"Pillars" of Japanese Long-Term Care Insurance
- Care Managers
April 18, 2021
Embedded Files
Donate for Charity Kaori Violin Concerts
"Pillars" of Japanese Long-Term Care Insurance
Author: Yoko Marikawa - Japanese Expert in Eldercare & Healthcare
Opinion: A care manager is the representative of a long-term care insurance company, just like the insurance broker of a commercial insurance company, providing comprehensive and whole services for the insured, including agency application, claims settlement, intermediary and coordination, etc., as well as acting as an agent for the official long-term care service applicants to do investigations and supervision, etc. They are called the "pillars" of long-term care insurance services.
I received a call early in the morning and was asked, "can I change my care manager?" From his anxious but hesitant voice, it seemed that he was in trouble. The caller, Mr. Hashimoto, lives in the United States. His elderly mother has been staying in a Japanese nursing home for two years. Due to Parkinson's syndrome, she has been unable to have a normal conversation. At ordinary times, he can only understand the mother's condition through the care manager, but Mr. Hashimoto became more and more dissatisfied with the care manager. He felt that the care manager didn't care enough about his mother. Last year, when his mother's condition deteriorated, the care manager did not take the initiative to help adjust the ward and insurance. The care manager only made the request to adjust when he went back to Japan to visit his mother. These should have been the duties of the care manager without Mr. Hashimoto having to interfere.
Mr. Hashimoto was furious and thought he should change the nursing manager immediately. However, he was stopped by his sister, who was also angry but worried. She assumed that the nursing managers were all appointed and could not be interviewed or selected. Who could guarantee that the next one would be better? The old nursing manager has known his mother for 10 years and understands the situation. The new manager needs a period of time to understand the situation from scratch. The mother is totally unable to take care of herself. What if she is bullied? They disagreed, so Mr. Hashimoto called for advice. It's a tough thing to do.
Why does the care manager make Mr. Hashimoto and his family so worried? Care manager is a professional profession set up when nursing insurance was implemented in 2000, in order to ensure the smooth and professional implementation and supervision of insurance and provide claim settlement services. Its full name is "nursing support specialist", which is usually referred to as "care manager". Practitioners need to pass the national standard examination to obtain the qualification certificate before they can work with the certificate.
Is it true that anyone who is smart can get a certificate? The answer is no. Those who can take the unified examination must have more than 5 years of practical experience in medical, nursing or professional nursing consultants, such as doctors, dentists, pharmacists, health care professionals, midwives, nurses, physiotherapists, social welfare professionals, mental health welfare professionals, nutritionists, etc.
According to statistics released by the Association of Nursing Care Managers, the largest number of applicants was in 2014, reaching 174,974, and 46,415 applicants in 2020. The pass rate was generally below 17%, and the highest was 21.5% in 2017. It can be seen that it is not easy to get the care manager certificate. According to the industry statistics in 2020, the monthly salary is 357800 yen (about 21449 yuan), and the overtime pay is 1389 yen (about 83 yuan) per hour, which is much higher than the income of nurses; What's more, because most of the work of the nursing manager is going out, the time is relatively free, and it is necessary to work overtime when visiting the family of the caregiver or the nursing home, so the overtime income is also very high, making this occupation very attractive.
What is the role of a care manager? They are the representatives of the care insurers, just like the insurance brokers of commercial insurance companies. They provide the insured with comprehensive and full services, including agency application, claims settlement, intermediary and coordination, etc., and also represent the official care provider. The applicant's work such as investigation and supervision is called the "axis" of long-term care insurance services. The work of care manager can be roughly summarized into the following five aspects:
The first aspect of the work is to formulate a "nursing care plan" (care plan), which is the most important part. The nursing manager is responsible for interviewing the "nursing care receiver" and their family members, conducting family visits, verifying and understanding the physical and mental health and family economic status of the applicant. Then, based on the overall situation of the "care receiver" and my requirements, write a "care plan" for them. This plan is an official document with more than 10 pages. The nursing service and claim amount that the caregiver can enjoy in the future are implemented according to the plan. Because this care plan is very important and related to the vital interests of the care receivers, it is generally necessary to maintain full communication and understanding with the nursing manager to ensure that the requirements and interests of the caregivers can be met to the greatest extent.
