Emi Machida
Responsible for the Advice and Support Centre for Disabled Children and Adults
Disability Welfare Section, Health and Welfare Division, Tochigi City

1. Overview of Tochigi City

The city is located in the southern part of Tochigi Prefecture, around an hour away from Tokyo by rail or highway. The current Tochigi City was formed as the result of three mergers between municipalities, in 2010, 2011, and 2014. The city covers an area of 331.50㎢, and had a population of 156,000 as of 31 March 2022, with a falling birth rate and ageing population.

Regarding the city’s residents with disabilities, there are 5,092 people with physical disability certificates, 1,422 people with intellectual or developmental disability certificates, and 1,240 people with mental disability certificates. There are around 1,933 users of disability welfare services, including both adults and children, with 23 designated advice and support offices, and almost 100% of the service users have service use plans drawn up by advice and support specialists. Moreover, the large number of welfare service providers due to the various municipal mergers is a distinctive feature of the city.

2. Establishment and maintenance of community life support hubs and similar facilities

In this city, against a backdrop of the deterioration of family functions due to nuclearization and ageing, the number of basic enquiries related to disability was increasing. At this time, the Ministry of Health, Labour and Welfare announced that “community life support hubs and similar facilities” would be established by the end of FY 2017. Due to this, and in order to move ahead with the establishment of a structure emphasizing “consultation and emergency response,” the city made use of the Model Project to Promote the Establishment of Community Life Support Hubs and Similar Facilities in FY 2015 to set up a preparatory committee within the Council to Support Independent Living, hold study meetings to examine the policy for the establishment of these facilities, and carry out an investigation of emergency responses (interviews with various providers about their responses in past emergencies) and short stay experiences (trial usage of short stay facilities by people who had no experience of using them). We decided on an area-wide model for the establishment of these facilities, making use of the advantage of having many welfare service providers within the city.

In FY 2016, we made use of the Tochigi Prefecture Community Life Support Hubs System Establishment Project to set up a hub working group within the Council to Support Independent Living, carry out examinations of concrete modes of emergency support, and launch a trial run of the Tochigi City Kurashi Daiji Network Emergency Support Project. We also held study meetings and built the Tochigi Share Network (sharing of data and information about vacancies at facilities with providers in the city). We decided that the name of the community life support hubs would be Tochigi City Kurashi Daiji Network. Daiji means “fine” or “important” in Tochigi dialect, and so it encompassed the sentiment of “Even if you are worried about things, it will be fine. It is important to us that you live in a way that suits you.” In FY 2017, the Kurashi Daiji Network Emergency Support Project went into full-scale operation, and in FY 2018, the outline was updated.

In addition, in order to construct a venue for experiences and opportunities, an investigation of people who wished to live alone and of the needs of the organizations involved was carried out in FY 2018, and in FY 2019, a trial run of the Living Alone Experience Project took place, before full-scale operations were launched in FY 2020.

Furthermore, since cooperation and collaboration between welfare service providers within the city is extremely important because of the area-wide model, we have held an annual Kurashi Daiji Network Reporting Meeting for welfare service providers since FY 2016, at which we report on the performance record and any issues.

3. The five current functions of Tochigi’s community life support hubs

(1) Advice and consultation

The city’s Advice and Support Centre for Disabled Children and Adults had already set up a hub in the City Hall, and outsourced advice and support activities to advice and support specialists from social welfare corporations. However, from October 2015, it was positioned as a core advice and support centre run directly by the city, and given a central role in advice and support for the community. There are 23 advice and support facilities within the city; we provide back-up for them in their provision of support and plan how to enrich this, as well as holding regular advice and support network meetings four times a year as a venue to improve the quality of the advice and support specialists in the city and to strengthen the network.

(2) Emergency intake

Emergency support uses a registration system: a usage registration form and basic information are collected in advance. Considering risk management, we ask people to register after considering this together with their families and supporters. Emergency responses include emergency short stays, emergency home nursing care, and rapid assistance on the spot (staff of facilities which carry out daytime activities rush to the spot to provide support). For emergency short stays, priority is given to facilities which the person has a history of using, but if there is no such history, the short stay facility is determined based on a weekly rota. Responses are handled by a two-person team from the Disability Welfare Section, one person in charge of taking calls and the other of providing support, who are on call 24 hours a day, 365 days a year. They confirm the situation, consider appropriate methods of support, and ask the receiving facility to provide support. The support period is set at a maximum of 7 days, and the city coordinates the transition from emergency to regular support. Various initiatives to prevent emergencies from arising have been carried out since the start of this project, centring on the advice and support specialists, including care meetings for people already registered and moves to understand the situations of people who have not yet registered.

(3) An opportunity and venue to try new experiences

Since FY 2019, one room of an apartment building owned by one of the organisations with which we have an outsourcing contract has been used for the Living Alone Experience Project. The advice and support specialist responsible for the disabled person considers the opportunity together with them and takes future prospects into account before making an application. After applying, one of the city’s advice and support specialists becomes the coordinator, investigates the person’s needs, and draws up an experience plan. Meetings are held together with the person concerned before and after the experience. During the experience, staff of the contracted organisation keep an eye on the person and have a system in place to provide rapid assistance, and home nursing care can also be used.

(4) Development of specialist personnel

In this city, we consider personnel development to be important to the establishment and maintenance of community life support hubs and similar facilities, and have been holding annual study meetings for home nursing care providers since FY 2015. We also carry out training for those providing support, such as holding child liaison meetings which aim to improve the quality of staff at welfare service providers for disabled children and to build networks, as well as study meetings to establish support structures for children and adults who need constant medical care.

(5) Building of local community structures

We are building local community structures, with the Council to Support Independent Living playing the central role. At present, it contains the “Working Group on Children and Adults Who Need Constant Medical Care”, which considers the support structure for these people, and an “All of Daily Life Working Group”, which aims to construct a comprehensive community care system that can respond to people with mental illness. It poses and considers issues and holds study meetings. In addition, representatives participate in meetings involving other organisations, building networks with the organisations involved.

5. Current issues and future prospects

From the start of the Emergency Support Project, emergency situations have been envisaged, and advice and support specialists and other people concerned have held meetings and prepared support systems in order to provide support smoothly. However, there have been problems when support systems were not prepared for people requiring an individualized response, such as children or adults who need constant medical care or those with severe behavioural disorders. For this reason, the Council to Support Independent Living and meetings of outsourced service providers considered how to make the registration system more effective. As a result, from FY 2022 onwards, in order to further enhance the system, after registration, in cases where there are no contracts with short stay facilities or home nursing care providers which can accept the person, we have decided to carry out a back-up in order to secure a place which can accept them in an emergency. In addition, an Emergency Support System Establishment and Maintenance fund was established to pay commission fees to advice and support providers which hold regular meetings and have set up team-based support systems.

At present, due in part to the COVID-19 pandemic, the Living Alone Experience Project has few users, and so we believe that further awareness-raising is necessary.

Since the establishment and maintenance of community life support hubs and similar facilities in this city was done using an area-wide model, we have considered cooperation and collaboration between welfare service providers within the city to be important. By carrying out evaluations at the Council to Support Independent Living and considering issues the following year, we have aimed to promote the establishment and maintenance of these hubs and enhance their functioning. We will continue to use the PDCA cycle as we work to build a local community in which people with disabilities can go on living with greater peace of mind.