage elderly people (age 75 or over)
Care Insurance System
The managing entity (insured) of the long-term care insurance system is your municipal office.
The national government and the Tokyo Metropolitan Government provide support to the municipality to ensure an effective implementation of the long-term care insurance system.
●
Those aged 40 to 64
[Category 2 insured individuals]●
Those aged 65 and over
[Category 1 insured individuals]※Foreign residents (living in Japan more than 3 months, special permanent residents, etc.) are subject to long-term care insurance.
Those whose mental or physical problem resulting in the care need condition, etc. is one of the 16 specified diseases
caused by aging, such as dementia at the presenility and cerebrovascular disease. (For further details, see page 3.)
【
Those not certified
】
For more details of the service available, see page 5.
【
Home care
services
】
&DUHSUHYHQWLRQKRPH help service &DUHSUHYHQWLRQGD\ service &DUHSUHYHQWLRQ short-stay daily-life service, etc. (13 types)【
Community-oriented
services
】
&DUHSUHYHQWLRQGDLO\
life group care service for the elderly with dementia, etc. (3 types)
【
Home care services
】
+RPHKHOSVHUYLFH +RPHYLVLWQXUVLQJ 'D\VHUYLFH 6KRUWVWD\PHGLFDOVHUYLFH etc. (13 types)
【
Facility services
】
:HOIDUHIDFLOLWLHVIRUWKHHOGHUO\requiring care (special nursing home for the elderly)
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elderly requiring care
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facilities for the elderly requiring care
【
Community-oriented
service
】
• Home help service at night.
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elderly with dementia, etc. (8 types)
●Secondary
Prevention Service For elderly in danger of requiring Long-Term care, etc., provide services needed to prevent decline in mental, physical and lifestyle functions.
Motor function improvement
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confinement, dementia, etc.
●Primary Prevention Service For all elderly: Lecture meetings, care prevention classes, training of volunteers for care prevention, etc.
Care (support) need certification
Elderly individuals likely to come to need care or
support in the future
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Individuals
【
Those certified as on
the support 1 or 2
】
【
Those certified as on
the care level 1 to 5
】
Those who need no continuous care but need some support in the daily life, such as support for
dressing themselves.
Those who need continuous care because of being bedridden, dementia, etc.
Services
available
Eligible
individuals
Managing entity
(insurer)Members
(insured individuals)※
7KHUHDUHFDVHVLQZKLFK&DUH3UHYHQWLRQDQG'DLO\/LIH6XSSRUWComprehensive Service by the municipality can be used.
Preventive
benefits
Care benefits
Long-Term CarePrevention Services in a
The Flow of Long-Term Care Insurance System
●
When you want to use the service of the long-term care insurance, you should first
apply for a care need certification or a support need certification to your municipal
office. If you get the certification, you can use the service according to the care plan
the care manager, etc. draws up for you after consultation.
●
Those who have not been certified and those whose life functions have become less
active can use the care prevention service provided by the community support service.
(For further details, see page 16.)
① Cancer (at the terminal stage), ② Articular rheumatism, ③ Amyotrophic lateral sclerosis, ④ Ossification of posterior longitudinal ligament, ⑤ Osteoporosis accompanied by fracture, ⑥ Dementia at the presenility, ⑦ Progressive supranuclear palsy, corticobasal degeneration or Parkinson’ s disease, ⑧ Spinocerebellar degeneration, ⑨ Spiral canal stenosis, ⑩ Progeria, ⑪ Multiple system atrophy, ⑫ Diabetic neuropathy, diabetic nephropathy or diabetic retinopathy, ⑬ Cerebrovascular disease, ⑭ Arterioscerosis obliterans, ⑮ Chronic obstructive lung disease, ⑯ Arthrosis deformans accompanied by marked deformation in both of the knee joints or the hip joints
●The (support need) certification makes judgment on the level of the need for care or support.
①Investigation by the visit
After you applied for a certification, the investigator will visit you to give you an interview about your mental and physical conditions, the situation of your daily life and other related matters.
②First judgment
The first judgment is carried out with a computer on the basis of the result of the investigation by the visit and part of the data contained in your doctor’ s opinion paper.
③Second judgment
The second judgment is made by the care need certification committee composed of specialists in public health, medical care and welfare on the basis of the result of the first judgment, your doctor’ s opinion paper and the special matters found in the investigation by the visit.
