International Forum on Independent Living
Workshop 2：What "Disabled People's Providing Service"Brings to Social Welfare
A consideration based on recent trend and problem of care insurance and fundamental structure reform of social welfare
Ms. Naoko Ibaraki, Meijigakuin University
Our social welfare system tends to change greatly. One source of the change is "care insurance" which is being introduced into health and welfare of the aged from 2001 year. Another is the policy of "fundamental structure reform of social welfare" which intends to fundamentally improve past social welfare service system carried by government. Both care insurance and fundamental structure reform of social welfare aim at realizing "user-centered principle" and "community care. "Apparently, the future of social welfare seems prosperous. But it is not necessarily true.
In the basic aspect, care insurance and fundamental structure reform of social welfare are certainly requested for the purpose of decreasing the glowing public payment to health and welfare services. Individuals who are using these services should be sensitive to such changing and must raise opinions against problems. Firstly, I want to examine problems anticipated when public care insurance is applied in the field of disabled people's welfare. Such problems are common to aged people welfare field. By care insurance, controversy is now concentrating on the portion how to conduct care management and who bears. Of course, it is important to discuss the care-management that shows the way how each user is provided with service. However, we must note that the above-mentioned care management of care insurance is the one which is planned within the limits of insurance money paid according to required-care points already determined by care assessment, and not the one which is planned by the decisive power of service enforcement like a from a "medical model." In such model, evaluation criteria are how much independence can be British care manager. Procedure to determine the required-care points is certainly come achieved in ADL of a disabled person. However, not included there is a point of view of disability based on "life model, " which has been supported by IL movement and been recognized as an international standard in the field of social welfare of disabled people. What is care? The true care is not only for supplying way of life of disabled, but also naturally for supporting people to participate in their society. IL movement has advocated until now that it is more valuable for disabled person, with support of care attendant, to spend his spare time for most meaningful part of his activity than to spend most of time to take meal by himself and dress and undress himself. Therefore, a doubt arises if we can really leave the foundation of community care based on such life model viewpoint to the medical model system of care insurance? I want to discuss this at symposium on the day.
When considering disabled people's community care, it is another big subject also with how to improve the life condition of disabled people who live in institutions. In the case of people with learning disability, one of every three adults are living in institutions. Number of people who live in nursing care homes for the physically handicapped is increasing every year. It is also a fact that more than the half of people who work in a social welfare field is also the institution personnel. Community care of disabled people cannot be argued without consideration to how to treat institution and how to treat lives of people in there. Giving thought to this, I want to discuss what the new system of disabled people welfare service should be, and what kind of roles between professionals and disabled people should be taken in it.