March 4th 2018
In April, revised disability support laws will go into force, moving those with disabilities who are receiving welfare services to public nursing care insurance to lower the price they pay out of pocket for services. However, there are strong arguments that the new system does little to solve the “65 and older problem” — the drop in the quality and quantity of services available for those with disabilities.
“I can’t do the things I enjoyed anymore. If only I had assistance getting around.” So laments Tsutomu Imahara, a 76-year-old resident of social welfare facility “Muginome no Sato,” operated by the social welfare organization “Muginome Fukushikai,” based in the city of Kagoshima. Imahara, who has cerebral palsy, uses an electric wheelchair to get around. While he can move the index and middle fingers of his left hand, he can barely move his right hand. He depends on assistance to eat and for basically all aspects of his daily life.
Imahara’s hobbies included going to art museums and reading books at the library, but 11 years ago, his situation changed drastically. When he turned 65 years old, his coverage changed to a nursing care insurance service, but it lacked the “mobility assistance” covered by the welfare service he had previously been under, meaning he could no longer get around like he used to.
The new comprehensive support law for those with disabilities stipulates that if a similar service is available, then nursing care insurance takes priority. However, municipal governments are free to decide to also offer welfare services for those with disabilities. Imahara requested that the Kagoshima Municipal Government grant him access to mobility assistance, but he has yet to see this happen. Now all he can do is watch television programs about art.
Among people with disabilities who cannot get the assistance that they need from nursing care insurance, some of the most heavily affected are elderly people with intellectual disabilities. One resident of a Muginome Fukushikai facility, a 66-year-old man who is congenitally deaf and speech impaired, and has epilepsy and intellectual disabilities, cannot cook or clean alone without great difficulty, and also has difficulty swallowing food. Though he has a fifth-class disability — the second-highest level in terms of assistance required — he was certified as needing the lowest level of nursing care, and the services he can use have fallen in both quantity and quality.
As people in such circumstances require services exceeding those covered by nursing care insurance, a growing number of people over 65 are paying out of pocket to guarantee that they get the help they need. The manager of a Muginome Fukushikai residence, Aki Yamada, says, “Under the current system, we can’t even guarantee a minimum-level quality of life.”
The new laws will see the burden of nursing care costs eased for low-income earners. However, the problems of people having to shoulder the costs if they exceed their quotas and municipal governments having the final say over whether or not someone with disabilities can receive welfare services remain unchanged.
“There are no legal regulations when it comes to tacking on welfare services for those with disabilities, and the question of whether or not a person needs a certain service is up to the interpretation of municipal governments,” says Kagoshima University professor Syuhei Itoh, who specializes in social security laws. “The practice of prioritizing nursing care insurance should be done away with, and those over the age of 65 should be able to continue to have access to the services they need,” he added.