④Notice of the judgment result
The municipal office decides the level of the certified (support) need
●The person who wants the service or his/her family member should apply to the municipal office directly.
【Those aged 65 and over】
→These individuals are eligible for the benefits of the long-term care insurance regardless of the cause that necessitated long-term care.
【Those aged 40 to 64】
→These individuals are eligible for the benefits only when they came to need long-term care due to one of the specified diseases listed below.
Application form
Long-term care insurance of your municipal office
Investigation by visit
Opinion paper
２
Care (support) need certification
Preventive benefits service
●When you want to use the service of the long-term care insurance, you and a care manager should first prepare a care plan, which is a combination of several types of service according to your need for care or support for an independent daily life.
【Those certified as on the care level 1, 2, 3, 4 or 5】
Those certified as on the care level 1, 2, 3, 4 or 5 should request a care manager at the in-home care management office to draw up a care plan for them. You can also make a care plan by yourself.
【Those certified as on the support level 1 or 2】
Those certified as on the support level 1 or 2 should request the comprehensive community support center to draw up a care plan for them. (For further details, see page 15.) You can also make a care plan by yourself.
Care benefits service Long-Term Care Prevention Services
in a Community Support Project
There are cases in which a Care Prevention and Daily life Support Comprehensive Service by the municipality can be used.
●The upper limit to the cost of service you can receive from the long-term care insurance ( “limit to benefits” ) differs according to the level of care need or support need certified. (See page 14 for the limit to benefits.)
●You use the service by signing a contract with a service provider on the basis of the care plan.
●When you sign this contract, check carefully the service hours, charges, contract clauses, cancellation procedures, settlement of complaints, and other related matters.
●You should bear 10% of the costs of long-term care service. But you should pay all the costs for the service you used beyond the limit to benefits.
●In some cases, those who have not been certified in the care of support need certification may use the service for helping you keep life functions offered by the community support service. For further details, contact the nearest comprehensive community support center.
※Instead of service use being the target, let’ s make the target be use of services to create suitable lifestyles.
Not certified
Level of support Level of care need
１
２
１
２
3
4
5
Levels of the certified care (support) and services available
３
Drawing up a care plan
４
Use of the service
●
If you will enter a facility, apply to the facility you want to enter, and make a care plan at the facility entered.Services Available from the
Long-Term Care Insurance System
・
・
Preparation of care plan
Services given at home
●
Two services are available in the long-term care insurance system. One is care benefits
designed for those certified as on the care level 1, 2, 3, 4 or 5. The other is preventive benefits
for those certified as on the support level 1 or 2.
●
The aim of preventive benefits is to maintain and/or improve the vital functions of those who
need some support in the daily life, in order to keep their condition from deteriorating.
●
Community-oriented service meets comprehensively the needs of the elderly in the community
where they have lived long. This service is available only to the residents of the municipality
where the service provider or facility concerned exists.
You can use services other than community-oriented service at facilities which exist in
municipalities where you do not live.
Preparation of care plan
Services given at home
■Home help service
For those certified as on the care level 1, 2, 3, 4, or 5
A caregiver visits the individual in need of care to provide care and household assistance such as meals, dressing, bathing cleaning, laundry, etc.
For those certified as on the support level 1 or 2
A caregiver visits the individual and assists him or her with things such as bathing, excretion and housework in order to prevent them getting into the state of care need.■In-home care management (those certified as
on the care level 1-5)
The care manager will draw up a care plan according to the mental and physical condition, environment, wishes, etc. of the individual in need of care and contact the service provider to make necessary adjustments so that the individual may use in-home care service and other services properly.
■Care prevention management (those
certi-fied as on the support level 1 or 2)
Putting emphasis on the prevention of the support need condi-tion from worsening and the improvement, the comprehensive community support center will draw up a care prevention plan so
that the individual may use in-home care which helps them to lead daily life independently.
※It is possible to make your own Care Plan.
■Home help service at night
A caregiver periodically visits the home of the individual in need of care or the home that requested a visit at night to give them care or to look after them.
■Regular visits/on-call visits home
help service
The home helper or nurse visits homes periodically and when requested, to give care and medical treat-ment, etc.
Only those certified as on the care level 1, 2, 3,
4, or 5 can use this service.
■Home-visit bathing
ser-vice
The staff visits those having difficult in taking a bath at their bathroom and helps them take a bath using, for example, a bathtub brought in the home.
