長期介護オプション
草野可奈子 , MSW
ヘルス・プロモーション・スペシャリスト
敬老シニアヘルスケア
1
今日のポイント
• 長期介護とは ?
• 誰が長期介護を必要とするか ?
• どんなオプションがあるのか ?
• 誰が長期介護を払うのか ?
2
最も高齢者の多い日系コミュティー2000 Census
3
長期介護を必要とする状況
• Activities of Daily Living  
日常生活動作
• Instrumental Activities of Daily Living
l 機能的日常生活動作
4
長期介護を必要とする状況US Dept of HHS
5
• 65 歳以上の 70% が将来、長期介護を必
要とします。– 14% が一生のうちに長期
介護を必要とします。
• 40% 以上が将来、ある期間ナーシング・
ホームでのケアを必要とし...
高齢者はどこに? MetLife 2000 Census
5%
65 and older
Nursing Home
95% Home
6
介護者は誰 ? Family Caregiver Alliance
42%
23%
27%
3%
Child
Spouse
Other Relative
Non-Relative
7
Have You Made Plans?
“ 将来のプランは立ててますよ”
“ 死ぬまで今住んでいる家で
暮らすつもりです”
“ 老後は家族や友人に世話に
なりながら、今住んでいる家で暮らす
つもりです”
8
49%
75%
75%
高齢者のための継続したケア
ウェルネス / 長
期介護
予防
希望
必要性
自宅  
施設
9
長期介護が提供される場
施設でのケア
10
地域に根ざしたサービス
ウェルネスや
予防プログラム
長期介護が提供される場
– 情報・サービスの紹介
– Meals on Wheels  食事宅配サービ
ス
– 訪問・電話サービス
– 交通
– 在宅リハビリ
– Case Management  ケアマネジメン
ト
– 法的・金銭的なカウンセ...
在宅ケアとは?
• Personal Care Services
– 入浴、着替え、身だしなみ、食事、トイレな
どの日常的な動作の介助
– 簡単な家事を含む場合もある
• Home Health Care Services
– 在宅で医療行為を...
• Certified Home Care Agencies and Hospice
Agencies: Provide both medical and nonmedical services
and have met strict fede...
自宅と地域での長期介護
• 家の適応性
• お互いのニーズ
• 家族関係
• 金銭面の取り決め
• 時間
• パーソナル・ケア
19
子供・高齢の親との同居
長期介護の提供される場
施設
施設 - 独立した生活
• リタイヤメント・コミュニティー
(Leisure World)
• 高齢者用アパート
• 公営住宅 / 低所得者用の Section 8 Housing
• 高齢者向け集合住宅
21
施設
Residential Care Facility for the Elderly
• 以下が含まれます :
– リタイヤメント・ホーム
– アシステッド・リビング
– ボード&ケア
22
施設 – ナーシングホーム
• 高度看護ケア :
– 3日間の入院期間が必
要
– リハビリや有資格ス
タッフによる高度なケ
アを必要とする場合
23
• 身の回りの世話 :
– 介護
– 薬の管理
– パーソナルケア (ADLs の補助 )
...
その他のサービスモデル
• アルツハイマー病特別病棟
• ホスピス・緩和治療
• Continuing Care Retirement Community
– Licensed as RCFE and/or SNF
24
長期介護にかかる費用– U.S. Averages
MetLife Mature Market 2013 Survey
How Much? Who Pays?
在宅介護 $21 to $22/hour In-Home Supportive Se...
長期介護保険
• 加入時の年齢や保障内容によってプレミアムが異なる
• インフレーションの影響あり
• 保障期間の制限あり
• 総合型 vs. 施設 vs. 在宅ケア
• ADL の2つ以上に介助が必要であるという条件
• Eliminatio...
今日のポイント
• 長期介護とは ?
• 誰が長期介護を必要とするか ?
• どんなオプションがあるのか ?
• 誰が長期介護を払うのか ?
27
Resources
 Family Caregiver Alliance - 80 Montgomery St, Suite 1100. San
Francisco, CA 94104. phone: (415) 434.3388 . (80...
お問い合わせ
Keiro Senior HealthCare
325 S Boyle Ave.
Los Angeles, CA 90033
www.keiro.org
29
Kanako Kusano
Health Promotion Spec...
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長期介護オプション WPC 06.2014

