My Mother's Hospitalization (6): Between Medical Insurance and Long-Term Care Insurance
◆1 Not wanting to blame anyone, just a record of being 'in trouble'
It is not that I want to blame anyone, but I am in a difficult situation and feel helpless. However, I am writing this because I think there might be some meaning in recording it.
◆2 My mother fractured her femur and applied for long-term care insurance
My elderly mother fractured her femur and was hospitalized.
Encouraged by the hospital social worker, I applied for long-term care insurance immediately after her surgery.
One month later, a city representative came to assess her care level.
At that time, my mother could barely reach the restroom using a walker.
The result was 'Support Level 1'.
◆3 At Support Level 1, welfare rehabilitation is out-of-pocket
At this care level, rehabilitation within the welfare framework must be paid out-of-pocket.
Furthermore, I learned later that once you receive long-term care certification, it becomes harder to receive rehabilitation under medical insurance.
This is because the system is designed so that long-term care insurance and medical insurance cannot be used simultaneously.
I understand the purpose of the system.
But as a family, we feel as though the doors to rehabilitation opportunities have been closed by both medical and long-term care insurance.
◆4 I learned later about the option of 'not applying for long-term care insurance'
I heard later that there is a way to prioritize medical rehabilitation by not applying for long-term care insurance, but it is unreasonable to expect a family unfamiliar with the system to make such a decision.
◆5 Long-term care certification makes it difficult to evaluate 'difficulty walking' and 'need for rehabilitation'
When I looked into it, long-term care certification focuses on:
・Whether one can eat on their own
・Whether one can use the restroom on their own
So it seems that 'difficulty walking' and 'need for rehabilitation' during hospitalization are not easily reflected.
I believe that is why the result was 'Support Level 1'.
This is my understanding, but I would appreciate hearing from those who have had similar experiences with medical and long-term care, or those who are knowledgeable about the system.
――― Postscript ―――
◆6 Differences in the purpose of medical rehabilitation and welfare rehabilitation
※ Medical rehabilitation is for improvement.
Welfare rehabilitation is for maintaining the status quo.
The purposes are different.
※ Rehabilitation when long-term care insurance certification is issued
Even though the attending physician said it was fine to go to the hospital for rehabilitation after discharge, the hospital social worker sometimes says it is not possible.
It seems that 'if a doctor deems it necessary, outpatient rehabilitation for those receiving long-term care insurance may be accepted,' but due to medical fee rules, it is actually impossible.
(Note: It seems there are exceptions for designated intractable diseases like Parkinson's disease.)
◆7 At Support Level 1, things that 'should be usable' under the system are not actually usable
※ I was told that visiting nursing rehabilitation is 'theoretically' available at Support Level 1, but while it exists in the system, in reality, providers are overwhelmed with patients who are 'bedridden and barely able to move,' so almost no one accepts Support Level 1.
※ At Support Level 1, there are almost no care managers who will take you on.
If you don't have a care manager, you basically cannot receive outpatient services.
Since I cannot drive and have my own health issues, I am truly at a loss as to what to do.
※ It is not something I want to think about, but does this mean that if my mother suffers a new injury or illness and her condition worsens, she will then be able to get a care manager and receive long-term care services and medical rehabilitation...?