Revised Medical Care Child Act Enacted | However, Can We Entrust Their Living Environment to Current Group Homes?

July 24, 2026, House of Councillors plenary session.
The revised Medical Care Child Support Act was passed unanimously with 244 votes in favor and 0 against.
It will come into effect on April 1, 2027.

This is a long-awaited revision.
For families who have hit the '18-year-old wall,' I believe this is a long-cherished wish come true.

What exactly will change?

What will clearly change with the enactment

◆ Change No. 1: People over 18 are now covered by the law

Previous laws focused on 'medical care children,' meaning those under 18.
The revised law adds 'medical care persons' (those 18 or older who require constant medical care) and 'people with severe physical and intellectual disabilities' to its scope.
The name of the law will also change.
The 'Act on Support for Medical Care Children, etc., People with Severe Physical and Intellectual Disabilities, and Their Families.'

◆ Change No. 2: 'People with severe physical and intellectual disabilities' are defined in the law

People who have both severe intellectual disabilities and severe physical disabilities.
This definition will be written into the legal text for the first time.
Until now, there was no legal definition for adults.

◆ Change No. 3: The foundation of daily life becomes the responsibility of the national and local governments

New articles have been established.

• Ensuring seamless access to medical care even after turning 18 (Article 11-2)

• Employment support. It even includes an obligation for employers to make efforts to fairly evaluate abilities and manage employment appropriately (Article 11-3)

• Securing housing (Article 11-4)

• Ensuring lifelong learning opportunities (Article 10, Paragraph 2)

Universities, colleges of technology, and advanced courses at vocational schools are added to the scope of responsibilities for schools and similar institutions.
This means that learning beyond the age of 18 has been included in the legal text.

◆ Change No. 4: Reduction of family burden is specifically written

• Temporary respite care

• Welfare and health medical services at home during the night

• Transportation support for commuting to school

To ensure these can be received, we will promote the placement of nurses and other staff at facilities.
At the same time, the requirements for who can provide medical care will also be reviewed.
New regulations have also been established to place care workers capable of performing tasks such as phlegm suction in nursery schools.

◆ Change No. 5: More Consultation Counters and Regional Discussion Forums

Medical Care Child Support Centers will be renamed "Medical Care Child and Other Support Centers" and can now be established not only in prefectures but also in designated cities and core cities.
Their duties will also expand.
Responding to consultations from people who are expected to require medical care in the future due to progressive illnesses, etc.
Cooperating in the creation of individual support plans.
Providing information in cooperation with municipalities during disasters.
It has also become possible to establish councils consisting of relevant organizations in medicine, health, and welfare.

◆ Change No. 6: Mutual Support Among Families and Verification of Regional Disparities

New regulations have been established to support peer support, which is the activity of families supporting each other.
Regulations to verify the status of support in each region and correct regional disparities have also been included.
In the supplementary provisions, it was decided to review the act within three years after its enforcement.

This is what has been written into the law.

There Was No Legal Basis for "Persons with Severe Physical and Intellectual Disabilities"

The term "person with severe physical and intellectual disabilities" had no legal basis.
The basis existed for "children with severe physical and intellectual disabilities."
Article 7, Paragraph 2 of the Child Welfare Act.
"Children" who have overlapping severe intellectual disabilities and severe physical disabilities. Only those under 18 years old.

So, what were adults doing?
Local governments were creating their own judgment criteria by inferring from the definition in the Child Welfare Act.

The judgment guidelines published by Okayama Prefecture state the following.
There is no definition of "person with severe physical and intellectual disabilities" in the law.
Therefore, in light of the provisions of the Child Welfare Act, "we consider them to fall under this category."

We consider, indeed.
Because it was not written in the law, local governments had no choice but to consider it.
If the person doing the considering changes, the place where the line is drawn also changes.

As a result, what was happening?

People who developed severe physical and intellectual disabilities after the age of 18 could not use the short-term or residential care of former facilities for children with severe physical and intellectual disabilities.
This is because the entrance was limited to "people who were in a state of severe physical and intellectual disability before the age of 18."
Even if they could use home-based services like helpers just like other people with disabilities,the only things missing were places to leave them and places to live.
In the end, they had no choice but to rely on medical institutions.

There is a term called a gap in the system.
For adults with severe physical and intellectual disabilities, rather than a gap, they were not even mentioned in the legal provisions in the first place.
That term will now be included in the provisions.

What the "18-Year-Old Wall" Was

I think it is difficult to convey the height of the wall if we only talk about the law.

During school age, there is after-school day service.
There are places that will look after them until 6 or 7 in the evening.
There was school, there was after-school, and during that time, families could work.

From the day after graduation, that disappears.

