ケアサポート９／ケアマネージャー（介護支援専門員）試験／ＴＯＰへ

　市区町村は３年ごとに介護サービスの利用量を予測し、新たに増やす施設（５種類）の定員数を決定。社会福祉法人などが都道府県や市区町村の認可を得て建設する。

　４月に都道府県を通じて計画と実際の整備状況を調査。特養は０６～０８年度に５万４千人分定員を増やす計画だったが、実際に増えたのは７２％の約３万９千人分。東京や千葉、大阪は５０％を切った。大幅に不足しているため、入居できずに自宅などで待機している人は、未集計の鹿児島と岡山（岡山市のみ回答）を除いて全国で約３６万人いる。

　介護老人保健施設は約２万８千人分の計画に対して６８％の整備率で、有料老人ホームなどは約３万人に対して４４％だった。介護保険を使わない人も利用できるホームなどは集計対象から除いた。認知症の人向けグループホームは約２万９千人に対して９５％の整備率だった。

　施設整備が進まない背景には、建設時の補助金削減や運営費に充てる介護報酬の引き下げが響いている。特養の全国協議会事務局長を務める福間勉さんは「建設費などコストが高いうえに、以前ほど行政の補助金が出ない。介護保険の報酬や利用者から徴収する費用だけでは採算ベースに乗りにくく、手を挙げる業者自体が少ない」と話す。

　従来は特養をつくる際は国が建設費の２分の１、都道府県が４分の１の補助金を出していたが、三位一体改革で国の補助金は０４年度で廃止。税源が地方自治体に移されたが、財政が厳しい都道府県は介護施設に対する補助金を抑制しがちだ。滋賀は０６年度、特養の整備費補助を１床あたり約４０万円減額した。

　介護事業所の収入の柱の介護報酬は０３、０６年度と２回続けて引き下げられてきた。

　また、介護ケアと医療の両方が必要な高齢者が長期入院する療養病床（介護型）は、計約１万１千人分増やす計画だったが、０６年に国が医療費削減のため介護型を全廃する方針を打ち出したことで、逆に２万４千人分減った。

　整備率を都道府県別で見ると、７道県がマイナスだ。計画していた定員数が２００人程度と少なかった愛媛は、療養病床が７００近く減ったためマイナス３００％を超えた。

　介護保険サービスを利用する高齢者にとって、保険料を徴収されているにもかかわらず、必要なサービスを受けられない状況だ。

　厚生労働省は、介護保険施設の整備は自治体側の責任だとしたうえで、「介護報酬の引き下げや介護の人材不足などで、施設建設に手を挙げる事業者が減り、整備がうまく進まなかった」としており、０９年度補正予算で３千億円を投入し、３年間で１６万人分の施設建設を目指す。（根本理香、及川綾子、太田啓之）  朝日新聞

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