1. Issues of Long Term Care from the IFA Meeting Dr. M F Leung

3. Some of the issues discussed Financing of Long Term Care Workforce for Long Term Care

4. The Reform of Long Term Care Insurance Scheme in Japan

5. Long Term Care Scheme in Japan Launched in 2000 A bill to make partial amendment to Long Term Care Insurance Law  Approved in June 2005  To be implemented in June, October 05 or April 2006

7. Achievements of the Long Term Care Insurance Scheme in Japan Rapid Expansion of community care services Expansion of services provided by profit- making agencies and new types of nonprofit agencies Changes in the attitudes of Japanese citizens towards the utilization of Long Term Care services Increase in voluntary activities

8. Problems of the Long Term Care Insurance Scheme in Japan Long waiting lists for admission into care facilities Defects in the quality of care, particularly in group homes for the demented elderly Shortage of skilled and experienced care managers Lack of effective co-ordination and liaison among different agencies and professionals

9. Problems of the Long Term Care Insurance Scheme in Japan Decline in the planning and co-ordinating function of municipalities Increase in the improper claim of benefits by profit making agencies

10. Strong pressures to include effective measures for containing the benefit expenditure Growth in benefit expenditures seen as a ‘problem’ Goal of ‘small government’ Need to facilitate the reconstruction of the state finance

11. Reform of the Long Term Care Insurance in Japan Measures to contain the benefit expenditure  Increase in charges in institutional care  Control mechanism of the amount of care services for some community care services  The reorganization and expansion of ‘preventive’ services  Targeting of service provision

12. Reform of the Long Term Care Insurance in Japan New Service Programs  Small-scale geriatric health care facilities  Nightime home care services  ‘small-scale multi-functional home care’ A new schedule of the payment of remuneration

13. Reform of the Long Term Care Insurance in Japan Measures to solve the problems  Obligatory disclosure of information  Measures to improve the quality of care management  ‘community total care support centre’  ‘locally-based services’ – transfer of authorities to municipalities  Regulatory power of municipalities strengthened  System of renewal of accreditation

14. Significance and prospects of reform New service programs and measures for the improvement in the quality of care Increase in the supply of accommodation for the aged and the replacement of large-scale care institutions by smaller one are needed It is not easy to predict the extent to which a ‘prevention’ centered approach will achieve its goal of reducing the needs of long term care services

15. Significance and prospects of reform A new understanding of the central role that municipalities play in the planning and co- ordination of long term care services The extent to which municipalities will actively engage in the improvement of the functioning of the community total care system yet remains to be seen It is debatable whether this reform has greatly enhanced the mid and long term financial sustainability of the LTCI scheme

16. Plan to reduce the lower age limit of the insured from 40 to 20  The most effective method to enhance the financial sustainability of the Long Term Care Insurance scheme

17. Manpower issues in Long Term Care AARP

18. OECD long term care survey found ‘staff shortages and staff qualifications’ were by far the most frequent mentioned concerns Nurses shortages are predicted worldwide in almost all developed countries Many African countries have 1,000 in Norway and Finland) Disproportionate numbers of migrating health care workers are in LTC settings

19. Brain Drain Philippines lost 25,000 nurses to migration in 2003, three times the number of nursing school graduates Africa bears 25% of the world’s disease burden but has only 0.6% of health professionals Every year 8% of nurses leave Jamaica, 5% per year from Fiji and Samoa

20. Conclusion Financing of long term care is key concern in all ageing societies in the world – preparation should commence in Hong Kong Planning of services and monitoring of quality are essential elements of a good Long Term Care Manpower for Long Term Care especially nursing shortage are key concerns – Do we have any solutions locally?

24. Thank you