Welfare Division for Persons with Disabilities,
Department of Health and Welfare for Persons with Disabilities,
Social Welfare and War Victims’ Relief Bureau, Ministry of Health, Labour and Welfare

1. Introduction

We revise the subsidy for the welfare of persons/children with disabilities once every three years so we can continue to provide services that meet their needs to ensure the effectivity and sustainability of the system.  The revision of the subsidy for FY2021 was conducted and enforced in April 3, 2021.  In this article, we would like to introduce an outline of this subsidy revision.

2. Background

Since the enforcement of the Services and Support for Persons with Disabilities Act (currently the Act on the Comprehensive Support for the Daily and Social Life of Persons with Disabilities), the number of users of welfare services among persons with disabilities, as well as the national budget for these services have tripled; and support for persons with disabilities has been expanding year by year.  Under these circumstances, in the light of improving the quality of the services and ensuring the sustainability of the system, a shift to a more well-balanced subsidy system has been called for.  In addition, triggered by the spread of COVID-19, we realized that it is important to provide the necessary services in a stable and sustained manner, especially when an infectious disease occurs.

Under these circumstances, the Ministry of Health, Labour and Welfare’s “Subsidy Revision Review Team for Services to Persons with Disabilities” had been discussing the revision of subsidy for 2021, while considering the opinions of concerned parties since February 2020.  In February 2021, the revision details were finally agreed on.

The overall revision rate is + 0.56%, which is higher than that of the previous revision.  We came up with a well-balanced revision of the subsidy, taking into consideration the following points:

• support for those leaving institutions and living in the community while paying attention to the increasing severity and aging of persons with disabilities,
• the improvement of the quality of consultation services, which is a core service,
• effective support for employment, and
• the promotion of support for children with disabilities who need constant medical care. 

Moreover, we also took into account the business conditions of welfare establishments and the sustainability of the system so that we can continuously provide the necessary services, even in case of the occurrence of infectious diseases by enhancing our ability to fight against them.

3. Main Points of the Revision of the Subsidy for FY2021

(1) The revision of the subsidy system is intended to provide better support for those leaving institutions and living in the community, taking into account the increasing severity of disabilities and aging of persons with disabilities, and to provide higher quality of consultation services:

• To assist those living in the community, we expanded the scope of persons with severe disabilities eligible for additional benefits; greater consideration shall be given to the support of those in need of constant medical care, as well as the support of those with severe disabilities by giving daily life care.
• We shall improve the standard of personnel, the application of subsidies, and adjust the subsidy itself to enhance support for independent living so that persons with disabilities can continue to live alone independently in the community without worry.
• High priority shall be given to the strengthening of the capability of facilities that facilitate short-term stays of persons with disabilities, such as day-care facilities and a greater capacity for home-visit services in case of an emergency, both of which are being developed to support the community life of persons with disabilities in anticipation of the growing severity of disability and the aging and death of their parents.
• We shall implement an increase of the basic subsidy and the new assessment of consultation services, anticipating that through the training of consultation staff and the improvement of the system in the community, this would result in better consultation services.

(2) More conscientious and effective support towards the employment of persons with disabilities according to their specific needs:

• We shall conduct an evaluation of the subsidy system relative to supporting the employment of persons with disabilities who are employed by regular companies based on the results of the previous revision and referring to their records, including their retention records, for their successful employment according to their wishes, abilities, and aptitudes.

• Efforts to enhance the effect of support and the responses to various employment needs shall be highly evaluated, including the introduction of a new score system of the Support for Continuous Employment (Type A) and the categorization of subsidy systems under the Support for Continuous Employment (Type B).
• To address the need of living at home, to provide for the family’s respite, and to enhance support for daytime activities, we shall strengthen the system so we can  accept people who need constant medical care by increasing the basic subsidy, and expand the scope of children needing constant medical care in short-term stays in day care facilities.
• We shall give higher consideration for conscientious services responding to users’ needs in support of admission to institutions and home visit services.

(3) Promotion for the support of children with disabilities, including those who need constant medical care:

• In support of children with disabilities (children needing constant medical care) constantly needing respirators and phlegm suction, we reviewed the criteria introduced in the previous revision.   With the advancement of medical technology, we have strengthened the service provision system by setting the category of children in the basic subsidy classification for child development support and after-school day services that makes it easier for children needing medical care to receive the necessary support in the community.
• As for the basic subsidy for after-school day services, Categories 1 and 2 have been abolished; rather, an additional benefit has been created to put more value on comprehensive assistance.
• As for the support of child development and after-school day services, a review of the subsidy system shall be done to evaluate the support given to children with disabilities needing thorough care and support by professionals, as well as a review of employee requirements to improve the quality of support.
• Relative to the facilities for children with disabilities, based on the recommendations made by the “Study Group on Facilities for Children with Disabilities,” a review of personnel standards, facility requirements for small-scale group care, and an evaluation of the placement of social workers were done.

(4) Promotion of a comprehensive community care system that responds to the needs of persons with mental disorders

• We shall evaluate efforts that contribute to the setting up of a care system from the perspective of promoting the creation of a “comprehensive community care system that includes persons with mental disorders,” in which medical care, disability welfare / long-term care, housing, social participation (employment), community support, and education are comprehensively secured so that persons with mental disorders can live life as they choose as members of the local community without worry.

(5) Strengthening the capability to respond to infectious diseases and disasters

• The following shall be mandatory:
  • Efforts towards business continuity under the business continuity plan (BCP),
  • Efforts for the prevention of outbreaks and spread of infectious diseases, and
  • The implementation of training using operating standards.

• Such efforts shall be compensated from the basic subsidy.
  • To continue providing support even during the occurrences of infectious diseases or disasters, we would like to clarify that ICT is used during normal times for employment-oriented work from home and for holding regular meetings necessary for discussing additional subsidies.

(6) Review of the subsidies to ensure the sustainability of disability welfare services and the provision of appropriate services

• A review was conducted on the subsidies and standards based on the actual business conditions of facilities and business establishments that provide services.  There was also a review of other subsidies in the medical cooperation system, considering the intensity of nursing work in medical care.
• To promote the prevention of abuse of persons with disabilities, it shall be mandatory to establish an abuse prevention committee that will conduct training; and it shall also be mandatory to establish a committee that creates guidelines, like promoting the avoidance of the use of physical restraints.
• To secure human resources, prevent fast turnovers and promote retention in the field of welfare for persons with disabilities, we must do the following:

• ease a portion of the requirements for “full-time” and “full-time equivalent” in consideration of work-family life balance;
• ease the allocation rule of additional subsidy for welfare and long-term care staff to improve their working conditions.

4. Conclusion

Based on the opinions raised in the review of this subsidy revision, it was decided to continue to study and verify some matters for the next subsidy revision.  We will prepare for the subsidy revision in 2024, verify the revision’s effects and discuss new issues.

[Reference]

Ministry of Health, Labour and Welfare Website: “Revision of Subsidy for Disability Welfare Services for FY2021”
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000202214_00007.html