Life care, which is a daytime place for adults, mostly ends around 3 PM.

In June 2026, organizations for the concerned parties and business operator organizations submitted requests to the supra-partisan parliamentary league for children and persons with medical care needs.
The structure organized there is the answer itself.

Daily life care services have lower reimbursement rates than after-school day services.
In some cases, a provider's income is cut in half when they accept individuals with medical care needs.
This is why acceptance is not progressing, leading to a shortage of services.

There are no places to accept them.
Even if one is found, it ends in the evening.
As a result, one of the parents has to quit their job.

The 'Association of Parents Raising Children with Disabilities and Medical Care Needs' has submitted a document titled 'The Four Barriers to Balancing Work and Care' to a Ministry of Health, Labour and Welfare study group.

• The barrier to returning to work

• The barrier after maternity/childcare leave

• The barrier after entering school

• The barrier after graduating from school

The last one is the '18-year-old barrier'.

The items listed there are as follows:

• When attending a workshop or similar facility, accompaniment to the bus stop for pick-up and drop-off is required

• The hours end early, and the child returns home at 3:30 PM or 4:00 PM

• There is no place equivalent to after-school day services, and quality of life decreases after reaching adulthood

• It is not guaranteed that one can work 8 hours a day, and employment itself is a narrow gate

Quality of life decreases after reaching adulthood.

The 18-year-old barrier is that kind of barrier.

Conversely, the destinations for those requiring medical care have been extremely limited until now.
Facilities specializing in children and adults with severe physical and intellectual disabilities, and some providers with nursing systems.
It was rare for other welfare providers to even interact with people requiring medical care.

In a study targeting daily life care providers nationwide, the factor most strongly related to whether they accepted individuals with medical care needs was whether they had at least one full-time nurse.
550 out of 1,250 locations nationwide responded, and among those, 209 accepted such individuals.
Since the response rate was 44.6%, it is possible that providers interested in acceptance were more likely to respond.
Even so, the result that the presence or absence of a nursing system determines everything is consistent with the feeling on the ground.

This revision addresses this issue.
Medical care, employment, housing, and learning after the age of 18.
These are all areas where the foundation was lost the moment they graduated.

With that in mind, let's read Article 11-4.

One of the newly established provisions: securing housing.

The national and local governments shall take necessary measures to secure residences where individuals can live together in the manner they and their families desire, as well as other residences where they can live in the community.

Residences where individuals can live together.
This refers to group homes.

We will secure housing for people with medical needs and those with severe physical and intellectual disabilities through group homes.
That is the direction we are heading.

What is the current state of those facilities?

In this industry, bad establishments do not go out of business.

For example, let's think about a hotel you stay at in a tourist destination.

A hotel with reasonable prices, delicious food, good customer service, and good facilities will survive,
while a hotel with high prices, mediocre food, bad employee attitudes, and poor facilities will likely go out of business.
This is because customers will stop choosing them.
It is a very normal market principle.

In group homes, this does not work very well.
The mechanism where customers choose does not function easily.

It is not that there are no vacancies in other group homes.
In fact, the number of facilities continues to increase, and the government is discussing adding them to the scope of total volume control, as there is a possibility that supply may be excessive in some regions.

There are rooms available.
Even so, users are often unable to move.

◆ Reason for not being able to move #1: Having no means to leave

Finding a place to move to. Visiting. Consulting. Signing a contract and moving belongings.

Not everyone can do this series of tasks on their own.
The less support one can expect from family, the more likely they are to get stuck there.
And those are the people who end up staying in low-quality homes for a long time.

"If you leave here, you have nowhere else to go."

This is a stock phrase used by operators who engage in enclosure to the individuals themselves. It is not a fact. They say things that are not true to people who have no way of verifying them.
It is a fact that such group homes exist.

◆ Reason for not being able to move #2: It is difficult to gather information

Where things are, what is available, and what kind of support is provided.
It is not impossible to look it up.
However, it is difficult.

Information is skewed toward the side of the operators and support staff.
It takes too much time and effort for users and their families to compare them on their own.

If there is no family support, how many times a year can one meet with a consultation support specialist, who is the only external supporter?

◆ Reason for being unable to move #3: Being unable to say no

If you complain, the relationship will sour.
That atmosphere is more intense in homes with lower quality of support.
Days go by without being able to say that you dislike something.

I believe this is also a form of entrapment.

There are also barriers for those trying to make changes.

When I was doing consultation support, talking about changing a user's home was always a heavy task.
Even though the individual's wishes should come first, the provider's intentions come to the fore.
They had their customer stolen—that is the kind of reaction they have.

If that's the case, they should just work on being chosen...

