What role will long-term care facilities play toward 2040? - Insight into future changes in long-term care management from the perspective of the Regional Medical Care Vision -

Right now, the medical service delivery system itself is about to be significantly redesigned with an eye toward 2040. I would like to explore how this will impact long-term care management.

Reiwa8year3month26th, the materials from the 126th meeting of the Social Security Council's Medical Subcommittee126materials from the 126th meeting of the Social Security Council's Medical Subcommittee11 present the "Summary of Discussions on the Regional Medical Care Vision and Medical Plans, etc."

As a new Regional Medical Care Vision (looking toward 2040), the focus is on challenges such as population decline and further aging after 2025, as well as the uneven distribution of physicians, and a direction is indicated to redesign the system to include better coordination with outpatient care, home medical care, and long-term care.
In other words, it means a full-scale shift from medical care that is completed solely within hospitals to medical care that supports people within their local communities.

And when read from the perspective of those involved in the long-term care field, this document can be seen as a very significant question posed to long-term care management.
What role will your long-term care facility play in the community of the future?

What role will your long-term care facility play in the community of the future?

New value and the power to connect medical care and daily life are required

First, as for the impact on long-term care management, I believe you are all aware that the number of users with high medical dependency in the long-term care field will likely increase.
I believe you are all aware that the number of users with high medical dependency in the long-term care field will likely increase.

The document mentions responses to elderly emergency care, aspiration pneumonia, etc., rehabilitation from the early stages of hospitalization, and the development of a support system for home medical care.

Conversely, this means that instead of staying in the hospital for a long time, the flow of returning to the community, home, or facilities at an early stage after receiving necessary medical treatment will strengthen.

If that happens, long-term care facilities and home-based services will require a medical perspective more than ever before.
Following this trend, there may be cases where patients are accepted for discharge before their treatment reaches a stable phase.

For example, "The CRP (inflammatory response) has not gone down, but there is nothing more we can do, so please monitor the situation on the long-term care side."
Or, "The treatment is finished, so please continue the appropriate procedures that we will inform you of."

In this way, it is predicted that people who previously spent their entire recovery period in the hospital will return before that period is over.
Long-term care facilities will also be required to have medical expertise that aligns with this trend.

Also, in daily life, the following will be required:
The ability to predict sudden changes.
The ability to face end-of-life care.
Coordination with medication management, nutrition, swallowing, and rehabilitation.
Information sharing with visiting physicians and visiting nurses.
Decisions on whether to hospitalize.
The ability to organize the intentions of the individual and their family.

It is necessary to improve these knowledge and skills, and indeed, there are already long-term care facilities that are doing so.
Indeed, there are already long-term care facilities that are doing so.

However, what is important is to proceed systematically to establish this as a mechanism for the entire facility, rather than relying on a few experienced staff members.

In other words, what is expected of long-term care facilities in the future is not to take on medical care entirely.

However, the level of
the power to connect medical care and daily life explained above will be required.

Evaluation axes for long-term care facilities as indicated by "Home Medical Care Coordination Functions"

In this document, 'home medical care coordination functions' are presented as one of the functions of medical institutions.

It mentions that in addition to providing home medical care in the community, this includes 24-hour support and inpatient support in coordination with other medical institutions, nursing care facilities, visiting nursing, and home-visit nursing care.

This is extremely important.

Nursing care providers that will be valued in the community in the future will not be able to rely solely on saying, 'We have vacancies' or 'We have staff.'

For example, from the perspective of a medical institution, it is important to know whether a patient can be handled appropriately without returning immediately after discharge.
In short, when viewed as a 24-hour support system, it is a matter of whether the provider clearly understands which part of the process they are responsible for.

It is important to become an entity that is thought of as follows:
'That facility has information connected with medical institutions.'
'That provider is a reliable receptacle after discharge.'
'That organization has a well-established decision-making process for emergencies.'
'That facility explains things carefully to families and can act as a bridge to medical care.'

For example, in pamphlets or on websites, it is not about abstract expressions like 'peace-of-mind nursing care' or 'medical coordination,' but rather whether, in actual daily operations, medical and nursing care information is connected, judgments are organized, and the situation can be explained to families.

Ultimately, this leads to the issue of the operational structure itself.

What does one acute care hub for every 200,000 to 300,000 people mean?

The document indicates that for acute care hub functions, the guideline is to 'secure one for every 200,000 to 300,000 people' in each planning area.

This is the idea of consolidating medical institutions that handle surgeries, severe emergency care, and responses to emerging infectious diseases for every certain population size.

