A Must-Read for Care Managers: The Trap of Housing Renovation Resets - Details on the 3-Level Rule, Moving, and Application Nuances You Need to Know

Continuing from the previous discussion.

The previous discussion was about how housing renovations, specifically the 'Reason for Housing Renovation' form, are a headache for care managers, how construction companies often have a shallow understanding of them, and how that gap often leads to trouble for users.


However, the seeds of that trouble actually lie in the design of the long-term care insurance system itself, and sometimes care managers, as professionals, end up sowing them.
It is the issue of resetting the benefit limit for housing renovation expenses.

The provision of housing renovation expenses under long-term care insurance is set at a limit of 200,000 yen per insured person.However, it cannot be used unconditionally.
First, you must have some level of long-term care certification, from Support Level 1 to Care Level 5, to be able to use long-term care insurance itself. These are the activation requirements.

A feature of this system is thatas long as it is within that limit, you can use it in multiple installments.Therefore, there is no need to rush, fearing it would be a waste not to use the full budget.
This allows for the judgment of using only what is necessary, as much as is necessary.

There is an underlying reason for this: under long-term care insurance, benefits can only be received for 'difficult situations you are currently facing'.
You cannot use long-term care insurance for reasons like 'I'm fine for now, but let's install a handrail here in anticipation of the future.' This might be the difference between this and so-called long-term care remodeling. Officially, benefits cannot be provided in anticipation of a user's physical decline.

However, since it is acceptable if the reason is something like 'the user has become unsteady on their feet and the risk of falling has increased, so a handrail is necessary,' I believe the reason form can be written if the user has muscle weakness due to aging. Please understand that you need to properly identify the fact that they are unsteady on their feet.

That was a long introduction.

The housing renovation system works like a savings account that you can draw from as needed, but the necessary renovation content changes depending on the person's physical condition and other factors.

It can happen that a handrail installed for someone who was walking with support when they were certified as Support Level 1 becomes a problem due to floor level differences when they require a walker, and the previously installed handrail actually gets in the way of operating it.

However, it is also possible that because the housing renovation expenses were used up when the care level was light, the long-term care insurance cannot cover new renovations even though they are needed.

For such times, housing renovations under long-term care insurance havea mechanism to reset previous benefit history, the so-called 3-level reset.It is a mechanism that assumes previous renovations are no longer very useful, so let's recharge the limit.

Many care managers are aware of this and seem to understand that once the care level increases by three levels, you can use up to 200,000 yen again.

There was a trap there.

So, when a care manager tells a user that their history will be reset and it's great that they can renovate the necessary areas again, and they work out a new housing renovation plan,

I encounter cases once every few years where it turns out it wasn't actually reset, and they decide to cancel because it would be entirely out-of-pocket.

Can you read the reason for that, which I posted in the top image?

The levels of the "degree of need for long-term care"?!

It doesn't say anywhere that it resets when your care level goes up by three. It just says,
when the level of the "degree of need for long-term care" has increased by three or more levels—a rare example of terrible Japanese phrasing. This is a sentence that makes you lose track of what you thought you understood just by reading it, so I don't blame care managers for getting it wrong.

The point is simple: when calculating a reset, Care Level 1 and Support Level 2 are counted as the same level. That's all.

The reason this is so complicated is that in the first revision of the Long-Term Care Insurance Act in 2005, Care Level 1 was subdivided, and a new category called Support Level 2 was created for cases where independence support was more appropriate. The official stance is that this category was just a way to sort people based on whether prevention (independence support) or care was more appropriate, and the idea is that there is no hierarchy between them.

Also, it's likely this way because they had to reconcile it with previous legal operations.

So, for care managers who have been working for a long time, this category was inserted halfway through what they had been taught as a simple 3-level reset based on care level.
They probably cover this in update training, but since the Long-Term Care Insurance law changes drastically every five years, I think it's understandable that it's hard to keep up.

Also, while this hasn't changed from before, it is strictly decided thatthe care level referred to during a reset is the care level at the time of the initial housing renovation.If you use it multiple times over a long period, you might fall into this trap.

For example, for a user who used 50,000 yen worth while at Support Level 2, and then used 100,000 yen after becoming Support Level 1, the initial level was Degree 2, so the reset occurs at Degree 5, which is Care Level 4.

In practice, it might be faster to remember the requirements for a 3-level reset as follows:

Care Level 3 if starting from Support Level 1
Care Level 4 if starting from Support Level 2 or Care Level 1

Since these two cases account for almost everything.

Also, there was one more reset technique.

Moving reset. It's a mechanism where they wipe the slate clean if you move.

However, there is a pitfall here too. When returning to a previous address from temporary housing due to rebuilding.

For example, if your resident registration address moved to another location for one year, and then you returned to the same address as before after the rebuilding was finished.

In this case,the first move results in a reset, but the second move back does not.
Or rather, the previous history is restored. (I believe) there was no consolidation with the first move history.

Actually, the Long-Term Care Insurance division tracks housing renovation history linked to the address.
According to someone inside the office, since you voluntarily discarded what you could have used until now by rebuilding, there is no reason to provide benefits again (loose translation). That makes sense.

In our experience, we have had cases where we were contacted by someone who had carefully kept the handrails installed in their previous home, and we visited their new home to reinstall them. Although it ended up being entirely out-of-pocket, they didn't have to pay for the materials.

So, I have outlined the pitfalls and key points that care managers should be aware of regarding home modification resets.
I hope this proves helpful.