「介護医療院」至れり尽くせり　　　　気ままなリライト９３

「介護医療院」という選択肢 - 日本経済新聞

In anticipation of the growing medical cost expected to escalate beyond 2025, when the Baby Boomer generation surpasses 75 years of age, another dimension has been added to the elderly care landscape by the government to enrich the elderly mental vista. Traditional hospital wards have been repurposed into more residential-style units, mirroring a homely environment, equipped with comprehensive medical and nursing care available around the clock for individuals enjoying their twilight years, despite their physical or health limitations. Those updated wards, predominantly nested within hospital structures, have been known as Kaigo Iryouin. They are offering a harmonized care system weaving together the vital elements of hospital care with the enduring residential support typically seen in traditional caregiver-focused nursing homes.

The establishment of Kaigo Iryouin has been driven by the need to reduce medical cost for elderly patients requiring long-term care. By transforming hospital beds, linked with high clinical costs, into redesigned residential pieces within the Kaigo Iryouin structure, the care recipients are kept in the same familiar environment, reimagined as guests in a more home-like setting, leading to considerable savings in medical expenses. The refurbished premises are charging accommodation fees, encouraging the Kaigo Iryouin staff to interact with and treat the residents as guests, rather than patients. This is creating an environment conducive to in-home medical care, offering a tailored and comforting approach to elderly care with medical professionals on-site or readily available. The emphasis on providing a homely care environment in hospitals is particularly relevant to the aging Baby Boomer generation, predicted to experience a shortage of available hospital beds. The adoption of the Kaigo Iryouin model is increasingly crucial, aiming to improve the quality of care offered to the expanding elderly population while curbing the spiraling healthcare cost.

Kaigo Iryouin facilities are emerging as an appealing choice for those seeking holistic and empathetic nursing services that extend beyond the scope of standard, insurance-covered nursing homes in Japan, such as Special Nursing Homes called Tokuyo, providing long-term care for elderly individuals struggling with independent living due to physical and mental health constraints and, Healthcare Facilities called Rouken, mainly providing rehabilitation services for seniors who retain some level of autonomy but still require consistent medical care and assistance. Unlike those traditional models in which doctors or other medical professionals are available on a limited basis, the Kaigo Iryouin model is a unique fusion of hospital, nursing home, and hospice care, providing a comprehensive healthcare solution for aging individuals. The defining characteristic of this hybrid medicare model is the high quality of end-of-life care, which sets it apart from conventional facilities. The service revolves around dignity-based decision-making about the biological limit of life, carried out by a multidisciplinary team of doctors, nurses, therapists and counselors. The team educates the guest’s family members about the potential suffering caused by artificial life-extension measures, such as intravenous administration, emphasizing the importance of accepting natural lifespan limits. The team also guides family members in understanding and accepting the concept of natural death, moving away from their egoistic viewpoints. The holistic approach ensures peace of mind through psychological and emotional support for family members experiencing the poignant reality of a loved one's life drawing to a close.

Ariyoshi-Hospital Group, located in Miyawaka City, Fukuoka Prefecture, is showcasing a role model as Kaigo Iryouin established in 2020. This model's interior design is imbued with the essence of a traditional Japanese inn, drawing on the natural tactile appeal of wooden architecture to evoke a feeling of being close to nature. It exudes a warm, inviting atmosphere that wouldn't seem out of place even if a nakai, akin to a concierge in a Western hotel, were to greet guests upon arrival. Upon entering, visitors are welcomed into an area surrounded by a multitude of unit-type private rooms, tallying at 90, with an area of 11 to 13 square meters each. The cost of accommodation in those private rooms, mostly covered by the elderly nursing care insurance, with the exact amount dependent on the guest's income level, ranges from 100,000 yen to 200,000 yen a month. The facility also features a communal space with a tatami mat floor and a low table over a dug-out floor where a heat source is placed in the floor pit, for precious moments with family members and friends. There's also a dining area to encourage socializing with fellow residents through various recreational activities. The facility, designed to create an immersive, hotel-like experience, primarily serves senior guests at care level 3 or higher. This classification presents the extensive level of assistance required by seniors with physical constraints to carry out daily activities, such as bathing, eating, and using the restroom. In Japan's elderly care insurance system, a care level assessment determines the services for which an individual is eligible. Each guest encounters the final unexpected event of life on a journey towards the inevitable end. This place serves as their final dwelling, where they cherish each day without dwelling on how many days are numbered, whether it is 400 days or 500 days.

Tsurumaki Onsen Hospital in Hatano City, Kanagawa Prefecture is tapping into the potential of its Kaigo Iryouin ward, consisting of 52 units. Adopting an all-encompassing approach, the focus is on promoting the emotional well-being of residents, allowing them freedom of choice and action within the boundaries set by their medical conditions. Physicians here are acting more as advocates for the residents rather than authority figures, navigating care management in collaboration with a team of specialists such as dieticians, physical therapists and care workers. This team is highly valuing the residents' autonomy, honoring their preferences in both dietary and recreational aspects. Championing the transition from nasogastric tube feeding to oral intake, dieticians are going the extra mile to please even beer-thirsty palates. The exchange of love and familial care is fostered through home-cooked meals brought in by the resident’s family members. The residents are encouraged to live the rest of their lives to its fullest. Opportunities for engaging pursuits such as balcony gardening and music appreciation are provided, along with the joy of breathing fresh air and the delight of basking in sunlight during carefully supervised outdoor activities.