■Home-visit nursing
A nurse, etc. visits the individual in need of care to give them medical care service and supplementary medical examination service needed.
■
Home-visit rehabilitation
A specialist in therapy and rehabilitation will visit the individual in need of care to give them training for keeping or recovering their mental or physical functions and for leading daily life independently.
■
Management guidance for in-home care
A doctor, dentist, pharmacist, nurse or other medical professional will visit the home of insured members being treated at their home and provide health maintenance instruction.
＊
＊This is a community-oriented service, so it is available only to the residents of the municipality where the service provider or facility concerned exists.
S e r v i c e s A v a i l a b l e
・
Services given
at a facility, etc.
Services given at a facility, etc.
■
Day service
For those certified as on the care level 1, 2, 3, 4 or 5
The individual in need of care goes to a facility to have care for taking a bath, having a meal, etc. and to receive function restor-ing trainrestor-ing.
Some facilities offer services to improve oral function improve-ment, to achieve dietary improvement and services for those who have cancers or other serious diseases under the supervi-sion of medical specialists.
For those certified as on the support level 1 or 2
The individual go to places such as day service centers in order to maintain and/or improve vital functions. Some facilities offer selective services: functional improvement through exercise machines, dietary improvement, oral function improvement.■Day service for the elderly with dementia
The individual in need of care goes to a facility to have the care and function restoring training adapted to the charac-teristic needs of the elderly with dementia. The aim of this service is to enable the elderly with dementia to live inde-pendently at their home.
■
Day rehabilitation service (day care)
Those certified as on the care level 1, 2, 3, 4 or 5 can
use the following service.
The individual in need of care goes to a medical institution or health service facilities to have training for keeping or recovering their mental or physical functions and for leading daily life independently. Some facilities offer oral care or dietary improvement classes.
For those certified as on the support level 1 or 2
The user receives a training for keeping and improving the life func-tions in order to live independently. Some facilities offer selective services: functional improvement through exercise machines, dietary improvement, oral function improvement.
-e -r r e
＊
■Short-stay daily-life service
(welfare-oriented short-stay)
The individual in need of care stays at a special nursing home for the elderly, etc. for a short period of time to have daily-life service and function restoring training.
This can be used continuously for up to 30 days.
■Short-stay medical service
(medical care-oriented short-stay)
The individual in need of care stays at a medical institu-tion, etc. to have medical care service and function restoring under the supervision of doctors and nurses. Users can stay 30 successive days or less.
■Small-scale and multifunctional in-home
care
The individual in need of care goes to a facility in the com-munity where he or she is mainly involved. The facility offers services such as meal, bathing and functional improvement. This service allows for users to stay over at care facilities, or for staff to pay visits to the homes of users, which enables users to stay at home even if the care level progresses.
＊There is also a service combining small multifunction in-home care with home-visit nursing.
C a r e f a c i l i t y al
rt d ys.
＊This is a community-oriented service, so it is available only to the residents of the municipality where the service provider or facility concerned exists.
＊
Care giver
Home help service Outpatient
S e r v i c e s A v a i l a b l e
・
Service given at a facility
Service given at a facility
■Welfare facility for the elderly
requiring care
(special nursing home for
the elderly)
Those in need of continuous care who find difficulty in home life stay and live at this facility. This facility provides assistance with bathing, using the bathroom, eating, and daily chores.
Only those certified as on the care level 1,
2, 3, 4, or 5 can use this service.
■
Community-oriented welfare facility for the elderly requiring care
(special nursing home for the elderly)
Those in need of continuous care who find difficulty in home life receive care at a small-scale special nursing home for the elderly. The capacity is 30 or less. This facility provides assis-tance with bathing, using the bathroom, eating, and daily chores.
Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service.
■
Health service facility for the
elderly requiring care
This facility provides for those who left hospital reha-bilitation in order to assist them in being able to inde-pendently handle every day challenges.
Only those certified as on the care level 1, 2,
3, 4, or 5 can use this service.
vel 1, 2, 3, 4, or 5 can use this service.
■Sanatorium type medical
care facility for the elderly
requiring care
This facility takes in those in need of daily medical care for a relatively long period of time, rehabilitation during the chronic period and long-term care.
Only those certified as on the care level 1, 2,
3, 4, or 5 can use this service.
