Takuya Kurihara
Assistant Manager of Community Life Support Promotion Office (and)
Chief of Community Transition Support Section 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

The Ministry of Health, Labour and Welfare aims to build a community life support system that allows adults and children with disabilities (hereinafter referred to as “persons with disabilities”) to live in the community with peace of mind.  By keeping an eye on the aging of persons with disabilities, the increasing severity of their disabilities, and their lives after the death of their parents, we promote the development of a community life support system which is expected to play a role in ensuring the peace of mind of persons with disabilities living in the community and in facilitating their transition from institutions and hospitals to the community.

In this article, I would like to introduce to you the history of the community life support system, its specific roles and functions, and our efforts to promote the development and improvement of those functions.

2. History of Community Life Support System

The “Act on the Development of Laws Relative to New Health and Welfare Measures for Persons with Disabilities toward the Realization of Inclusive Communities” was enacted in June 2012.  The study of the community life support system was triggered by a statement in the supplementary resolution of both the House of Representatives and the House of Councilors, which states, “From the perspective of further promoting support for children and persons with disabilities living in the community, while keeping an eye on the aging of persons with disabilities, the severity of their disabilities, and their lives after the death of their parents, there is an urgent need for us to seriously consider these issues.”

Based on this supplementary resolution, the Study Group on the Promotion of Community Life for Persons with Disabilities established by the Ministry of Health, Labour and Welfare in 2013 studied on how to proceed with enhancing the function of residential support in the community; and according to Japan’s Basic Guidelines relative to the 4th Plan for the Welfare of Persons with Disabilities (FY2015-FY2017), it was decided that by the end of 2017 at least one support system should be established in each municipality or each designated area for the health and welfare of persons with disabilities.

We have been working with local governments to promote the development of the community life support system by creating the “Collection of Good Practices of the Community Life Support System” in 2017, and in 2018, we  held  prefectural block meetings to promote the development of the community life support system to strengthen and enhance its necessary functions.”

3. Roles and Functions of the Community Life Support System

<A mechanism to support persons with disabilities living in the community >

1. To provide prompt and reliable consultation services and short-term admission in an institution in case of an emergency to ensure a sense of security in community life.
2. To establish a system that provides the opportunity to experience life in the community, which can facilitate the transition from an institution, hospital or parents’ home to a group home and a place where they can live independently.

As for residential support, specifically, there are five functions that a community life support system should provide: consultation, hospital admission in case of emergencies, opportunities to experience life in the community, acquiring human resources and training them for professional services, and the creation of a mechanism for the community.

<Consultation>

A function to identify and register households that are not expected to cope with an emergency in advance, to secure constant communication, and to provide support such as coordination and consultation relative to the services necessary in emergencies.

<Hospital admissions in case of emergencies>

A function to admit persons with disabilities in case of emergencies (i.e. sudden illness of a caregiver, a deterioration in the condition of a person with disability), and to take necessary measures such as contacting medical institutions.

<Opportunities to experience life in the community>

A function that provides opportunities and places to experience community life in the context of a group home or the experience of living independently before transitioning to live in the community or becoming independent from parents.

<Acquiring human resources and training them for professional services>

A function to acquire human resources and train them so that professional services may be provided to those who need medical care or have behavioral disorders.

<Creation of a mechanism for the community>

A function to assign a coordinator and to secure a service provision system that can respond to various needs of the community and to build a cooperative mechanism among social resources in the community.

In creating these functions, it is important to build a cooperative system throughout the community to prepare for emergencies so that we can better respond to persons who are difficult to support, including persons with severe physical and mental disabilities who require medical care and persons with severe behavioral disorders and persons with higher brain dysfunction.

In addition, it has been pointed out that there are cases where community life support system is only a formality.  It is important for municipalities to take the lead in developing community life support systems based on the needs of the community.  It is also beneficial to evaluate the state of the system and its operations in order to be readily equipped with functions that meet the needs of the community.

As to the form of system development, they should be according to the actual situation of the community.  There are kinds of “multifunctional development,” which is development of a system added to group homes and support facilities for persons with disabilities, and “area development” where multiple organizations in the community share the functions, and a combination of the two.

4. Promoting the Development of a Community Life Support System with Efforts to Enhance its Functions

The National Basic Guidelines relative to the 6th Plan for the Welfare of Persons with Disabilities (FY2021-FY2023) established by the local government states that, “For the community life support system, while establishing at least one support system in each municipality or each designated area, verification and review of its operational status shall be conducted at least once a year in order to improve its functions.”

As of April 1, 2021, the number of municipalities that have established community life support systems is 922 out of a total of 1,741 municipalities (preliminary figures), and still there are many municipalities that have yet to establish the system.

Moreover, even in municipalities that have the system already in place, it is important to know the needs of local users and their families, to constantly verify whether the  necessary functions address the community’s needs, and to strengthen those functions according to the actual situation of the community.

In the revision of the subsidy for welfare services for persons with disabilities in 2021, in order to promote the development of a community life support system and enhance their functions, an additional subsidy has been created to avail of better services which the municipalities have created as a community life support system in response to emergencies, such as short-term admission in institutions and visitation services that provide emergency care.

In addition, in the 2021 Comprehensive Welfare Promotion Program for Persons with Disabilities, we are deliberating on the “verification of the actual operations of community life support systems and the development of evaluation indexes for effective functions.”  We shall create standard metrics and evaluation processes to continuously verify and examine whether the municipalities are equipped with the necessary functions in meeting the needs of the community throughout the PDCA cycle.

From now on, we will enhance the functions of the community life support system by disseminating the evaluation indicators and processes nationwide.

5. Conclusion

Currently, the Social Security Advisory Council’s Subcommittee on Persons with Disabilities is considering a review three years after the enforcement of the revised Services and Support for Persons with Disabilities Act, and is also discussing the development of the community life support system and strengthening its functions.

We shall deliberate on how to build a support system that will make persons with disabilities feel secure in the community and how to better facilitate the transition to community life, including the further development of the system and its functions, the improvement of group homes where people with disabilities live, and the enhancement of support to help them live independently in the community.

[Reference]

Ministry of Health, Labour and Welfare’s website “Community Life Support System”
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000128378.html