Legal Basis
Visiting Care for persons with severe disabilities is one of the disability welfare services stipulated in the Act on Services and Supports for Persons with Disabilities (official name: Act on Providing Comprehensive Support for the Daily Life and Life in Society of Persons with Disabilities). In paragraph 3 of Article 5 of the same Act, “Visiting Care for persons with severe disabilities” means “caregiving services for persons with severe physical disabilities or other disabilities prescribed in Ordinance of the Ministry of Health, Labour and Welfare as those who require constant care,” This includes, but is not limited to assistance bathing, assistance eliminating, or assistance eating meals at their residences or other places equivalent thereto prescribed in Ordinance of the Ministry of Health, Labour and Welfare. Furthermore, assistance may also be required whilst in transit running errands, for those who have severe physical disabilities or other disabilities and who require care at all times. The definition of “Visiting Care for persons with severe disabilities” is to comprehensively provide care at home or at a place specified by an Ordinance of the Ministry of Health, Labour and Welfare as an equivalent place for those in need of such care. It is a different service from “home-visit care,” which is an in-home service based on the Long-Term Care Insurance Act.
Targets of visiting care for persons with severe disabilities
The target of Visiting Care for persons with severe disabilities is defined in Article 1-4 of the Ordinance of the Ministry of Health, Labour and Welfare (Ordinance for Enforcement of the Act for Comprehensive Support for Daily Life and Social Life of Persons with Disabilities) as persons with severe physical disabilities or persons with disabilities who have significant behavioral difficulties due to severe intellectual or mental disabilities and who require constant nursing care.
The target of severe home-visit care is defined in Article 1-4 of the Ordinance of the Ministry of Health, Labour and Welfare (Ordinance for Enforcement of the Act on Services and Supports for Persons with Disabilities) as persons with severe physical disabilities or persons with disabilities who have significant behavioral difficulties due to severe intellectual or mental disabilities and who require constant nursing care.
The following criteria should be met.
Persons whose disability support category is Category 4 or above (In the case of Category 6, if they are hospitalized or admitted to a hospital, etc., and have been using visiting care services before hospitalization or admission) and who fall under both of the following categories
1 A person who falls under both of the following
(1) Those who have paralysis in two or more limbs.
(2) Those who are not defined as “no need of support” for “walking,” “transferring,” “urinating,” and “defecating” out of the items of the certification survey for the disability support classification.
2 Those whose total score of behavior-related items (12 items) among the certified survey items of the disability support category is 10 points or more.
[General service contents of visiting care for persons with severe disabilities]
In general, this service visits the homes of persons with severe disabilities who require constant personal care, or those in hospital, and provides personal care not only for excretion and eating, but also for all personal needs. Furthermore, it is common to have instances where caregiving services are needed all day.
[Problems with visiting care for persons with severe disabilities]
〇The use of Visiting Care for persons with severe disabilities services for working purposes is not permitted by law.
On July 21, 2017, the Disability Welfare Division, Disability Health and Welfare Department, Social Support Bureau, Ministry of Health, Labor, and Welfare issued a response stating that “support related to economic activities is not allowed. In the case a person with severe disabilities needs a caregiver to commute to work, the company is supposed to bear the burden, however, the company cannot take on that much of the burden. This creates a contradiction as often times companies find themselves in a standstill when it comes to employing and providing assistance for people with severe disabilities.
“This is an undue hardship problem”
[The use of visiting care for children with severe disabilities is not permitted]
The target of visiting care for persons with severe disabilities defined as “persons with disabilities” in Article 5-3 of the Act on Comprehensive Support for Persons with Disabilities, and the definition of “persons with disabilities” is defined in Article 4 of the same law as “those who are 18 years old or older” (with disabilities), which means that disabled children under 18 years old cannot use visiting care.
In fact, families with severely disabled children do not have a system like the visiting care for persons with severe disabilities care system that allows them to have a helper assist them for an extended time, thus they are forced to combine short-time systems such as in-home care, visiting nursing care, and transportation support, which is a very heavy burden (expensive) for the guardians and their families.