In other words, they are customers who do not speak up.
Even if the food is bad or the staff's attitude is poor, there are customers there who have no choice but to keep using the service.

And this is where it gets malicious.

Low-quality providers are aware of this.

Once they realize it, they start cutting costs from the services provided to users.
They reduce staffing.
They cut back on meals.
They stop outings.
Even then, the users do not leave, and the compensation keeps coming in.

Extreme cases are reported as abuse incidents.
What comes to light is only a small fraction of the reality.

Even so, there is no need to suppress market entry

Even so, I believe it is fine to have many providers enter the market.
The reason is that it increases the choices for users.

If there is only one place, no matter how sloppy it is, you have no choice but to go there.
If there are three, they can be compared.
If it doesn't fit, you can change.

The government is currently doing the opposite.

For group homes newly designated on or after June 1, 2026, the basic compensation is 972/1000.
A 2.8% reduction.
Along with Type B Employment Continuation Support, Child Development Support, and After-School Day Services, the compensation was lowered only for new facilities.

Furthermore, a proposal to include them in the scope of total volume control has also been approved.
This allows the designating authority to refuse designation.

The reason cited by the government is based on this perception:
"Providers are entering the market rapidly without conducting needs assessments, and they are recruiting users only after opening."

Such providers do indeed exist.
They rent properties without even checking how many potential users are in the area, and then market themselves to consultation support specialists after opening.
This is not uncommon.

Even so, I believe that restricting entry is the wrong approach.

This is because restricting entry does not cause any trouble for the low-quality providers already inside.

The ones who will be troubled are those trying to enter from now on.
Among them, there might be providers who could have created decent homes.

Low-quality providers remain, while providers who might have been good are kept out.
That is what restricting entry means.

What is needed is an exit.
A mechanism for low-quality providers to be forced out.
If market principles do not work, the administration has no choice but to force them out through guidance and audits.

My organization is also on the side that receives guidance and audits.
I am prepared to undergo them as much as necessary.
And, when actually undergoing them, they are lenient.
They focus mainly on checking documents, and they rarely delve into the substance of the support provided.

This is not to say that the staff in charge are slacking off.
The number of facilities continues to increase while the number of personnel in the departments responsible for audits remains stagnant.
There is simply no time to spend on a single facility.

If there is enough manpower to spare for the task of cutting compensation for new facilities by 2.8%,
I would like that effort to be redirected toward audits.

However, this argument does not apply to medical care.

The discussion so far has a premise.
The premise is that even if the quality is low, the business starts first and is corrected over time.

This premise cannot be applied to medical care.

Until now, many of the incidents in disability facilities that led to death were caused by significant malice.
Beating, locking up, or neglect.

Medical care is not like that.

Even without malice, people die.

A single delay in nighttime suctioning.
Failing to notice a ventilator alarm.
Skipping a step in the feeding procedure.
Skipping position changes because it is too much trouble.

Negligence and mistakes can be fatal.

Moreover, these individuals are even less able to speak up than previous users.
The fewer the facilities that accept them, the less families can complain.
What can a family say to the one place they finally found after being turned away repeatedly?

Furthermore, the individuals themselves may have severe disabilities and lack any means of communicating their intentions.

They cannot say it hurts.
They cannot say stop.
They cannot say they dislike it.

Can we entrust the lives of these people to providers who think about cutting costs from services for users?

I do not believe we can.

That is why, for group homes for those requiring medical care and those with severe physical and mental disabilities, high hurdles are necessary from the start is that not the case?
There are areas where correcting things later is too late.

The exception was placed in the opposite direction

The proposal for total volume regulation includes an exception.

If there is a need for people with severe behavioral disorders or those requiring medical care, they can be excluded from the target.

In other words, that area will not be restricted.

I understand the logic.
Since there are not enough places to accept them, we must increase them.

However, is the order not reversed?

Talk of narrowing the entrance for general group homes is progressing, while the area that most needs its quality questioned remains open.

For providers whose compensation for new entries has been lowered, medical care becomes the remaining entrance.

Review in 3 years, enforcement in April 2027

The supplementary provisions of the revised law include a review to be conducted within three years after enforcement.

I don't think we can wait those three years.

The law will be enforced on April 1, 2027.
There will also be a compensation revision in the same fiscal year.
When the system moves, providers move.
Group homes that accept individuals requiring medical care will increase from that point on.

The question is not about three years from now.

What conditions should be put in place by April 2027?

Is this really going to be okay?

#SocialWorker #DisabilityWelfare #ChildrenRequiringMedicalCare #SeverePhysicalAndMentalDisabilities #GroupHome #MedicalCareChildSupportAct #The18YearOldBarrier #GuidanceAudit #AggregateRegulation

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