Nowadays, many IT companies are developing software, trying to template and electronicize the work of writing "nursing care service plans" in order to reduce the workload of care managers, which branched out a new industry. In the "Ageing Industry Three-dimensional Chain Theory" proposed by the author in 2009, it is mentioned that the eldercare industry is composed of core industry, relative industry and derivative industry, which brings about great potential and can be extended indefinitely. A booming eldercare industry will form a huge virtuous economic base. The implementation of care insurance in Japan is a good case. It not only directly created new positions as caregiver and care manager, but also resulted in the creation of jobs such as care service providers, equipment rental providers, various software and robots of care services. The industrial sector of eldercare services continues to expand.
The second aspect of care manager’s duty is to apply for "identification of care" on behalf of the insured. If the insured needs to apply for agency from the administrative office of the jurisdiction, the administrative office will assign the care manager in the area where the applicant is located to visit, interview and provide agency application service. Generally, the applicant is unable to choose which care manager they are assigned to. However, in reality, all applicants want to have the freedom and power to choose care managers. However, due to the shortage of care managers in Japan, it all depends on how many care managers there are in the applicant's jurisdiction and whether the workload of care managers allows for more clients at that time, because according to the guidance and suggestions of the Japan Association of care managers, each care manager is able to provide services for up to 40 people at the same time.
The third aspect is intermediary nursing homes, nursing care institutions, and shops that can rent or purchase nursing equipment. As we all know, this process is complicated and prone to contradictory work, because these nursing homes, institutions and shops will actively please the care managers in order to get more recommendations for their institutions or products, so as to get more users. Additionally, care managers also have their own preferences and prejudices. Therefore, care receivers often do not fully trust the places recommended by the care manager, and they will search and inquire about them to choose the service provider they are satisfied with. Especially, the choice of staying in a nursing home is related to the long-term wellbeing of the elderly, so the care manager will also take the elderly to visit the nursing homes recommended by him, provide information and explanations, and the elderly have the right to choose freely, but in the end they must go through the introduction where the care manager must confirm, and finally clarify how much the insurance can pay and how much the insurance will not pay before the contract can be signed. Though there is professional ethic to restrict the managers, but is this highly commercialized era, it's still a high-risk grey zone, hence, it's a key aspect for further regulation and monitoring.
The fourth aspect is post-adjustment, coordination and follow-up services, etc. Because nursing care services are long-term, there will be many changes in the process after the service starts, such as the deterioration of the health status of the "care receiver", the gradual aging of mental or intellectual aspects, and the change of the economic situation. All these need the help of the care manager to coordinate and adjust the content of the care service and the compensation fee. Sometimes it is necessary to re-apply or update the "identification of care required". In general, the author suggests that the "care receivers" who have contradictions should increase the interview with their care managers, and honestly explain their own situation and requirements. If they still can't settle the conflict, they should complain to the administration management.
The fifth aspect is to accept the entrustment of the city, town and village to investigate, verify and supervise the "care receivers" on behalf of the jurisdiction.
The author Yoko Marikawa is an expert in the elderly care industry in Japan and a pioneer in the elderly care industry. She has long been committed to ensuring and improving the well-being of the elderly by improving the management of nursing homes and the quality of elderly care services. In recent years, in order to find effective solutions to the problems of poor medical services for the elderly, elder abuse, the surge of elderly dementia patients, and the shortage of eldercare workers, Yoko Marikawa has devoted a lot of energy in researching how to use high technology to help solve these serious and urgent social issues, including the use of nursing robots, quantitative management and monitoring systems, etc. This article is an article in Yoko Marikawa's newspaper column "Yoko Marikawa Talks about Eldercare".
About the Author
About the Author
Yoko Marikawa
Japanese expert in Healthcare & Eldercare industry; Founder and Chairman of YOKO Management Consulting; United Nations Representative; Scholar & columnist; Former Chief Officer at World Blockchain Organization.
Yoko is an advocate for healthcare and eldercare, elderly wellbeing, senior care service, nursing home management, and medical care technology. Recently, she is focusing on implementing advanced technology to improve senior care service and nursing home management quality. She is an active columnist, enriching the knowledge of the eldercare industry and contributing to the academic field.
Google Sites
Report abuse