5 Ways to Deal with the Problem of Seniors 'Acting Energetic' in Front of Care Certification Investigators
The day of the long-term care certification investigation. In front of the investigator who arrived at my parents' home, my mother straightened her back and answered questions firmly. 'What is your name?' 'It's [Name].' 'What is today's date?' 'April... um, the 20th.' Even during the walking test, she managed to walk on her own, despite stumbling.
A month later, the notice that arrived said 'Support Level 2'. Even though she usually wanders around three times a night and requires almost full assistance with meals and using the toilet. The reality of not being able to receive the necessary services was waiting for our family.
There is no end to the cases where people are dissatisfied with the results of the long-term care certification and undergo a re-investigation through a classification change application. One of the causes is the problem of 'the individual acting more energetic than usual in front of the investigator'.
A difference of one level in long-term care needs can change your monthly costs by tens of thousands of yen.
Long-term care certification based on the Long-Term Care Insurance Act (Act No. 123 of 1997) is divided into 7 levels (Support Levels 1-2, Care Levels 1-5), and the standard limit for service usage is determined for each level.
A difference of one level results in a difference of tens of thousands of yen per month. The specific standard limits for service usage are as follows.
Support Level 1: Approx. 50,000 yen
Support Level 2: Approx. 105,000 yen
Care Level 1: Approx. 167,000 yen
Care Level 2: Approx. 197,000 yen
Care Level 3: Approx. 270,000 yen
Care Level 4: Approx. 309,000 yen
Care Level 5: Approx. 362,000 yen
The difference between Support Level 2 and Care Level 1 alone is about 60,000 yen per month. Annually, that is a difference of 720,000 yen. Since any amount exceeding this limit is paid entirely out of pocket, the impact on the household budget is significant if the assessment is off by even one level.
5 points to avoid failure in the certification investigation
It is a common psychology for both people with dementia and the elderly to answer 'I'm fine' or 'I can do it.' 'I don't want to be a burden to my family,' 'I am still capable.' These thoughts lead to a certification that is lighter than the actual situation. You can prevent this with the following measures.
1. Family members must be present
If the individual is alone, they often answer 'I can do it' even for things they cannot usually do. By having a family member provide supplementary explanations on the side, the actual daily situation is conveyed to the investigator. Based on Article 35 of the Ordinance for Enforcement of the Long-Term Care Insurance Act, the certification investigation is conducted to accurately grasp the individual's condition. Supplementary input from family members is a legitimate action.
2. Summarize problems in a memo beforehand
Saying 'It's difficult' will not get through to the investigator. Please write it down specifically, using numbers and frequency.
"I wake up three times a night to assist with the toilet."
"Bathing requires full assistance, and they use day service three times a week."
"They fell twice last month, and one of those times required an emergency ambulance."
"They ask me the same thing more than 10 times a day."
It is even more effective to organize this information to correspond with the 74 items on the survey form.
3. Consult with your primary doctor in advance
The certification is determined by a review board based on the investigator's report and the primary doctor's opinion paper. If you inform your primary doctor about the daily situation, the content of the opinion paper will more closely reflect reality.
4. Avoid choosing a 'good day' for the investigation
If the investigation is conducted on a day when the person is feeling well, the assessment tends to be lighter than usual. Especially in cases of dementia, symptoms fluctuate significantly from day to day, so choosing the date of the investigation is an important factor.
5. Keep a record of daily care
Having a care diary for one to two weeks allows you to objectively convey the daily reality to the investigator. 'Tuesday, 2:00 AM, wandering,' 'Friday, three instances of incontinence.' The weight of these records is ten times that of words alone.
If you are not satisfied with the results, you can apply for a change in care level
Based on Article 29 of the Long-Term Care Insurance Act, if you are dissatisfied with the certification results, you can undergo a new certification investigation by applying for a change in care level. You can apply at any time, and your care manager can handle the application on your behalf.
Since a different investigator will be assigned, it is not uncommon for the results to differ from the previous ones. In fact, it is common for someone who was initially certified as Support Level 2 to be reclassified as Care Level 1 after applying for a change in care level. Please present the information you were unable to convey last time, along with notes and records of daily life.
Additionally, separate from the application for a change in care level, you can also file a request for review (appeal) with the prefectural Long-Term Care Insurance Review Board. This must be done within three months from the day after you receive notification of the certification results.
The reality of care costs and systems for reducing the burden
The average total cost of care is approximately 5.42 million yen (2024 survey by the Japan Institute of Life Insurance).
Initial costs (home modifications, care beds, etc.): Average 470,000 yen
Monthly costs (at home): Average 53,000 yen
Monthly costs (facility): Average 138,000 yen
Average caregiving period: 4 years and 7 months
There are two systems you should know about to keep costs down.
High-Cost Long-Term Care Service Fees (Article 51 of the Long-Term Care Insurance Act) is a system where the portion of your monthly out-of-pocket expenses that exceeds the limit is refunded. For households with average income, the out-of-pocket limit is 44,400 yen per month.You will not be refunded unless you apply, so please check with your care manager.
Specific In-Facility Long-Term Care Service Fees (Article 61-2 of the Long-Term Care Insurance Act) is a system that reduces food and housing costs for low-income individuals when they enter a facility. If you are in a household exempt from resident tax, you may be eligible.
For those about to undergo a certification investigation
Long-term care certification is the gateway to caregiving life. It is the first and most important step that significantly influences subsequent service content and costs.
There are five points: Have a family member present. Take specific notes. Consult with your primary doctor in advance. Make the investigation day a 'normal day.' Keep a caregiving diary. It doesn't take much effort to prepare these. However, the difference can amount to tens of thousands of yen per month, or hundreds of thousands of yen per year.
Caregiving is a long-term battle. Please use all available systems to establish a structure that is sustainable for both the caregiver and the person receiving care.
Please make use of our site, which automatically organizes the order and deadlines for caregiving procedures. By simply answering questions, it will list only the procedures you need.
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