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

1. 丘陵山区养老保障制度的实际情况和需要解决的问题丘陵山区的地理条件和居民经济条件给养老保险制度的实施带来了一定的困难。例如，日托服务在当地社区已经站稳脚跟，不仅是为需要照顾的老年人提供服务。它还作为一种生活支持服务，为分散和隔离在社区的单身老人和老年夫妇家庭提供与他人交流或购物的机会。但随着护理保险制度的出台，这项服务的使用受到了限制。为保障丘陵山区特殊条件下的老年居民，使他们在达到需要护理的阶段后仍能继续在社区生活，有必要增加各种社会功能，加强狭义的卫生福利服务。除护理保险服务以外的保健和福利活动以及在当地居民倡议下开展的福利活动也可在这方面发挥重要作用。在岛根县的丘陵和山区，妇女在社区建设和生活支持活动中发挥着重要作用。岛根县高龄化地区养老保险制度的现状与任务从岛根县各市的情况来看，存在着居家养老能力低的市设施能力高，居家养老能力高的市设施能力也高的趋势。这种不平衡应在未来通过提高家庭护理能力得到充分纠正。为了使护理保险制度正常运转，提高护理保障水平，弥补这一制度的局限性，需要各市自行采取政治措施。在岛根县的丘陵和山区，缴纳护理保险费的人中有75%是低收入者。一些地方政府已经采取财政措施，免除低收入老年人的保险费，并降低他们的服务费用。这些措施应进一步扩大和完善，以减轻低收入老年人的养老保险负担。对于老年申请人是否符合保险护理和服务使用资格的认证状况，有必要调查并了解未认证者不申请的原因，以及认证者尚未要求服务或不使用服务的原因。掌握他们的实际生活状况、经济背景和家庭的护理能力也很重要。少

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