■
Daily-life group care for the elderly
with dementia
(group home for the elderly with
dementia)
Five to nine people with dementia receive care while lead-ing group life in a homely atmosphere.
Those certified as on the support level 1 cannot
use this service.
■Daily-life care service in
specified facilities
The individual in need of care receives care while living in a fee-charging home for the elderly, care house, etc. Some specified facilities outsource a certain amount of services to outside companies. So you can also use other care service in some specified facilities.
■Community-oriented daily-life care service
in specified facilities
The individual in need of care receives care while living at a small-scale
fee-charging home for the elderly, care house, etc. Only those certified as on the care
level 1, 2, 3, 4, or 5 and his/her spouse can stay at this facility. However, his/her
spouse cannot receive care service
Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service.
e
＊This is a community-oriented service, so it is available only to the residents of the municipality where the service provider or facility concerned exists.
＊
■Rental of welfare equipment
Those certified as on the care level 2, 3, 4, or 5
Insured members may rent welfare equipment such as special beds and wheelchairs to complete everyday activities.
Those certified as on the care level or as on the support level 1 or 2
Insured members are only able to rent handrails, ramps, walkers, and walking sticks unless dictated otherwise in their Care Plan.
■Allowance for purchasing welfare equipment
Since welfare equipment such as sitting-type toilets and bathing chairs come into direct contact with its user’s skin, insured members can purchase them from a supplier specified by the municipal government. Insured members must first purchase the equipment using personal funds, then 90% of the amount is reimbursed (the maximum reimbursable amount is ¥90,000 per year).
Other services
<
What is community-oriented service?
>
Community-oriented service is designed to provide a flexible service so that people can lead their lives at home or in their community.
A. This service is available only to the residents of the municipality where the service provider or facility concerned exists.
B. Your municipal office designates service providers.
C. In accordance with local circumstances, your municipal office decides insurance premiums (only for visit care nursing with periodic visits and care as needed, home help service at night, small-scale and multifunctional in-home care, and combined services).
■
Allowance for home renovation
An allowance for the small-scale home renovation such as installation of handrails and elimination of steps, is paid.
Insure members must first pay the fee at full price using personal funds, the 90% of the cost is reimbursed (up to ¥180,000 a house).
＊Persons are required to submit home renovation plans before beginning any renovation. Please contact your municipal office for details.
How to Choose a Service Provider
●When using a long-term care insurance system, the individual in need of care should use services with a company that best suits him/her. If you cannot decide which services and which service provider you should utilize, consult the municipal office or a Community Comprehensive Support Center.
●If you have your personal care manager, choose necessary services under his/her supervision.
●Under the “Long-term Care Information Publication System,” users are able to compare different providers and select one that appeals to them.
B Service provider
Publicized information enables you to choose appropriate services for
your parents who live separately. This system provides you with
information shared by a care manager.
Comparing information given by a provider and evaluation conducted by an assigned evaluation institution helps you to judge whether your service is
appropriate or not.
A Service provider
Compare publicized information and choose
the best service provider for you
Evaluation Institutions assigned by Tokyo Metropolitan Government conduct a number of evaluations on different providers, and ask user directly to confirm accuracy of reported information. You can check the Internet to see how each service providers are improving their services.
Check “Tokyo Fukushi Navigation” http://www.fukunavi.or.jp for Long-term Care
Information Publication System and assigned evaluation institutions
Choosing an appropriate provider leads to the improvement of the service.
Effect of the information disclosure
You can easily find information about the services provided by facilities and their organization on the internet.
Users Their families
Care manager
Long-term Care Information Publication System
Facility Service Costs to Be Paid by the User
＜
10% of service cost are borne by the user
＞
◆If insured members use service given at a facility(Note), the long-term care insurance system pays 90% of the costs, with the remaining 10% paid by the user.
(Note): Welfare facility for the elderly requiring care, community-oriented welfare facility for the elderly requiring care, health service facility for the elderly requiring care, sanatorium type medical care facility for the elderly requiring care.
＜
Costs for meals, etc. to be paid by the user
＞
◆Cost for meals, for room, and for daily necessities are borne by the user.
◆These amounts to be paid by the user are determined by the contract between the user and the service provider but are reduced based on the income bracket as shown in the table below.
