No.52 Inagi City Version: Towards the Establishment of a Community-Based Integrated Care System

(Inagi Newsletter March 15, 2016 issue)

In response to the advancement of super-aging society, we are promoting the establishment of a "Community-Based Comprehensive Care System" that provides integrated medical care, long-term care, preventive care, housing, and living support, allowing individuals to continue living in their familiar homes and communities even when they require long-term care.
Regarding the promotion of home medical care and long-term care collaboration, the city has already started the swallowing function support promotion project since fiscal year 2013, and from fiscal year 2014, it has initiated the home medical care and long-term care collaboration promotion project. In May 2015, a consultation room was established at the Inagi City Medical Association.
Currently, we are working on "multidisciplinary collaboration" as a pioneering example. While Kashiwa City is gaining attention as a leading case, with the support of Fujitsu Research Institute and the University of Tokyo's Home Medical Care Center, we are implementing practices based on Kashiwa City's program while considering the actual conditions of Inagi.
As another pioneering example, we are early implementing the "Comprehensive Project for Preventive Care and Daily Living Support." This project transitions preventive care services and living support services for those requiring assistance, which were previously provided as insurance benefits under the Long-Term Care Insurance system, to municipal projects. It aims to provide diverse services in nearby municipalities while responding to individual needs in a detailed manner. Since April 2015, only Inagi City and Kunitachi City have started this in the Tama area of Tokyo.

The first theme for future initiatives is "Dementia Measures." Currently, we have placed dementia support coordinators at two Community General Support Centers in the city, with plans to increase this in the future.
Since fiscal year 2008, we have been training dementia supporters, and after holding 100 courses, we have produced approximately 3,500 supporters. Additionally, starting from fiscal year 2015, we plan to train all city employees over three years, and I also took the course and became a dementia supporter.
The dementia care path, which shows the flow of providing appropriate services according to the state of dementia, is scheduled to be completed as a brochure in fiscal year 2016.
In September of last year, Inagi Dai Hospital was designated as a community-based dementia disease medical center by Tokyo, and we plan to establish a dementia early-stage intensive support team by fiscal year 2017.
The second theme we are working on is the formulation of the "Inagi City Medical Plan." This is separate from the medical plans set by the national and metropolitan governments and is unique to the city.
It is estimated that by 2025, both the late-stage elderly and dementia patients will double, and for the future construction of the Community Comprehensive Care System, it is essential to closely collaborate with medical services, as simply enhancing nursing and preventive care will not suffice. We aim to evaluate the current state of medical resources, understand the needs for home medical care, promote collaboration between medical care and nursing, and discuss with the medical association how to develop the foundation of medical resources in response to the anticipated increase in medical needs in the future, striving for a better plan.
Moving forward, we will collaborate with citizens and stakeholders to build the Community Comprehensive Care System early, aiming for community development that allows people to live healthy and happy lives in their familiar neighborhoods without relying too much on institutional facilities.