Issues of Long Term Care from the IFA Meeting

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Issues of Long Term Care from the IFA Meeting

• Dr. M F Leung

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Some of the issues discussed

• Financing of Long Term Care
• Workforce for Long Term Care

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The Reform of Long Term Care Insurance Scheme in
Japan
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Long Term Care Scheme in Japan

• Launched in 2000
• A bill to make partial amendment to Long Term
  Care Insurance Law
• Approved in June 2005
• To be implemented in June, October 05 or April
  2006

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Achievements of the Long Term Care Insurance
Scheme in Japan

• Rapid Expansion of community care services
• Expansion of services provided by profit-making
  agencies and new types of nonprofit agencies
• Changes in the attitudes of Japanese citizens
  towards the utilization of Long Term Care
  services
• Increase in voluntary activities

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Problems of the Long Term Care Insurance Scheme
in Japan

• Long waiting lists for admission into care
  facilities
• Defects in the quality of care, particularly in
  group homes for the demented elderly
• Shortage of skilled and experienced care managers
• Lack of effective co-ordination and liaison among
  different agencies and professionals

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Problems of the Long Term Care Insurance Scheme
in Japan

• Decline in the planning and co-ordinating
  function of municipalities
• Increase in the improper claim of benefits by
  profit making agencies

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Strong pressures to include effective measures
for containing the benefit expenditure

• Growth in benefit expenditures seen as a
  problem
• Goal of small government
• Need to facilitate the reconstruction of the
  state finance

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Reform of the Long Term Care Insurance in Japan

• Measures to contain the benefit expenditure
• Increase in charges in institutional care
• Control mechanism of the amount of care services
  for some community care services
• The reorganization and expansion of preventive
  services
• Targeting of service provision

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Reform of the Long Term Care Insurance in Japan

• New Service Programs
• Small-scale geriatric health care facilities
• Nightime home care services
• small-scale multi-functional home care
• A new schedule of the payment of remuneration

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Reform of the Long Term Care Insurance in Japan

• Measures to solve the problems
• Obligatory disclosure of information
• Measures to improve the quality of care
  management
• community total care support centre
• locally-based services transfer of
  authorities to municipalities
• Regulatory power of municipalities strengthened
• System of renewal of accreditation

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Significance and prospects of reform

• New service programs and measures for the
  improvement in the quality of care
• Increase in the supply of accommodation for the
  aged and the replacement of large-scale care
  institutions by smaller one are needed
• It is not easy to predict the extent to which a
  prevention centered approach will achieve its
  goal of reducing the needs of long term care
  services

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Significance and prospects of reform

• A new understanding of the central role that
  municipalities play in the planning and
  co-ordination of long term care services
• The extent to which municipalities will actively
  engage in the improvement of the functioning of
  the community total care system yet remains to be
  seen
• It is debatable whether this reform has greatly
  enhanced the mid and long term financial
  sustainability of the LTCI scheme

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• Plan to reduce the lower age limit of the insured
  from 40 to 20
• The most effective method to enhance the
  financial sustainability of the Long Term Care
  Insurance scheme

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Manpower issues in Long Term Care

• AARP

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• OECD long term care survey found staff shortages
  and staff qualifications were by far the most
  frequent mentioned concerns
• Nurses shortages are predicted worldwide in
  almost all developed countries
• Many African countries have lt20 nurses per
  100,000 (gt1,000 in Norway and Finland)
• Disproportionate numbers of migrating health care
  workers are in LTC settings

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Brain Drain

• Philippines lost 25,000 nurses to migration in
  2003, three times the number of nursing school
  graduates
• Africa bears 25 of the worlds disease burden
  but has only 0.6 of health professionals
• Every year 8 of nurses leave Jamaica, 5 per
  year from Fiji and Samoa

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Conclusion

• Financing of long term care is key concern in all
  ageing societies in the world preparation
  should commence in Hong Kong
• Planning of services and monitoring of quality
  are essential elements of a good Long Term Care
• Manpower for Long Term Care especially nursing
  shortage are key concerns Do we have any
  solutions locally?

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Thank you