高齢夫婦への生活支援の観点から見る日本の介護保険制度の限界 :ケアマネジャーの役割を通して

Abstract

Due to the decline in multi-generational households and the increase of elderly couples in Japan, issues such as ‘elderly care by the elderly’ have arisen. It is the urgent need of the hour to examine whether or not the Long-Term Care (LTC) insurance system in Japan is capable of dealing with the problem of the collapse of the quality of life of elderly couples. This paper discusses the essence of this issue and seeks a solution to it based on the principles of insurance. Since LTC in Japan focuses on the individual and the related insurance benefits are also set on the basis of the individual, this may yield a problem when an elderly couple is living together, because for example it may be impossible to separate the specific needs of each of them in relation to common requirements such as the provision of meals. In this context, this paper focuses on the role of the care manager in devising care plans and managing LTC benefits, in order to assess how to support elderly couples in an optimal way. The study discusses the limitations of care plans, depending on whether or not they are expanded through systemic reform, and through a case study examines whether it is feasible to develop better care plans for elderly couples in this respect. If not, the provision of life-supporting services will be much more limited. An elderly spouse who needs a little more care or has a lower degree of LTC certification may become responsible for the reduced satisfaction of the needs of the couple, which are supposed to be supported by LTC services.