In urban areas, a zone of 200,000 to 300,000 people may be an area that can be traveled to in a relatively short time by car or public transport.

However, in rural areas, the situation is completely different even with the same population size.

If you try to create a zone of 200,000 to 300,000 people, there are some regions that will cover a very wide area.
If you include mountainous areas, peninsulas, remote islands, and heavy snowfall areas, the distance to the acute care hub hospital increases significantly at once.

In my parents' hometown, there are already zero obstetrics and gynecology or ophthalmology clinics.
They are within the secondary medical area, but concrete inconveniences are arising for the residents.

In addition, there are other issues:
Emergency transport takes time.
It becomes difficult for families to visit or accompany patients.
It becomes difficult to participate in pre-discharge conferences.
Elderly spouses cannot commute to the hospital.
Nursing care facilities also face an increased burden of accompanying patients to medical visits and coordinating information.

In other words, while the consolidation of medical functions is discussed in terms of 'efficiency' and 'functional differentiation' in the system, from the residents' perspective, it is accompanied by the reality that the distance to medical care increases.

Nursing care providers need to look at this quite realistically.

The government also assumes the 'distance problem' as a premise.

Indeed, the materials also state that
while the basic principle for medical care zones is a population of 200,000 or more, they will be set flexibly based on local circumstances.

Furthermore, regarding measures to address the uneven distribution of physicians, a direction has been indicated to reflect geographical factors such as population density, distance to secondary emergency hospitals, remote islands, and special heavy snowfall areas.

In other words, even while the government says "one for every 200,000 to 300,000 people," I believe they are operating on the premise that distance and geographical conditions will be major challenges in rural areas.

However, the fundamental premise is that
future system design does not prioritize "close and convenient medical care" for residents above all else.

Rather, there is a growing emphasis on the idea of where to concentrate limited physicians, nurses, hospital beds, and surgical capabilities
in order to maintain medical care for the region as a whole.

Even if there is a hospital nearby, if there are not enough doctors to provide adequate emergency care or surgery, residents cannot be protected.

On the other hand, even if it is a little further away, if services are consolidated at a hub equipped with the necessary professionals and facilities, it may be possible to maintain the quality and safety of medical care.

From here on out,
between convenience for residents and the sustainability of the medical care delivery system,
a major conflict will likely continue.

And I believe that it is the local nursing care facilities that will bear the brunt of that conflict at the most immediate level.

Even when reading the materials, the impact on us is hard to see

When reading such government materials,
many nursing care facilities might perceive it only as "talk about hospital reorganization."

Regional Medical Care Vision.
Medical institution functions.
Acute care hub functions.
Required number of hospital beds.
Measures for uneven distribution of physicians.

Looking only at the words, it seems a bit distant from the daily operations of nursing care facilities.

But in reality,
the direction of such systems will gradually affect the front lines in a few years.

Hospitals will become further away.
Hospitalization periods will become shorter.
A safety net after discharge will be needed.
Family support will become more complex.
The observation and judgment skills of nursing care staff will be tested.
Collaboration with medical professionals will become a management strength.

Whether or not one can read these changes early will greatly change how nursing care facilities prepare for the future.

Specifically,
・Patients will be transported to hub hospitals in the zone for acute illnesses.
・After treatment, they will be discharged early and may be referred not only to convalescent hospitals but also back to facilities or home.
・In the first place, because they are hospitalized in distant hospitals, families may not be able to visit enough, making discussions to decide on life plans after discharge more complex.
・At the same time, facilities will be required to share information with distant hospitals, coordinate discharge, explain things to families, and prepare for acceptance with a sense of speed.

From now on, the reality that hospitals will be physically further away is unavoidable.
In such a situation, what is increasingly required of nursing care facilities is
to not miss small daily changes,
and to acquire the ability to connect patients to nearby medical care before their conditions become severe.

In short, more precise daily health management is needed,
and operations that stay one step ahead of medical needs are required.

Regional nursing care providers will become 'hubs that fill the gaps in convenience'

In reality, in regional areas,
the more acute care medical services are consolidated, the heavier the role of nursing care providers becomes.

This is because as hospitals become more distant, the support systems closest to residents will be the nursing care facilities, home-visit care, home-visit nursing, home medical care, and community comprehensive support centers remaining in the region.

Of course, this does not mean that nursing care providers will replace medical institutions.

However, in areas where access to medical care is difficult,
the nursing care setting will be the place where changes are first noticed.

