Model of a community-based care environmental system for "aging in place" - A case study from a historical port town in Japan

One of the major factors causing elderly people to move from their own homes is the frailty associated with aging. Japan has been developing its social welfare system since 1989 and introduced "the Integrated Community Care System" in 2013. A unique feature of the system is the desire to promote "local welfare" that provides support based on public care and informal support. Our previous study clarified the actual condition of a reciprocal complementary division of roles between welfare facilities and informal support services for the elderly. This paper clarifies the changes in the local living support environment caused by the aging of previously independent persons and proposes an enhanced local living support model. A survey and on-site observations were performed to record the behaviors and support provided for 3 people. The paper's conclusions are as follows: (1) Environmental transitions while 4 years were observed for previously independent persons, such as institutionalization and a shift of facilities. (2) Because of these transitions, the roles of informal supporting organizations were observed to decrease. (3) There are 2 types of elements that indicate a turning point in environmental transitions, which are private elements, such as hospitalization, and environmental elements, such as the limitations of self-help caregivers and local informal supporters. (4) For promoting the effective use of independent and spontaneous local informal support, care managers (formal caregivers) are needed to seamlessly connect this local informal support and formal care and to network them into the lives of individual elderly human beings. The result of this integration would be that formal care and local informal support would be synchronized and would complement each other. (5) However, there is a limitation to local informal support, and from a mid-long-term point of view, it is necessary to help these local informal supporters. (6) To not break the continuity of the local living environment during the elderly individual's environmental transition time, appropriate communication regarding the turning points is important.