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  • JA 23.6%
    Japan 22.7%
  • If an individual needs some assistance in Activities of Daily Living and/or Instrumental Activities of Daily Living, he/she may benefit from long term care.
    Activities of Daily Living are the 6 essential tasks for someone to be independent. They are – eating, bathing, dressing, getting to and using the bathroom, getting in and out of bed or chair, and mobility.
    摂食、入浴、着替え、トイレへの移動、排泄、ベッドまたは椅子から起き上がる事、移動。
     
    Instrumental Activities of Daily Living are the tasks include – going outside the home, keeping track of money or bills, preparing meals, doing light housework, using the phone, taking medications and so on.
    外出、金銭管理、料理、簡単な家事、電話の使用、薬の服用など。
     
    You will need long term care if you can no longer perform those tasks. Such situation happens often as a result of chronic illnesses or disability.
     
  • About 70% of people over age 65 will require some type of long term care services during their lifetime. More than 40% will need care in a nursing home. Things that increase your risk or make it more likely that you will need long term care include:
    Age – the older you get, the more likely it is that you will need help.
    Living alone – if you live alone, you are more likely to need paid care than id you are married or single and living with a partner.
    Gender – Women are more likely to need long term care than men, primarily because women tend to love longer.
    Personal history – Health and family history can increase the chances you will need long term care.
  • If you pick a day, any day, and count number of people over age 65 and older, only 5% live in nursing home, and the rest are living in community like most of you!
  • A caregiver can be your family member, partner, friend, or neighbor who helps care for you while you live at home. About 80% of care at home is provided by unpaid caregivers. Caregivers provide an array of emotional, financial, nursing, social, homemaking, and other services.
     
    About 65.7 million people in the US (one in four adults) were unpaid family caregivers to an adult or child in 2009. About 2/3 of caregivers are women. 14% of caregivers caring for older adult are themselves age 65 or more years old.
     
    Most people can live at home for many years with help from family and friends, and from other paid community support.
  • What percentage of people do you think say – “I am planning for my future”?
     
    CLICK
    It is 49%. But many do not appear to follow through the plans. しかし多くの場合、プランを実行していません。
     
    What percentage do you think say –“ I will be able to stay in current home for the rest of my life”?
     
    CLICK 
    75%. Among them, 51% plan to make changes to their homes.
     
    CLICK
    About 75% of older adults say –“ I will be able to rely own family and friends to help me with tasks that will allow me to stay home in the future. However, about 2/3 say that they are not counting on their children to take care of them.しかし、3分の2は子供に介護をしてもらうことを当てにしていません。
     
    65% Californians underestimate the cost of long term care or have not considered the financial impact such care would have on their families.
    65%の加州人口はロング・ターム・ケアの費用を安く見積もるか、または、家族に対するその経済的な影響を配慮していません。
  • When you are well and independent, you receive mostly wellness and/or preventive services, and they are based on “what you want” rather then “what you need”. You are probably still home living independently.
    You move towards the left on the arrows when services you receive is something that you “need” ongoing basis. Often times such care is delivered at a facility, not home.
  • Adult day services provide health, social, and therapeutic activities in a supportive group environment for individuals with cognitive and/or functional impairments. Social model day services provide meals, recreation, and some basic health-related services. Medical models, on the other hand, provide social activities as well as more intensive health and therapeutic services such as nursing services and rehabilitation therapy.
     