[Overall picture of welfare services for persons with disabilities]
The following are the disability welfare services stipulated in the Comprehensive Support for Persons with Disabilities Act. The services are roughly divided into two categories: caregiving benefits and benefits for training.
＜Caregiving benefits: Services to provide caregiving>
In-home care
Services to provide care for bathing, elimination, meals, etc. at home.
<Visiting care for persons with severe disabilities>
Comprehensive services for persons with severe physical disabilities or other disabilities who require constant care, such as care when bathing, eliminating, or consuming meals at home or in hospitals, etc., and care during transportation when they go out.
[User’s cost when using welfare services for persons with disabilities]
In principle, users of welfare services for persons with disabilities under the Law for Comprehensive Support for Persons with Disabilities are required to pay “10%” of the total cost of the service, and the rest is covered by taxes. In addition, a maximum monthly user fee is set according to the previous year’s income for each household, and no more than this amount is to be paid by the user. Households receiving public assistance and households exempt from residential taxation do not have to pay user fees.
<Monthly maximum amount of user fees for persons with disabilities
Households receiving public assistance: 0 yen
Households exempt from municipal inhabitant tax: 0 yen
Households subject to municipal inhabitant tax
（Households subject to municipal inhabitant tax (less than 160,000 yen per income: annual household income of approximately 3 million yen to 6 million yen in the previous year) ・・・ 9,300 yen
Households other than the above (annual household income of over 6 million yen): 37,200 yen
The scope of what is considered a household includes the individual who uses the service and his/her spouse. In the case of a disabled person aged 18 or older, the cost is determined by referencing the previous year’s income of the individual and his/her spouse. The parent’s income is not included in individual’s previous year’s income.
In the case of a person with disabilities under 18 years of age, the household in the Basic Resident Register to which the parent or guardian belongs is covered.
However, living expenses such as food, utilities, and transportation costs incurred at service offices and group homes are to be covered personally.
[How to use welfare services as a person with disabilities]
To use the services stipulated in the Comprehensive Support for Persons with Disabilities Act, it is required to apply for and receive a grant decision by the following procedures listed below.
(1) Apply to the municipality of residence
Apply for the grant at the disability health welfare office of the municipality in which you live.
In addition, a physician’s written opinion is required for the application for care benefits, however, there may be instances when the municipality may request the physician to provide a certified written opinion.
(2) Certification survey for disability support classification
Upon receiving an application, the municipality conducts an 80-item certification survey, including an interview, to determine the necessity of services, and certifies the disability support category.
There are a total of seven disability support categories, ranging from “not applicable” to “categories 1-6,”. The higher the category number, the higher the level of support is required to maintain daily life.
(3) Inquiry of intention to use, preparation and submission of service utilization plan
If the municipality requires submission of a “draft service utilization plan,” said plan must be submitted. A draft service utilization plan can be prepared by requesting a consultant at a “designated specialized consultation support office” designated by the municipality, or a “self-plan” can be prepared by the person themself, family members, or supporters.
*First and foremost, in the case of requesting a draft service utilization plan at a designated specialized consultation support office, an application must be processed at the municipal office for disability health and welfare. Next, during the application process, one must select which company they wish to receive support from and proceed to make a contract with said company. Lastly, in order to write up the draft service utilization plan, an interviewer from the designated specialized consultation support office will proceed with an interview with the desired company. (Creation of a utilization plan is free).
(4) Grant decision
Generally, it takes one to two months from the date of application to receive a decision. If the grant is approved, the applicant is sent a grant decision notice and a beneficiary certificate.
(5) Preparation and submission of service utilization plan
The service utilization plan is prepared and submitted to the municipality. Unlike the draft service utilization plan, the service utilization plan is filed with the municipality, stating the specific name of the business that will use the service.
6) Commencement of service
The user presents their beneficiary certificate at the place of business indicated in the service utilization plan, sign a contract, and begin to use the service.
