A Small-size Visiting Care Service Provider's Survival Strategies: Research on the Management/System concerning Visiting Care Services
I have been conducting research on the system, human resource, and management concerning visiting care service providers with the viewpoint of the operator of the visiting care service provider.
The reason I conduct research on visiting care service providers is my experience that my former wife, who passed away, had disability and we actually used the service provided by a visiting care service provider based on the support expense system and Services and Supports for Persons with Disabilities Act. At that time I experienced various regulatory inconsistencies, which made me think about how such inconsistencies influenced the management of visiting care service providers and what kind of issues they produced. After managing my visiting care service provider, I see the reality that visiting care service providers with a large capitalization keep expanding while all those with a small capitalization can do is to keep their services. It is also heard that since large-size care providers only provide fixed services under the system, it is inconvenient for users to use their visiting care services. On the other hand, small-size care providers can be flexible in various ways. Although the services they provide are same, they can be flexible for users concerning the date and time and sudden requests.
However, the reality is that large-size care providers keep expanding more and more while small-size ones are destroyed. This does not mean that small-size care providers are unnecessary. This situation provides me with the research issue of how small-size care providers can survive.
When we think about small-size care providers, I think that the aspect of “locality” is important. Concerning the aspect of locality I think that there are two research issues-management related to the acts, which is the basis of the system, and gaps among regions.
First of all, let me explain about the acts concerning visiting care and actual management. Visiting care service providers can be broadly separated into two categories-those for elderly care (based on the Long-Term Care Insurance Act-hereafter the Long-Term Care Insurance Act) and those for disabled persons (based on the General Welfare Act for Persons with Disabilities-hereafter the General Welfare Act).
The work contents of visiting care service providers include physical care (care concerning the body), residential care (various services within a family such as household tasks and cleaning), visiting care for persons with severe disabilities (every assistance concerning the daily life of persons with severe disabilities), guide helpers for persons with visual disabilities, transportation support service. Physical care, residential care become the common services both under the Long-Term Care Insurance Act and the General Welfare Act and the national government is in charge of the services. The local government is in charge of visiting care for persons with severe disabilities, guide helpers for persons with visual disabilities, and transportation support service.
It is said that differences exist between elderly care and assistance for disabled persons. Surely, there are differences between care (mainly supporting what cannot be done (fixed support) ) and assistance (assisting disabled persons a little (not fixed support but every kind of support disabled persons want) so that they can live a better life). The most decisive difference is that in assistance it is possible for users (disabled persons) to do what they want, including affairs related to their hobbies and going to concerts. That means users can live an independent life as normal persons can do so. I think that such sensitive assistance for the independent life of users at local small-size care service providers has important significance. I also think that continuous care support will reach a deadlock without such sensitive assistance.
The other research issue I have is gaps among regions. In Kobe City, where I run my visiting care service provider, there are some areas recipients of such services concentrate in. For example, Chuo-ward, Hyogo-ward, and Nagata-ward are such concentrated areas under the Long-Term Care Insurance Act and Nagata-ward and Suma-ward are such concentrated areas under the General Welfare Act. It is considered that the reason Chuo-ward and Hyogo-ward are concentrated areas is that long-time residents in the areas are increasingly aging. There are also such areas in Nagata-ward and Suma-ward, but in Nagata-ward some residents move to another area due to the earthquake and in Suma-ward the recipient rate of disabled persons becomes much higher. It is often heard from care service providers and disabled persons that Nagata-ward and Suma-ward are areas where disabled persons can take advantage of such services. Actually, my former wife lived in Suma-ward and was able to receive its maximum amount of the service. Thus, the fact is that gaps exist among regions. Moreover, concerning the helper dispatch service which is regarded as a local support business it is left to the local government's discretion. What this means is that there are gaps of budgets between local governments in metropolitan areas and those in local areas without a distinctive industry. Therefore, disabled persons who live an independent life live in metropolitan areas where they can have easy access to the services in many cases.
Persons without knowing this fact are forced to live a hard life due to gaps. I do not think it is good to have such gaps. Thus, I would like to consider, as my future research issue, what small-size care service providers can do so that we can overcome such situations and existing issues to make a better local society both for the elderly and disabled persons.
TSUJI Yoshihiro