    According to MetLife Market Survey in 2011, the national average rate for adult day services is $70 per day, while it is 75 per day in CA.
    MacArthur Foundation Study:
    30% of physical aging and 50% of changes in mental function are genetic.
    Environmental or lifestyle factors have the greatest impact on obesity, high blood pressure, high cholesterol and triglyceride levels and lung function.
    AARP: 4 out of 5 people 50+ have at least one chronic condition.
    Alzheimer’s disease - People with even moderately elevated cholesterol in their 40’s have twice the risk of developing Alzheimer’s disease in their 60s, 70s and 80s. 
    Fall Prevention Center of Excellence:
    55% of falls occur in home
    Leading cause of injury deaths among older adults
  • Aging adults may choose to live on their own for many years. For people who develop chronic illnesses and other conditions, aging in place often demands outside services, which can allow them to love as independently as possible in their own homes.
    Most home care is non-medical care provided by “trained” workers. They are trained to provide hands-on care and assistance to people in their homes who need help with ADL. They are also able to help with needs tasks such as cooking, shopping and laundry.
    However, some home care can only be provided by licensed health care professionals, such as nurses, physical and occupational therapists, or specially trained home health sides under the direction if a physician or a nurse. This kind of “skilled care” is most often needed after an acute event such as a hip fracture, when follow-up rehabilitation services are needed at home after a hospitalization.
    Home health aides will assist with basic health care such as taking vital signs (temperature and pulse), changing bandages and dressings, and assisting with medications.
    Skilled Health Care may be provided by registered nurses, licensed practical nurses, and physical, occupational, and speech therapists who give skilled nursing care and rehabilitative therapies at home. Medicare will pay for short-term home care when skilled services are needed, usually following surgery or acute care stay in a hospital
  • Many different agencies and organizations provide home care services. Each provider offers different levels and kinds of care. Prices and the amount of time that you may have to spend participating in caregiving will vary depending on the agency you choose.
    You can hire a caregiver through an agency, or hire on your own. Let’s talk about pros and cons for each situation.
     
    If you decide to get a caregiver through an agency, they can do all the necessary work for you – they will screen the workers, take care of taxes, insurance, shits, and so on.
  • There are certified and non-certified home care agencies.
    Certified agencies can provide medical and nonmedical services and are monitored by federal requirements for patient care and management.
    In some cases they can provide home health services covered by Medicare and Medicaid. These agencies take care of all benefits and tax requirements for their employees.
    Non-certified agencies can also provide medical and nonmedical services, however they are not licensed. They are not required to do background checks for their caregivers, either.
  • Placement services use self-employed independent contractors to provide medical and nonmedical services.
    Provide medical and non medical services. The providers are self employed independent contractors, not employees.
    Independent workers are employees hired by the elder or their family who becomes legally responsible to pay state payroll taxes and worker’s compensation. There is no oversight by an organization or licensing for these services, and no source of coverage to pay for them.
    Beginning in January, 2015, workers who provide companionship services to the elderly and are employed by home care or other third party agencies will be entitled to the minimum wage and overtime protections afforded by the Fair Labor Standards Act (FLSA) under a final rule (www.dol.gov/whd/homecare/) issued by the Department of Labor (DOL) on Sept. 17.  According to the agency, the rule will affect nearly two million direct care workers.  The final rule, however, continues to exempt from minimum wage and overtime protection individual workers who are employed only by the person receiving services (or that person’s family or household) and are engaged primarily in fellowship and protection, as well as care incidental to such activities. 
  • In home support services (IHSS) is a program that will help pay for services so you can remain at home safely. To qualify, you must be over 65 years old, or disabled (including disabled children), or blind. These services are considered an alternative to out of home care, such as nursing homes or board and care facilities.
    IHSS authorized services include housecleaning, meal preparation, laundry, grocery shopping, personal care services, accompaniment to medical appointments, and protective supervision for the mentally impaired.
    You may be eligible for IHSS if you:
    You are a Medi-Cal recipient who meets SSI/SSP disability criteria.
    There are other ways you may qualify for In Home Supportive Services.
    For more information or to apply for IHSS, complete an application and submit it to the local IHSS office at the county welfare department. To find your local office, look for the closest county welfare department office listed under the County Government Section in the telephone book.
  • There are several ways to find home care and caregiving services.
    Your local Area Agency on Aging or Council on Aging keeps information on home care agencies in your community. They may also offer free initial care assessments.
    Private home health care agencies are often listed in phone books and online, if you choose to go that route.
    Ask your primary care physician or geriatric specialist to recommend agencies. They may have firsthand, recent information based on the experiences of other elders they treat. Your primary care provider or geriatric specialist may also be able to recommend agencies that they have information on based on partnerships or experiences from other elders they treat.
    Ask other family members, friends, and co-workers. Family members, friends, coworkers, and your insurance company may also be able to offer recommendations and referrals.
    Check with your employer or insurance company to see if they offer referral services.
  • When it comes to choosing a caregiver for your loved one, of course you’ll want to be picky. Some questions that you may want to ask are whether the agency is Medicare or Medi-Cal certified, if they offer the specific types of are that you need, are they recommended by a hospital or rehab discharge planner, social worker, or doctor, if they have multilingual staff in needed, and if the agency performs background checks on all of their staff.
  • Sometimes, parents decided to move in with their adult children as they become to need more help. When that’s the case, here are the things you can consider…
     
