Long-term Care Insurance System: Key Structures and Procedures You Should Know | Monex 100-Year Life Design | Manekuri Monex Securities Investment Information and Media Useful for Money

The author has experienced "triple work" for many years, including work, child-rearing, and caregiving (4 years of long-distance caregiving and 8 years of home caregiving). In this process, the perspective shifted from the ideal of "perfect caregiving" that is often discussed to "caregiving that allows both parents and families to be happy without self-destruction," discovering a caregiving mindset for modern people. Over the next four installments, I plan to deliver that content. The theme of the first installment is the basics of long-term care insurance.

Many people only start to become concerned about caregiving when their fam members become elderly. The anxiety about caregiving is something that people tend to want to postpone. However, once you reach the age of 75, the likelihood of needing caregiving rises sharply to about 30% (approximately 3 out of 10 people). This time, let's review the basics of the long-term care insurance system, which will be a strong ally when faced with caregiving.

What is the Long-Term Care Insurance System

In Japan, there is a social insurance system to prepare for risks in people's lives, such as illness, injury, insufficient funds for old age, and unemployment. Following pensions, medical care, employment, and workers' compensation, the social insurance system established in 2000 to support the elderly and others who need nursing care is called the "Long-Term Care Insurance System."

Long-term care insurance is managed by municipalities across the country, and enrollment becomes mandatory when individuals turn 40. The insurance premiums are generally collected together with health insurance or deducted from pensions. When hearing about care, one might think it pertains only to the elderly; however, individuals aged 40 to 64 are at a higher risk of needing care due to diseases related to aging. Additionally, the likelihood that one's parents will reach an age where they require care also increases. When individuals reach the age of 40 and begin to pay premiums, they may feel that long-term care is more relevant to their own lives.

When using nursing care services with long-term care insurance, the user's burden is 10% of the incurred costs (20% or 30% for those with certain higher incomes). For example, if you use 10,000 yen worth of nursing care services, the amount you will pay is 1,000 yen (2,000 yen in the case of 20%). It is not the case that nursing care services can be used without limit, as there is a defined extent of use (service limit). The upper limit varies depending on the level of care needed, and if the limit is exceeded, the entire amount will be borne by the individual.

Who can use long-term care insurance?

To utilize the long-term care insurance, it is necessary to meet the following two conditions.

(1) They are a policyholder of the long-term care insurance.

・Individuals aged 65 and over (Type 1 insured): If it is certified that you require nursing care for any reason, you can utilize long-term care insurance.

・Aged 40 to 64 (Category 2 insured persons): You can only use long-term care insurance if you are recognized as requiring care due to specific diseases (diseases caused by aging).

(2) Received long-term care certification survey and was certified as "Need Support Level 1 & 2" and "Need Care Level 1 to 5."

There is no fixed timing for undergoing the long-term care certification survey. You can apply whenever you feel the need to use long-term care insurance services, but here are some examples of situations that may serve as triggers.

・When you are hospitalized and it seems that you will need care after being discharged

When you feel the decline of your legs and hips, etc.

When the ability to manage one's surroundings decreases.

When it becomes difficult to live independently due to the progression of dementia.

When considering admission to facilities such as nursing homes

Application Procedures for Long-Term Care Insurance and Usage Process

The general flow from application to the use of long-term care insurance services is as follows.

[Chart] The process from the consultation desk to the application and approval of long-term care insurance. Source: Created by the author based on the website "Flow until Service Use" of the Ministry of Health, Labour and Welfare.

Application for Long-term Care Certification (Preparation of Required Documents and Application)

You will apply for long-term care certification (including support certification) at the municipal office where your resident record is registered. The name of the office may vary by municipality, such as "Elderly Support Division" or "Long-Term Care Insurance Division." Gather the application form and other necessary documents and submit them at the office. Proxy applications can also be made by family members or community comprehensive support centers, in addition to the individual.

Certification Survey

Surveyors from municipalities will visit homes, facilities, hospitals, etc., to conduct assessments to confirm the physical and mental condition. The creation of the attending physician's opinion letter is requested by the municipality from the attending physician, and if there is no attending physician, a consultation with a designated physician from the municipality will be required.

During the certification survey, it is common for “the person (parent) to be overly enthusiastic and able to perform actions and conversations more than usual.” To ensure that the parent's condition is understood correctly, it can be a good idea to anticipate the information needed by the certification surveyor and provide it before the certification survey. When I was caring for my parent, I created a memo summarizing the items I wanted to convey, attended the certification survey and the examination, and handed that memo to the certification surveyor and the attending physician.

Let me introduce the items in the memo I created.

(1) Name, date of birth, age, medical history, etc.

(2) The situation and current status that led to caregiving

For example: The patient became wheelchair-bound due to a femoral neck fracture. They are having trouble finding someone to accompany them to medical visits.

(3) The individual's physical condition and caregiving situation

Example: Rolling over is supported by the fam.

The medicine is managed by the fam and administered.

Shopping is being done by the fam.

Subsequently, some items from the survey results and the attending physician's opinion are entered into a computer, and the assessment of care levels is conducted uniformly nationwide (primary assessment). Based on the results of the primary assessment and the attending physician's opinion, a determination is made by the care certification review committee (secondary assessment).

Notification of Certification Results

Based on the assessment results of the long-term care certification review committee, the long-term care certification is conducted, and the results are sent to the applicant. The standard timeframe from application to notification of certification is within 30 days. The certification results are divided into seven levels: "Support Required 1 and 2" and "Care Required 1 to 5," as well as non-eligible.

Creation of Care Plan

When using nursing care services, it is necessary to create a care plan. For the care plan for "Support Required Level 1 and 2" (Nursing Care Prevention Service Plan), consult with the regional comprehensive support center, and for the care plan for "Nursing Care Level 1 to 5" (Nursing Care Service Plan), request it from a home care support provider designated by the governor, where a nursing care support specialist (care manager) is available. The nursing care support specialist will create the care plan while considering the individual's and family's wishes and physical and mental conditions, as well as which services to use and how.

Start of Long-term Care Insurance Service Use

A variety of services (※) are available based on the care service plan.

Long-term care insurance may initially seem daunting due to the procedures, assessments, and renewals involved, but knowing this information can significantly alleviate the burden. In today's world, where it is difficult for a fam to provide care alone, this system is very helpful for both the individual and their fam. For more details, please consult the elderly and long-term care insurance department of your local municipality or the community comprehensive support center.

*For your reference: Types and contents of services available under the Long-Term Care Insurance (Ministry of Health, Labour and Welfare)