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He also urged the importance of continuing professional educational programs for those who are named as so-called professional yet without having the due and authorized licenses and certificates as it is done in other countries. He emphasized the importance of continuing educational programs which will pave the way for those professional to be classified as the authorized professional in engaging with their respective professional areas in care services for the elderly.

Commenting on some difficulties facing the providers of care services for the elderly from view points of the providers, he pointed out "regional discrepancies "exist in terms of pay scale for labor and wages for medical doctors/nurses in spite of all most same fees for care services extended to the elderly regardless of whether institutional facilities are located in relatively cost burden and less cost burden regions. For an example, the wages for nurses and care givers in Akita Prefecture in Japan and Nagoya city is shown in wage differential which is 30% less as far as the labor cost of care givers is concerned compared to Nagoya, yet the fees to be charged to the beneficiaries of the care services under the current system is same. This will lead to difficult financial picture of the providers in the major metropolitan cities where the demands for entry into institutional facilities are much greater compared to some of the remote regions. In nutshell, he recommended that the Ministry of Health, Labor and Welfare should look into this particular issue more closely in order to keep the current system to be viable for the providers of care services for the elderly, particularly in the metropolitan regions where the cost of living including wages are much higher.

Dr.Mokuno stated some of the issues further during the panel discussions which will be outline at Part II of this summary.

Mr.Fong made remarks by saying that he would refrain from stating again concerning the overview of the issues of aging in the United States as other delegates from the United States had already presented. His remarks were centered on a very specific issues relating to the long-term care services system for the elderly in the past, present and the future. He focused on (3) major lessons from which one should learn in order to enhance more elaborated and sound system and the policy implementation for improving the cons-side as experienced in the past years. He stated that the United States experienced difficulties in the implementation of effective programs which are Medicare and Medicaid as these programs at the time of implementation was based on certain predictions and assumptions which have proven to be not adequate in terms of the assessment at that time due to the emerging new factors difficult to predict at that time. Secondly, he stated that so much "unknown factors" which have emerged recently to become major factors which required for review of the programs due to the unexpected factors affecting on the programs. He pointed out that the role of the government in these programs were larger in 1900Ős, which was demonstrated in the case of "management care "and so-called "pre-conceived approach to the issue of aging was one of the dominant phenomenon". He stated that the United States is now faced with "Back lush".

He concluded that the issue of aging is so complex and it is particularly true among the community of so-called minority because of different historical heritages in terms of the building of the nations from where Asian, Hispanic and Pacific Islanders immigrated and settled as the first generation of Asian, Hispanic and Pacific IslanderŐs American who were inherited with their mother countries culture, way of life and other factors. Then, the second generation of those settlers did grow in population and it is now the case that Hispanic and Asian Americans are becoming the noticeable percentage of the population in the United States. Nonetheless, their heritages pose significant factors in their lives, particularly, in their ageing period. NAPCA has been the organization to advocate the dynamic policy in implementing an appropriate approach to the elderly of Hispanic and Asian origin to make them more comfortable in their environment of aging period.

After these remarks were presented, the symposium moved on to free discussions among the delegates on the issues and concerns as expressed by each delegates. At the end of the panel discussions, many questions were raised from the audiences toward the delegates. The summary of the panel discussions and the questions raised from the audiences at the symposium will be introduced in the part II of this paper. Professor Daisaku MaedaŐs concluding remarks at the symposium will shed some lights on the issue of aging from the global perspectives.

Written and edited by Yusuke Kataoka
Acting Chairman & Executive Director
U.S. Foundation for International EconomicPolicy

April, 2004


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