    Adapting home: Space, assistive devices, pets.
    Needs of parent: Social contact, physical activities, privacy.
    Relationships: Who makes decisions? How will spouse, kids feel?
    Money: Financial arrangements, siblings share?
    Time: Need caregiver during the day, family caregiver time.
    Personal care: Comfortable providing personal care, how is health of family caregiver?
    Lifestyle changes such as bedtimes, chores, foods, visitors, noise, etc.
  • There are different levels in facility based services.
  • Independent living facilities provide minimal services other than housing.
    Leisure World: Own or lease 2-3 BD homes/condo, golf course, pool, tennis courts, fitness center, activities
    Senior apts: May provide meals, housekeeping
  • These facilities are licensed by Department of Social Services and provide services for older adults.
    Most Board and care homes have 6 or fewer residents. Both types of facilities provide meals, personal care, and a 24-hour staff. Some nursing and medical services may be provided. Rooms may be private or shared. State licensing requirements and the names for these types of facilities vary greatly.
     
    Like board and care homes, assisted living is designed for people who want to live in a community setting but need help with personal care, other daily activities, or supervision, but who do not need as much care as provided by a nursing home. In general, assisted living facilities are larger than board and care homes. As a resident you would often live in your own apartment or room. You would receive services such as meals, assistance with personal care, help with medications, housekeeping, and laundry, 24-hour security, onsite staff for emergencies, and social programs.
    The average cost for an assisted living care in CA is $3,500 per month.
     
    In general, residential care facilities for the Elderly provide the following services:
    Care management and monitoring
    Help with ADLs
    Housekeeping and laundry
    Medication management
    Recreational activities
    Security
    Transportation
    Two or more meals per day
  • Nursing homes, also called skilled nursing facilities (SNF), provide a range of services, including nursing care, 24-hour supervision, and assistance with Activities of Daily Living. They also offer rehabilitation services such as physical, occupational, and speech therapy. You may only need nursing home services for a short period of time for recovery or rehabilitation after a serious illness or operation. Or you may need longer stays because of chronic physical health problems or cognitive problems (e.g., memory loss) that make it necessary for you to have 24-hour care or supervision.
  • Continuing care retirement communities offer several levels of care in one location. They offer a mix of independent housing (for people who need little or no care), assisted living, and nursing facilities for those who need more care and supervision. If you live in the independent housing unit of a CCRC and become unable to live independently, you can either receive help there or move to the assisted living area. If necessary, you can enter the onsite or affiliated nursing home. The fee arrangements for CCRCs vary and include both a monthly fee and an entrance fee.
  • Traditional health insurance and Medicare do not cover the costs of many long-term care services. They do not cover services in your home, including personal care, as well as care in a variety of facility and community settings. Long-term care insurance, on the other hand, will cover the costs of long-term care services.
    Long-term care insurance policies provide flexibility and allow for a great deal of choice. You can select a range of care options and benefits that allow you to get the services you need, where you need them.
     
    The cost of your long-term care policy is based on the type and amount of services you choose to cover, how old you are when you buy the policy, and any optional benefits you choose, such as benefits that increase with inflation. If you are in poor health or already receiving long-term care services, you may not qualify for long-term care insurance. In some cases, you may be able to buy a limited amount of coverage, or coverage at a higher “non-standard” rate.
     