Level 1: Welfare recipient or old-age welfare pension recipient who belong to non-taxed household
Level 2: The insured member is exempt from paying municipal taxes and his or her total income and pension together is ¥800,000 or less.
Level 3: The insured member is exempt from paying municipal taxes and don’t belong to income bracket 1 or 2. Level 4: Taxed household
Notes:
《Rough amount of user payment (the care level 3)》
（Ten thousand yen）Health service facility for the elderly requiring care
Sanatorium type medical care facility for the elderly requiring care
Level 1
Level 2
Level 3
Level 4
Level 1
Level 2
Level 3
Level 4
Level 1
Level 2
Level 3
Level 4
Level 1
Level 2
Level 3
Level 4
Care service costs (10% paid by the user)
Food expenses Residential expenses Total Unit-type private ward Multiple-bed ward (shared by two or more users) Multiple-bed ward (shared by two or more users) Multiple-bed ward (shared by two or more users) Welfare facility for the
elderly requiring care (special nursing home for the elderly)
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Home Care Service Costs to Be Paid by the User
Measures to reduce the payment by the user
The following measures to reduce the payment of care service costs by the user are available.
＜
10% of service cost are borne
by the user
＞
◆As for the home care service (services other than the facility services stated in the left page), the user has to pay 10% of the costs.
◆The upper limit to the monthly amount of service use (“basic limit to benefits”) is determined for each care level.
＜
Costs for meals, etc. to be paid by
the user
＞
◆As for the service given at a facility such as day service, the user has to pay both the food and living expenses at the facility.
◆As for a short-stay, the user has to pay both the food and living expenses. The amount of the user’s payment is reduced according to the user's income level.
Support level 1 Support level 2 Care level 1 Care level 2 Care level 3 Care level 4 Care level 5 ￥49,700 ￥104,000 ￥165,800 ￥194,800 ￥267,500 ￥306,000 ￥358,300 ￥4,970 ￥10,400 ￥16,580 ￥19,480 ￥26,750 ￥30,600 ￥35,830
Care level Rough basic limitsto benefits per month
Rough amount of user payment (10% of the basic limit) when the insured members use services to the standard basic limit to benefits
＜
High-cost care service
benefits
＞
When the user’s total monthly payments of 10% of the care service provided exceed the prescribed upper limit, the amount exceeding is refunded to the user at their request according to the income bracket (see the table at right). If your payment for the medical insurance and the long-term care insurance is extremely high, you can receive high-cost care service benefits and high-cost medical/care service benefits.
＜Measures to reduce the payment for those who live under difficult conditions＞
As for those who are designated as living under difficult conditions by the municipalities, the payment of 10% of care service may be reduced to about 7.5%, and living and food expenses may be reduced to about 75%.
¥24,600 for the entire household ¥37,200 for the entire household
Contact your municipal office for further details about measures available.
Income bracket Upper limit
①Old-age welfare pension recipient ②Household whose sum of taxable pension income and earned income is ¥800,000 or less
Those who do not belong to bracket ① and ② Welfare recipient
Household on which municipal inhabitant tax is imposed
¥15,000 per individual Household
exempted from municipal inhabitant tax
Note: The actual basic limit to benefits is determined by the number of units. The price per unit differs according to the municipality and the type of service. The figures in the table at left were calculated supposing the price per unit to be ¥10.
Community Support Service
１
Community Support Service
The Community Support Service aims to prevent the care need (support need) condition for elderly, and even if a person is in the care need condition, provides support to enable independent daily life as much as possible. It is provided by municipalities.
２ Comprehensive community support center
To assist the elderly in continuing to live in communities that have grown familiar to them, it is necessary to provide not only an insurance system, but comprehensive care which integrates various community resources: specialists in the field of health and medical support and welfare work, volunteers, etc.Municipalities set up Comprehensive Community Support Centers, where they assign staff such as head care managers, public health nurses and care workers. They use their expert knowledge and skills together to provide comprehensive support to elderly and their families, etc.
To set up a care plan considering the motivation and the ability of the user for the purpose of successfully carrying out care prevention service.
To build a network with related people in the community, offer consultation to the elderly and their family, and help them to receive proper services using appropriate systems and local resources.
To functions as an information counter for protection of rights and prevention of cruelty to the elderly through introducing legal guardian system, finding out elder abuse in its early stage, or dealing with consumer issues in order that the elderly live with dignity.
