Verifiable Study on Social Issues and Social Policy in the Regions with Excessively High Ratio of Older Population

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1. Actual Situation of and Tasks to Be Tackled Regarding Nursing Care Security System in Hilly and Mountainous AreasIn hilly and mountainous areas, their geographical conditions and residents' economic conditions make it difficult in some ways to implement the nursing care insurance system there. For example, day care service has taken a hold in local communities not only as a service for elderly people who need to be cared. It has also worked as a life support service providing opportunities for single elderly person and elderly couple households living scatteredly and isolated in communities to have exchanges with others or to go shopping. But with the introduction of the nursing care insurance system, the use of this service is restricted.To back up elderly residents under the peculiar conditions of hilly and mountainous areas, so that they can continue living in their communities even after they have reached the stage that they need nursing care, it is necessary to add various soci … More al functions to and enhance health and welfare services in a narrow sense. Health and welfare activities other than the nursing care insurance services, and welfare activities carried out under the initiatives of local residents can also play a major role in this regard. In hilly and mountainous areas in Shimane Prefecture, women perform a significant part in community building and life support activities.2.Present Situation and Tasks of the Nursing Care Insurance System in the Regions with Excessively High Ratio of Older Population in Shimane PrefectureLooking into the situation in each municipality in Shimane Prefecture, there is a tendency that those municipalities with low home-nursing capacity show high facility capacity and those with high home-nursing capacity also have high facility capacity. Such imbalance should be redressed adequately by improving home-care capacity in future.To have the nursing care insurance system function properly and to raise the level of nursing care security to make up the limitations of this system, municipalities are called to take political measures on their own account. In hilly and mountainous areas in Shimane Prefecture, 75 percent of those who are charged nursing care insurance premiums are low-income earners. Some local governments have already taken financial steps to exempt lower income elderly persons from insurance premiums and reduce service fees for them. These measures should be expanded and improved further, so as to alleviate low-income elderly people's burdens in nursing care insurance.With regard to the state of the certification of whether elderly applicants are eligible for nursing care under the insurance program and the use of services, it is necessary to investigate and make known the reasons why those uncertified have not applied and the reasons why those certified who have not yet demanded services or who have abstained from using services. It is also important to grasp their actual living conditions, economic background, and their families' nursing care capacity. Less