    Many long-term care insurance policies have limits on how long or how much they will pay. Some policies will pay the costs of your long-term care for two to five years.
    Some insurance companies offer policies that will pay your long-term care costs for as long as you live—no matter how much it costs. But there are very few companies today that offer such unlimited or lifetime policies. However, some companies do have a “high coverage option” which might offer a $1 million lifetime limit.
     
    Most policies sold today are “comprehensive” policies. They typically cover care and services in a variety of long-term care settings including:
    Your home
    Adult day service centers
    Hospice care
    Respite care
    Assisted living facilities (also called residential care facilities or alternate care facilities)
    Alzheimer's special care facilities
    Nursing homes
     
    In the home setting, comprehensive polices generally cover these services:
    Skilled nursing care
    Occupational, speech, physical, and rehabilitation therapy
    Help with personal care, such as bathing and dressing
     
    Many policies also cover some homemaker services, such as meal preparation or housekeeping as long as it is in conjunction with the personal care services you receive.
     
    When you start receiving benefits is based on the policy’s “benefit trigger,” the length of the elimination period you choose, and sometimes when you start receiving paid care. Benefit triggers are the criteria insurance policies use to determine when your long-term care begins. Usually, the benefit triggers are defined in terms of Activities of Daily Living or cognitive impairments. For example, most policies pay benefits when you need help with two or more of six Activities of Daily Living or when you have a cognitive impairment.
     
    The “elimination period” is the amount of time that must pass after a benefit trigger occurs but before you start receiving payment for services. An elimination period is like the deductible you have on car insurance, except it is measured in time rather than by dollar amount. Most policies allow you to choose an elimination period of 30, 60, or 90 days. During the elimination period, you must cover the cost of any services you receive. Some policies specify that in order to satisfy an elimination period, you must receive paid care or pay for services during that time.
     
    Once your benefits begin, most policies pay your costs up to a pre-set limit. Other policies pay a pre-set cash amount for each day that you meet the benefit trigger whether you receive paid long-term care services on those days or not. These “cash disability” policies offer more flexibility but are much more expensive.
  • 長期介護オプション WPC 06.2014

