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During the panel discussions and responding to questions raised by the audiences at the symposium, President Igata and other delegates have expressed their respective comments, views, opinions and exchange of views among the delegates which will be dealt in the next summary of this symposium at our website.

As CEO of providers of long-term care services for the elderly with invaluable experience as well as scholars specializing in the issues of aging, Dr.Mokuno introduced his remarks focusing on some specific issues relating to the current system and made his views and recommendations in the process of reviewing the current system which are now being undertaken for the completion of the review and revision by the end of March 2005.

He has provided the materials concerning comparative notes between Japan and the United States in the system of long-term care services. Although the structure of the system is different due to law(s), regulations and codes between the two countries, he touched on some of important points which will be implemented in the operation of institutional facilities providing long-term care services under the current system but also recommended items to be reviewed and revised in order to create more realistic and sound system.

He has listed a number of issues which are regarded to be reviewed for improvement in the system through the process of review and revision of the on-going task of completing the review process by the end of March 2005. Firstly. He sated that the auditing system into institutional facilities for care services for the elderly under the current system should be improved. He pointed out that the auditors being assigned from the regional government in charge of the long-term care service insurance system, is not appropriate nor productive by large in terms of how the operation of providers of care services be audited in terms of its methods and contents of the auditing. His observations based on his involvement at the time of auditing demonstrate that those assigned to conduct the task of auditing of the providers of care services at institutional settings are less interested in how the operation of facilities are being conducted in accordance with the regulations and guidance applied under the current system but they are primary concerned about the financial figures of how it is properly documented to meet the requirements.

The auditors assigned are, in the most cases, neither knowledgeable nor professionalized in terms of how the long-term care services being provided. Since the auditors are assigned from respective regional government in which the institutional facilities are located, the auditors tended to think of their task not only in terms of how the providers of care are maintaining financial records but also they tended to think that the providers of care services for the elderly be directed by these bureaucratic staff. These auditing methods prevent providers of care services for the elderly from properly evaluated, particularly how the detailed task of care services are being provided for the elderly, which will provide the opportunity for the users of the facilities in their choice.

Dr.Mokuno recommended that institutional facilities for care services for the elderly be audited by more independent entities rather than regional government, which will provide full disclosure of quality of care services provided for the choice by potential beneficiaries of the current system.

Another issue he focused on is a question of the issue of licensing and certificates for professional persons who are engaged in care services. Although Japanese Ministry of Health, Labor and Welfare has implemented some of licensing and certificate programs but it is not enough to enhance the ability and quality of those professional persons to meet the requirement of changing care services and medical services to provide them with the elderly. In this regard, he urged that some of the measures implemented in the United States be helpful to advance these issues.


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