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Ｑ療養通所介護の対象者は「難病等を有する重度要介護者」とあるが、「難病等」の「等」にはどのような疾患が含まれますか。

Ａ療養通所介護とは、重度要介護者の中で医療ニーズも相当程度抱えており、一般の通所介護ではサービス提供を行うことがなかなか難しいと考えられる者を対象とすることを考えています。このような介護ニーズ、医療ニーズともに相当程度抱えている利用者を対象としていることから医療との連携も含め、サービスの質の確保は特に重要であると考えています。このため、療養通所介護の指定基準においては、利用者の病状の急変等に迅速に対応するため、緊急時対応医療機関の設置を求めることや、地域の医療関係団体や保健、医療又は福祉の専門家等から構成される「安全・サービス提供管理委員会」の設置を求め、当該事業所より適切にサービス提供が行われているかどうか、またサービスの内容が適切であるかどうか定期的に検討し、サービスの質の確保に常に努めることとしているところです。
　療養通所介護の提供に当たってはこうした指定基準の趣旨の徹底が図られ、地域の医師をはじめとする医療関係者と、他のサービス事業者との一般的な連携（協力医療機関等）以上の緊密な連携が確保されていることも含め、サービスの提供に当たっての安全性や適切な運営が十分に担保されることが重要であると考えています。このため、対象者については、指定基準の趣旨の徹底が図られるまでの間は、重度要介護者であって、難病又はがん末期の状態にある者に限定する取扱いと考えています。ただし、従前から療養通所介護と同様のサービスを提供しており、地域における医師をはじめとする医療関係者と、他のサービス事業者との一般的な連携以上の緊密な関係が既に認められる事業所（具体的には、現に試行的事業において療養通所介護と同様の事業を実施している事業所であって、療養通所介護の提供に当たっての都道府県知事の指定を受けた事業所）においては、既にサービスを受けている利用者の方々が継続して当該サービスを利用することができるようにする観点からも、平成18年度から例外的に難病やがん末期に併せ、サービス担当者会議等において、主治医が療養通所介護の利用が不可欠であると判断する者についても対象とする取扱いとします。

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