Top > ご連絡など > ケアマネジャーの介護保険NEWS > 【介護支援専門員 NEWS】24時間巡回型、公募式は民間参入制限だ
【介護支援専門員 NEWS】24時間巡回型、公募式は民間参入制限だ
狩野氏は、特別養護老人ホームの整備について「整備費は追い風となっているが介護報酬が止まったまま。小規模施設でも安定した経営ができるよう定員別に介護報酬を設定するよう国に要望している」と述べた。また「東京23区で1番土地を持っているのは国。国有地の活用を訴えたところ"時価で"と言われた。坪100万円の土地を事業者が借りて経営が成り立つと思うのか。国はせめて東京都のように時価の半額程度で貸し出してほしい」と国有地の貸付料の減額を求めた。
法改正案の地域包括ケアにうたわれた「24時間巡回型訪問サービス」については、介護報酬を出来高でやるのか包括報酬でやるのか、その併用とするのか3つの選択肢があるとした。狩野氏は「包括化すると一定の費用負担でサービスがたくさん利用でき利用者にとって良いように見えるが、サービスの利用頻度が低い利用者にとっては費用負担を高く感じるだろう。また、支給限度額との関係上、出来高にするのか併用かという問題もあり、小規模多機能型居宅介護が東京都で普及しない理由の一つに他の訪問介護が利用できなかったように、他のサービスが利用できなくなる可能性が極めて高い」と懸念した。
さらに24時間巡回型訪問サービスは、市区町の公募方式がうたわれていることをあげ、「公募するということは他の事業者はやってはいけないと、参入制限すること。田舎の場合は公募しなくてもやる事業者が決まるが、東京都のように民間事業者がたくさん参入しているところで本当に公募方式が成り立つのか、事業者からかなりクレームがつくのではないか」と語った。
また生活支援の多様な類型をスライドで示しながら、「地域包括ケアのメニューはいろいろあって、ジグゾーパズルのパーツが個々にあっても絵柄が1つに完成しないイメージ」と例えた。
東京都として「医療、介護、住まい、生きがい、生活支援の5分野で、どのピースが欠けているのかきちんと調査し、2012年から始まる第5期介護保険事業計画で反映させたい」と述べた狩野氏は、次期制度改正について「訪問介護、訪問看護をはじめ現場に影響ある改正の行方を皆さんも注視してほしい」と呼びかけた。
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