'Breathing is a bit labored today'
'Appetite has decreased'
'Walking style has changed'
'Facial expression looks vacant'
'Sleeping more than usual'
'Family caregiving capacity is declining'

Whether or not these small changes can be detected is the gateway to preventing serious conditions. Furthermore, the role of supporting life after hospital discharge will also grow.

After lives are saved in acute care hospitals, people return to their daily lives.
However, returning to daily life does not simply mean being discharged from the hospital.

Continuing medication.
Managing meals.
Preventing falls.
Accepting family anxiety.
Supporting the individual's motivation.
Preventing readmission.
Connecting necessary medical and nursing care.

This rebuilding of daily life is the major role that nursing care providers must undertake.

That is why I believe that, especially for regional nursing care providers,
rather than being mere service providers,
they will become hubs that fill the gaps in regional life-based medical caregoing forward.

Yes, the more medical functions are consolidated,
the higher the value of nursing care close to daily life becomes.

Before going to a distant hospital, how much support can be provided locally?
Can changes be detected before transport becomes necessary?
After discharge, can a system be created to live without relying solely on distant hospitals?
How can the anxiety of distances that families cannot travel be compensated for through regional cooperation?

These are not issues that a single nursing care provider can solve on their own,
but rather important themes for discussion among medical and nursing care providers in that region.

Small and medium-sized nursing care corporations will face difficulties unless they clarify their 'regional role'

For nursing care corporations that have managed to operate reasonably well until now,
there is an urgent need to clarify 'who is responsible for what' within the region.

From now on, rather than facilities that do everything at an average level,
providers with clear strengths will be more likely to be chosen,
such as what they are good at,
what kind of elderly people they support,
and what role they play in the region.

Do they accept elderly people with high medical dependency?
Are they strong in dementia care?
Are they strong in end-of-life care?
Are they strong in rebuilding life immediately after hospital discharge?
Will they become a hub for supporting elderly people living alone in the region?
Is it a strengthening of collaboration with multiple professions including rehabilitation, nutrition, oral care, and medication management?

Being able to articulate this will become a management strength.

Human resource development will no longer be sufficient with just "nursing care skills"

This trend also significantly impacts human resource development.

In the document,
sustainable working styles and securing human resources for medical professionals are also important points of discussion.

Nursing care facilities, which face the reality of a limited number of nursing staff, are no different.

Beyond just training nurses,
future nursing care staff will need not only the ability to perform tasks,
but also higher levels of observational, judgment, and communication skills.

The ability to notice changes in condition.
The ability to record information to convey to medical professionals.
The ability to explain things to families.
The ability to communicate with various professionals.
The ability to understand the individual's wishes for their life.
The ability to support ethical decisions regarding emergency transport and end-of-life care.

These will become more important than ever before.

In other words, nursing care staff training needs to shift from "knowledge, skills, and procedure training"
to judgment, communication, and observation training.

And this is precisely the core of management training.

Simply telling on-site staff to "please notice" or "please coordinate"
will not change the organization.

What should be observed?
How should it be recorded?
To whom and at what timing should it be conveyed?
How should it be explained to families?
How should decisions regarding end-of-life care and emergency transport be supported by the organization?

These need to be organized within the organizational structure.

What managers should think about now

If you read this document from the perspective of nursing care management,
I believe the following question is the most important.

What role will your facility play in the community in 2040?

Will it be a safety net after emergency care for the elderly?
Will it be a place of peace of mind for those whose home life is reaching its limit?
Will it be a place for rebuilding life for those returning to the community from the hospital?
Will it be a place to support those with both dementia and physical illnesses?
Will it be a social infrastructure to support those with distant families, those living alone, or those without relatives?

I do not think future nursing care management can be discussed while avoiding this question.

Have you already decided what kind of presence your organization should be in the community?

The first question
"What role will your facility play in community-based integrated care?"

Today's discussion was about
redefining the significance of facilities in connection with the Regional Medical Care Vision.

Is your facility's
management meeting ending with topics like occupancy rates and methodology?

As a manager,
have you declared, 'In this region, we will bridge the gap between medical care and daily life in this way'?

The direction written in institutional documents will certainly manifest in the profile of users a few years from now, the problems faced by families, the skills required of staff, and the nature of regional collaboration.

That is precisely why nursing care managers
need to read them while imagining what will happen in their own regions.

To me, this document looks not like a 'Regional Medical Care Vision,' but a 'Regional Nursing Care Vision.'

What do you, as managers, think?