To support care manager and coordinate care manager and other medical ④ Extensive and continuous
③ Protection of rights
② General consultation and guidance
① Care Management for Care Prevention, etc.
① Long-Term Care Prevention Services
② Care Prevention and Daily Life Support Comprehensive Service
③ Comprehensive Support Service
④ Voluntary Service
For ① and ②, the wards, cities, towns and villages decide which municipalities will provide the service.③ is provided by all wards, cities, towns and villages. ④ is not provided by the municipality in some cases.
This service supports stable operation of the Long-term Care Insurance Service, and independent daily lives of elderly the community.
This service implements the Community Comprehensive Support Center.
→See “2. Community Comprehensive Support Center.”
While using diverse manpower and social resources, this service comprehensively provides living support services (care prevention, food delivery, watching over, etc.) for people subject to the Support Need and Secondary Prevention Service.
→See the next page.
Those eligible for care
Provision of support Public health nurse Cooperation Caseworker Comprehensive community support center Management Care manager Support for activities Head care manager Prevention service Request for advice
【
Community Support Service Description
】
３
Care Prevention Service
The Care Prevention Service supports mental and physical improvements and environmental adjustments, to enhance the elderly’s living functions and for participation in the community’s social activities, with the aim of achieving meaningful lives and self-actualization in each person’s life.
There are two types. The first is the “Primary Prevention Service” for all elderly aged 65 or older. The second is the “Secondary Prevention Service” for specific elderly persons whose living functions decline and are likely to need care, etc.
To participate in the Care Prevention Service, take the basic health check of decline in living functions.
※Those certified as on the support level or on the care level cannot use this service.
Provision of Basic Health Check
The decision is made based on the basic health check, which consists of questions such as “Do you walk about 15 minutes continually?”
Those without declining life
functions
For more information, please contact your municipal office or comprehensive community support center.
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Secondary Prevention Service
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・Specified elderly individuals take part in the follow-ing programs accordfollow-ing to the care plan drawn up by a comprehensive support center.
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Primary Prevention Service
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・Lecture meetings, public relations programs at the section in charge of the municipal office, training of volunteers for care prevention and others.
※In addition to these, some municipalities provide back pain and knee pain counter-measures programs, programs to prevent and support depres-sion, self-confinement and dementia, etc.
Those aged 65 and over
The flow of Care Prevention Service
A. Exercise classes are set up for those whose physical strength has markedly deteriorated and are less active.
B. Lectures are held about nutrition for those who suffer from under nutrition.
C. Lectures and training classes are held about brushing guidance, denture cleaning guidance, and rehabilitation so that people can continue to enjoy their food.
D. A public health nurse visits specific elderly people for whom there is a risk of confinement to the home, senile dementia, or depression.
Those with declining life
Long-Term Care Insurance Premiums
【Amount of insurance premiums】
The amount of insurance premiums for those aged 65 and over is calculated by multiplying the base amount determined by the municipality by the rate prescribed according to the income bracket, giving consideration to the income level of the insured.
The amount of insurance premiums is based on the long-term care insurance plan made at each municipalities. The payment is calculated by dividing the 21% of the total cost by the population of those 65 and over. The long-term care insurance plan is revised every three years. Therefore, the present premiums are going to be applicable until fiscal 2014. Rough estimate of premium according to one’s income bracket is as follows. For more details, please contact long-term care section of your municipal office.
※Some municipalities charge lower insurance premiums for (a) people in Level 3 with previous year total income plus
taxable pension income which totals ¥1,200,000 or less, or (b) people in Level 4 with previous year total income plus taxable pension income which totals ¥800,000 or less.
※Premiums can differ. For example, some municipalities divide income brackets into 7 categories. Others change how
much the user has to pay according to its own calculation.
【
How to pay insurance premium
】
There are two methods for paying insurance premiums: special collection by which insurance premiums are deducted from the pension and ordinary collection by which insurance premiums are paid through a financial institution, etc.
Special collection applies to those receiving ¥180,000 or more a year as an old-age retirement pension, survivor's pension or disability pension. Insurance premiums are deducted from the pension paid periodically (six times a year) to them. Ordinary collection applies to all the other people to whom special collection is not applicable, and a tax notice is mailed to them from the municipal office. The time and frequency of payment differ from municipality to municipality. Level 1 Level 2 Level 3 Level 4 Level 5 Level 6
Income Level Applicable Persons Premium
Those who receive a livelihood protection allowance or an elderly welfare pension, and belong to a household in which all members of the household are exempt from paying municipal taxes. Those who belong to a household in which all members of the household are exempt from paying municipal taxes, and the insured Member’s total income and pension together are less than ¥800,000.
