高齢夫婦への生活支援の観点から見る日本の介護保険制度の限界: ケアマネジャーの役割を通して

• 영문명: The limitations of Long-Term Care (LTC) insurance in supporting elderly couples in Japan:focused on the role of the care manager
• 발행기관: 고려대학교 글로벌일본연구원
• 저자명: 何妨容(He, Fang rong)
• 간행물 정보: 『일본연구』第37輯, 59~89쪽, 전체 31쪽
• 주제분류: 사회과학 > 지역학
• 파일형태: PDF
• 발행일자: 2022.02.28

국문 초록

複数世代世帯の減少と高齢夫婦のみ世帯の増加のもとで､どのようにすれば日本の介護保険制度は高齢夫婦のみ世帯の共同生活の破綻という問題に対処できるであろうか｡本稿では､日本の介護保険制度が｢個人｣を被保険者とし､介護給付も｢個人｣を基礎に設定されている､というところに問題の本質と解決法を見ようとするものである｡高齢夫婦が共同生活を営んでいるとき､介護給付が｢個人｣で完結する範囲に限定されてしまうと､食事など夫婦としての生活部分に重なる生活場面に対する介護ニーズは､夫婦の共同生活の中に｢埋没｣させられてしまい､結果として､要介護でない､あるいは要介護度が低い方の配偶者の負担が､同様に高齢であるにもかかわらず､大きくなってしまう｡これが｢老々介護｣や｢認認介護｣の問題であるが､その実態は､介護保険体制が複雑化する中では､｢介護予防｣あるいは｢自立支援｣という理屈に隠されている｡本稿では要介護者の介護給付を管理する立場であるケアマネジャーの役割を通して､制度改編の中でケアマネジャーの役割や負担がいかに拡大してきたか､また､彼らが高齢夫婦の介護問題をどのように認識し､さらに変化する介護メニューをどのように選び取って高齢夫婦の共倒れを避けようとしているか､を検討することによって問題を解明したい｡

영문 초록

Due to the decline in multi-generational households and the increase of elderly couples in Japan, issues such as ‘elderly care by the elderly’ have arisen. It is the urgent need of the hour to examine whether or not the Long-Term Care (LTC) insurance system in Japan is capable of dealing with the problem of the collapse of the quality of life of elderly couples. This paper discusses the essence of this issue and seeks a solution to it based on the principles of insurance. Since LTC in Japan focuses on the individual and the related insurance benefits are also set on the basis of the individual, this may yield a problem when an elderly couple is living together, because for example it may be impossible to separate the specific needs of each of them in relation to common requirements such as the provision of meals. In this context, this paper focuses on the role of the care manager in devising care plans and managing LTC benefits, in order to assess how to support elderly couples in an optimal way. The study discusses the limitations of care plans, depending on whether or not they are expanded through systemic reform, and through a case study examines whether it is feasible to develop better care plans for elderly couples in this respect. If not, the provision of life-supporting services will be much more limited. An elderly spouse who needs a little more care or has a lower degree of LTC certification may become responsible for the reduced satisfaction of the needs of the couple, which are supposed to be supported by LTC services.

목차

Ⅰ. はじめに

Ⅱ. 介護保険制度における生活支援の変容

Ⅲ. ケアマネジャーが埋める｢ギャップ｣

Ⅳ. 糊塗される矛盾と制度の限界

Ⅴ. おわりに

키워드

老々 介護 高齢 夫婦 ケアマネジャー 介護保険 制度 生活支援 elderly care by the elderly elderly couple care manager Long-Term Care (LTC) insurance life supporting services