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2014年4月 8日 (火)

特養待機者急増 在宅支援の拡充が不可欠だ

The Yomiuri Shimbun 7:52 pm, April 07, 2014
Elderly need more at-home support as waiting lists for special facilities grow
特養待機者急増 在宅支援の拡充が不可欠だ

The figure now stands at 524,000. That is how many elderly people are on waiting lists for admission to special nursing care homes, according to a survey by the Health, Labor and Welfare Ministry. The number has increased by more than 100,000 since a similar survey was conducted four years ago.
 52万4000人――。厚生労働省の調査で明らかになった特別養護老人ホームの入居待機者の数だ。4年前の調査より10万人以上増えた。

More must be done to get people off these waiting lists.
 待機者の解消に力を注がねばならない。

The number of people waiting to be admitted almost matches the total number of inhabitants in special nursing care homes across Japan. Although the capacity of these homes is increasing, the truth is that it cannot keep up with the rising demand for spots at these facilities caused by the aging of Japan’s society.
 待機者数は、全国の特養ホームの総定員数、つまり入居者数とほぼ同じだ。定員は増えているが、高齢化に伴う需要増に供給が追いついていないのが現状である。

Especially disconcerting is that 87,000 elderly people are waiting at home to be admitted to these special homes despite being officially recognized as requiring care level 4 or 5—the two levels with the greatest requirements for long-term care.
 特に問題なのは、要介護4、5の重度者でありながら、自宅で待機している人が8・7万人にも達していることだ。

The government has submitted to the current Diet session a bill to amend the Nursing Care Insurance Law and restrict entry to special nursing care homes to people classified as requiring care level 3 or higher from fiscal 2015.
 政府は、2015年度から特養の入居要件を要介護3以上に限定する介護保険法改正案を今国会に提出している。

There is no option but to limit entry to these homes to people who have the greatest need for such care.
 入居の必要性が高い人に対象を絞り込むのは、やむを得まい。

Many elderly people want to stay at these homes because they can receive care around the clock and the facilities are relatively cheap compared with fee-based nursing homes and other similar facilities. For low-income people in need of long-term nursing care, these special homes are generally their only choice.
 特養は24時間介護が受けられる上、有料老人ホームなどに比べて低料金であるため、入居希望者が多い。低所得の要介護者が入れる施設は、特養にほぼ限られる。

However, even among the services covered by nursing care insurance, special care for the elderly is quite expensive, which places a heavy financial burden on the central government and local authorities. Massive construction costs are also sometimes required, which has hampered the establishment of some facilities.
 だが、介護保険の対象サービスの中でも特養の費用は割高で、国や自治体の財政負担は重い。多額の建設費が必要なこともあり、整備はなかなか進まない。

Difficulty finding land

This is especially so in large cities, where land prices are high. The difficulty in acquiring land makes it even harder to build new special nursing care homes, which is why the Tokyo metropolitan area and other major cities are home to many elderly people on waiting lists.
 特に、地価が高い大都市部では、用地取得が困難で、特養の新設は、より難しい。首都圏などに待機者が多いゆえんである。

We urge local governments to leave no stone unturned in the search for land and buildings suitable for these nursing homes. Perhaps, for example, they could be set up on the vacant grounds of merged or abolished schools, or on a floor of a condominium building.
 統廃合された学校の跡地利用や、マンションの一部フロアでの開設など、自治体は、特養向けの用地や建物の確保に知恵を絞ってもらいたい。

Given that it will not be easy to quickly construct the sheer number of special nursing care homes currently required, it is all the more important to provide excellent at-home nursing care services to handle the needs of the elderly.
 特養の大幅な増設が容易でないことを考えれば、受け皿となる在宅介護サービスの充実が、ますます重要な課題となろう。

Many elderly people wish to continue living in areas where they have resided for many years. Doing so will require providing an environment in which they do not rely on care facilities and instead can continue to live at home with peace of mind.
 住み慣れた地域で暮らし続けたいと願う高齢者は多い。施設頼みを脱し、在宅生活を安心して続けられる環境整備が求められる。

In concrete terms, they need a system that provides integrated medical and nursing care services, even at night. The welfare ministry and local governments must upgrade and expand the provision of 24-hour home-visit nursing services and home-based medical care.
 具体的には、医療・介護サービスが夜間も含め、一体的に提供される体制が必要だ。厚労省と自治体は、24時間対応の訪問介護・看護や在宅医療の拡充を進めなければならない。

Elderly people who want to live at home also will need assistance with things like shopping and meal deliveries, and people to regularly check up on them.
 在宅生活を支えるには、見守りや配食、買い物などの生活支援も不可欠である。

To provide proper services while keeping a lid on costs, local governments should proactively utilize volunteer groups, nonprofit organizations, private-sector companies and other entities.
費用を抑えつつ適切なサービスが提供されるよう、自治体はボランティアやNPO、民間企業などの活用に、積極的に取り組むべきだ。

Finding and retaining enough care workers is also a pending concern. The wages earned by nursing care staff are low despite their heavy responsibilities and tough working conditions, so many walk away from the industry before long. Improving the treatment of these workers is an urgent task.
 介護の担い手確保も懸案となっている。介護職員の賃金は、責任の重さや厳しい労働条件の割には低水準で、早期の離職者が多い。処遇改善が急務である。

(From The Yomiuri Shimbun, April 7, 2014)

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