Those who don’t belong to level 1 and level 2, and all the members of the household are exempt from paying municipal taxes.
Insured member is exempt from paying municipal taxes but belong to a household in which someone must pay municipal taxes.
Insured member is not exempt from paying municipal taxes and his or her total income is less than ¥1,900,000.
Insured member is not exempt from paying municipal taxes and his or her total income is ¥1,900,000 or more. Standard amount X 0.5 Standard amount X 0.5 Standard amount X 0.75 Standard amount Standard amount X 1.25 Standard amount X 1.5
１
Insurance premiums for those aged 65 and over (Category 1 insurance premiums)
Since the long-term care insurance is designed to mutually help the elderly people, even those who do not use this system have to pay premiums.
When delinquent in making premium payments, certain restrictions are put on insurance benefits.
①
Nonpayment for 1 year
ĺ
Change in payment
The insured Member must temporarily hear all necessary cost. Ninety percent of the cost that has been temporarily paid by the insured Member will be reimbursed to the Insured Member later if he or she files a claim with a local government.
②
Nonpayment for 1 year and 6 months
ĺ
Temporary Suspension of Benefits
Payment of insurance benefits will be suspended. In some cases the amount of delinquent premiums will be deducted from the amount of suspended insurance benefits.
③
Nonpayment for 2 years
ĺ
Reduced Insurance Benefits
Payment of premiums will not be possible after a period of 2 years has elapsed. In this case, the cost that must be personally borne by the Insured Member will be changed from the standard 10% to 30% over a set period of time. Furthermore, expenses for the high-cost care service benefits and others will not be reduced.
Delinquency in Payment of Premiums may impose
Metropolitan Tokyo set up a Fiscal Stability Fund, with the national, metropolitan and municipal governments each funding one-third. This provides fund grants and loans, to municipalities with care insurance fiscal shortages.
Under the fiscal 2011 revision of the Long-term Care Insurance Act, in order to reduce increases in insurance premiums and to use long-term care insurance services, only in fiscal 2012, funds can be drawn down. The amount drawn down is returned one-third each to the national, metropolitan and municipal governments.
Metropolitan Tokyo is using the returned amount for long-term care services: care service infrastructure development, obtain and maintain care staff, etc.
【
Drawdown of Fiscal Stability Fund
】
● Financial resources
●
Total care benefits and care premiums
※The chart above shows how financial resources of
long-term care insurance are distributed. The national government provides 20% and Tokyo metropolitan government 17.5% of subsidies for welfare facilities.
※Since 5% of the total cost shared by the national
government is used as a subsidy for adjustment and is distributed according to the financial situation of the insured, the percentage municipalities share can vary.
※Source: Tokyo Elderly Health and Welfare Plan (Fiscal 2012 to
2014)
※Monthly payment is based on rough estimates of each
municipalities. 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Year 4,045 4,992 4,102 3,273 3,056 2,500 3,000 3,500 4,000 4,500 5,000 5,500
Total care benefits Monthly premium National Government 25% Tokyo metropolitan government 12.5% Municipalities 12.5% Insurance premiums (Category 1 insurance premiums) 21% Insurance premiums (Category 2 insurance premiums) 29%
Points of Contact
Publisher: Long-term Care Insurance Section, Aging Society Affairs Division, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government
North side, 24th floor, First Building of the Tokyo Metropolitan Government Office, 8-1, Nishi Shinjuku 2-chome,
①
Points of contact of your municipality or comprehensive community support center
②
Tokyo Metropolitan Federation of National Health Insurers' Associations
③
Tokyo Metropolitan Government’ s points of contact
Point of contact for the Tokyo Metropolitan [long-term care insurance system] Secretariat of the Tokyo Metropolitan Long-term Care Insurance Examination Committee [for complains about the result of care need certification, etc.] Tokyo Metropolitan Consumers’ Center [for consultation about contracts, etc.] General consultation
Hotline for the elder who suffer from damage Hotline for the consumer of advanced years
Tokyo Metropolitan Health and Medical Information Center [provides information about medical institutions, etc.]