    1. 1. 長期介護オプション 草野可奈子 , MSW ヘルス・プロモーション・スペシャリスト 敬老シニアヘルスケア 1
    2. 2. 今日のポイント • 長期介護とは ? • 誰が長期介護を必要とするか ? • どんなオプションがあるのか ? • 誰が長期介護を払うのか ? 2
    3. 3. 最も高齢者の多い日系コミュティー2000 Census 3
    4. 4. 長期介護を必要とする状況 • Activities of Daily Living   日常生活動作 • Instrumental Activities of Daily Living l 機能的日常生活動作 4
    5. 5. 長期介護を必要とする状況US Dept of HHS 5 • 65 歳以上の 70% が将来、長期介護を必 要とします。– 14% が一生のうちに長期 介護を必要とします。 • 40% 以上が将来、ある期間ナーシング・ ホームでのケアを必要とします。
    6. 6. 高齢者はどこに? MetLife 2000 Census 5% 65 and older Nursing Home 95% Home 6
    7. 7. 介護者は誰 ? Family Caregiver Alliance 42% 23% 27% 3% Child Spouse Other Relative Non-Relative 7
    8. 8. Have You Made Plans? “ 将来のプランは立ててますよ” “ 死ぬまで今住んでいる家で 暮らすつもりです” “ 老後は家族や友人に世話に なりながら、今住んでいる家で暮らす つもりです” 8 49% 75% 75%
    9. 9. 高齢者のための継続したケア ウェルネス / 長 期介護 予防 希望 必要性 自宅   施設 9
    10. 10. 長期介護が提供される場 施設でのケア 10 地域に根ざしたサービス ウェルネスや 予防プログラム
    11. 11. 長期介護が提供される場 – 情報・サービスの紹介 – Meals on Wheels  食事宅配サービ ス – 訪問・電話サービス – 交通 – 在宅リハビリ – Case Management  ケアマネジメン ト – 法的・金銭的なカウンセリング – リフォーム – 成人用デイケア 11 – 在宅ケア – ホスピス 地域に根ざしたサービス ウェルネス・予防プログラム
    12. 12. 在宅ケアとは? • Personal Care Services – 入浴、着替え、身だしなみ、食事、トイレな どの日常的な動作の介助 – 簡単な家事を含む場合もある • Home Health Care Services – 在宅で医療行為を行う – 資格を持ったスタッフによって行われるケア
    13. 13. • Certified Home Care Agencies and Hospice Agencies: Provide both medical and nonmedical services and have met strict federal requirements for patient care and management. • Non-certified Agencies: Also provide medical and nonmedical home services, but are not licensed. 14
    14. 14. 自宅と地域での長期介護 • 家の適応性 • お互いのニーズ • 家族関係 • 金銭面の取り決め • 時間 • パーソナル・ケア 19 子供・高齢の親との同居
    15. 15. 長期介護の提供される場 施設
    16. 16. 施設 - 独立した生活 • リタイヤメント・コミュニティー (Leisure World) • 高齢者用アパート • 公営住宅 / 低所得者用の Section 8 Housing • 高齢者向け集合住宅 21
    17. 17. 施設 Residential Care Facility for the Elderly • 以下が含まれます : – リタイヤメント・ホーム – アシステッド・リビング – ボード&ケア 22
    18. 18. 施設 – ナーシングホーム • 高度看護ケア : – 3日間の入院期間が必 要 – リハビリや有資格ス タッフによる高度なケ アを必要とする場合 23 • 身の回りの世話 : – 介護 – 薬の管理 – パーソナルケア (ADLs の補助 ) – 娯楽
    19. 19. その他のサービスモデル • アルツハイマー病特別病棟 • ホスピス・緩和治療 • Continuing Care Retirement Community – Licensed as RCFE and/or SNF 24
    20. 20. 長期介護にかかる費用– U.S. Averages MetLife Mature Market 2013 Survey How Much? Who Pays? 在宅介護 $21 to $22/hour In-Home Supportive Services 長期介護保険 (LTCI) 個人負担 成人用デイケア $72/day ADHC: Medi-Cal ADHC/ADC: LTCI 個人負担 アシステッドリビ ング (RCFE) $3,500(CA) + additional fees LTCI 個人負担 ナーシングホーム $249/day 高度看護 : Medicare 身の回りの世話 : Medi-Cal LTCI 個人負担 25
    21. 21. 長期介護保険 • 加入時の年齢や保障内容によってプレミアムが異なる • インフレーションの影響あり • 保障期間の制限あり • 総合型 vs. 施設 vs. 在宅ケア • ADL の2つ以上に介助が必要であるという条件 • Elimination period  保障が始まるまでの期間 26
    22. 22. 今日のポイント • 長期介護とは ? • 誰が長期介護を必要とするか ? • どんなオプションがあるのか ? • 誰が長期介護を払うのか ? 27
    23. 23. Resources  Family Caregiver Alliance - 80 Montgomery St, Suite 1100. San Francisco, CA 94104. phone: (415) 434.3388 . (800) 445.8106 . fax: (415) 434.3508. www.caregiver.org  Los Angeles Caregiver Resource Center - 3715 McClintock Avenue. Los Angeles, CA 90089-0191. 1(800) 540-4442 (CA only). (213) 821-7777. FAX: (213) 740-1871. http://lacrc.usc.edu/  Orange Caregiver Resource Center - St. Jude Centers for Rehabilitation and Wellness. 2767 E. Imperial Hwy., 2nd Floor. Brea, CA 92821. (800) 543-8312. (714) 870-3530. www.caregiveroc.org/  California Employment Development Department, “Household Employment,” DE 231L Rev. 21 (12-08). http://www.edd.ca.gov/pdf_pub_ctr/de231l.pdf 28
    24. 24. お問い合わせ Keiro Senior HealthCare 325 S Boyle Ave. Los Angeles, CA 90033 www.keiro.org 29 Kanako Kusano Health Promotion Specialist kkusano@keiro.org (323) 980-2353 Dianne Kujubu Belli Chief Administrative Officer dbelli@keiro.org (323) 980-2350

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