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 Integrated Care System" that provides medical care, nursing care, preventive care, housing, and living support in an integrated manner, so that individuals can continue to live in their familiar homes and communities in their own way, even if they become in need of care.
Regarding the promotion of home medical care and nursing care collaboration, the city has already started the swallowing function support promotion project since fiscal year 2013, and has initiated the home medical care and nursing care collaboration promotion project since fiscal year 2014. 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 an advanced case, in our city, 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, further taking into account the actual conditions of Inagi.
As another pioneering example, we are implementing the "Comprehensive Project for Preventive Care and Daily Life Support" at an early stage. This project aims to transition preventive care services and daily 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 seeks to offer a variety of services in local municipalities while responding to individual needs in a detailed manner. Since April 2015, only Inagi City and Kunitachi City in the Tama area of Tokyo have started this initiative.

The first theme for future initiatives is "Dementia Measures." Currently, there are two Community General Support Centers in the city where dementia support coordinators are stationed, and there are plans to increase this in the future.
The training of dementia supporters has been ongoing since fiscal year 2008, and after holding 100 courses, approximately 3,500 supporters have been produced. Additionally, starting from fiscal year 2015, there is a plan to train all city employees over a period of three years, and I also took the course and became a dementia supporter.
The dementia care path, which shows the flow of appropriate service provision 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, which was designated as a community-based dementia care medical center by Tokyo, is planning to establish a dementia early intervention support team for the fiscal year 2017.
The second theme is the development of the Inagi City Medical Plan. This is separate from the medical plans established by the national and metropolitan governments and is unique to the city.
It is estimated that by 2025, both the number of Late-Stage Elderly and dementia patients will double. To build a future community-based care system, it is essential to not only enhance nursing care and prevention but also to ensure close collaboration with medical services. We aim to evaluate the current state of medical resources, understand the needs for home medical care, and promote the collaboration between medical services and nursing care. While exchanging opinions with the medical association, we want to develop a better plan on how to establish the foundation of medical resources in response to the anticipated increase in medical needs.
In the future, we will work in collaboration with citizens and stakeholders to establish a community-based care system as soon as possible, aiming for community development that allows individuals to live healthy and happy lives in their familiar neighborhoods without relying on institutional facilities as much as possible.