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2014 Conference Presentation

(Inter)national systemsInformal care Japan

1 September 2014

Fifteen years of carer-blind LTCI system in Japan

Tsuneo Inoue, Doshisha University, Japan


With growing recognition of the role and contribution of family carers, requirement of closer links between policies for older people and their carers has hitherto been addressed. This presentation examines the last fifteen years of Japan’s Long-term Care Insurance (LTCI) system in terms of family carers support, points out that its carer blind principle has been eroded and argues that older people and carers should be like the two wheels of a cart in the LTC policy.

After the introduction of a LTCI system in 2000, every Japanese older people with certification of eligibility has access to public LTC services whether or not a family carer is available. Japanese people opted for a carer-blind LTC system rather than a cash allowance system for family carers. Because of this, family members are not required to engage in caring and carers can have respite while the public LTC services do the caring.

Although the shift from family care towards the socialisation of care was welcomed, home help services has become available virtually only to those living alone or whose family members are sick or disabled. The LTCI Reform 2005 transferred the majorities of LTCI recipients with the lowest care need from Care Need Levels to Support Levels with lower benefit ceilings. Furthermore, the central Government has pursued to transfer the Support Levels recipients into non-LTCI programmes administered by local governments and finally day services and home help services will depart from the mainstream LTCI system in the near future.

All these policy changes have been made on the pretext of rationing LTC resources for older people with the most care needs, regrettably without paying due attention to specific needs of family carers. While the carer-blind principle has been maintained, new studies about the effects of the LTCI Reform 2005 show that not a few Support Level recipients do away with home help services or rely on family members. Japan’s experiences tell us that a carer-blind LTCI system itself is no panacea for family carers and we need a two-pronged LTC policy, whereby pursuing cost-efficiency matched by increased support to carers.


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