訪問介護が崩壊の危機

　ホームヘルパーは低賃金で、人手不足が恒常化している。そこに24年度介護報酬改定で、訪問介護はマイナス改定されたため介護事業所の倒産・廃業が相次ぎ、存続の危機に瀕している。

　　訪問介護はホームヘルプサービスで、介護保険制度を作る時に介護は「施設から在宅へ」の理念の下に在宅福祉サービスの３本柱「ホームヘルプ、デイサービス、ショートステイ」に位置付けられた。　

改悪続く訪問介護　

　　しかし、訪問介護の介護報酬は改悪され続けた。とりわけ24年度改定では、介護報酬全体で１・59％のプラス改定だったが、訪問介護はマイナス２％強。主因は、サービス付き高齢者向け住宅（略称＝サ高住）が増えたことにある。　

　　そこでは同じ建物の中に訪問介護事業所を設置し、入居者へのサービスを提供している。移動距離は建物の中なので訪問効率が良く、営業利益は高い。　

　　これと、地域でサービスを提供する訪問介護事業所の営業実績を合算して収益計算したため、収益性が高いとされマイナス改定が行われた。分けて積算すべきなのに作為的だ。　

倒産・廃業が増え　

　　東京商工リサーチが４月16日公表した調査結果では、訪問介護事業者の24年度の倒産は、86社（前年度比21・１％増）。また、24年の休業・廃業は４４８件（介護事業者全体６１２件の７割以上）だ。　

　　地域で奮闘してきた小規模の訪問介護事業所には、マイナス改定が大打撃になっている。そのため、訪問介護の利用者は１００万人以上だが、ヘルパー不足でサービス利用できない人が増え、「保険あって介護なし」が現出している。　

　　Ｎ Ｈ Ｋ は４ 月10日、24年に「訪問介護事業所なしの町村は１０９」、さらに「事業所が１つしかない町村は２６８」で、合わせると３７７町村で、全市区町村の５分の１以上になると報じた。　

　　移動時間が長く、報酬では全くカバーできない中山間・人口減少地域では、公務員ヘルパーを配置するほかない実態が生じている。　

自治体支援も必須　

ヘルパーはもともと介護報酬が低く、低賃金状態に置かれてきた。３年おきの介護報酬改定にこだわらず、国庫負担を増やして介護報酬を抜本的に改善することが喫緊(きっきん)の課題だ。　

　　また、自治体によっては、ヘルパーが移動に使う車のガソリン代の補助などの独自の事業所への支援などを始めているが、自治体の支援は不可欠である。


英訳版↓

No. 1403 Personal Care Assistant System is Collapsing

Salary that personal care assistants receive is low, thus, constantly, lack of workforce is widespread. In addition, the salary payment has downed further after the fiscal 2024 revision. Consequently, managing offices for visiting care services have gone bankruptcy or been closed one after another on the brink of existence.

NATIONAL GOVERNMENT’S FINACIAL SUPPORT NEEDED FOR PERSONAL CARE ASSISTANT SYSTEM

The visiting care service system was introduced when the elderly care insurance system was set up: it covers various services to support the elderly at their homes, relying on the official policy that the elderly’s care should be shifted ‘from facilities to private homes’. The system consists of three main pillars, which are caregiving, day-caring and a short-time stay in the facility.

Visiting care assistants have not been rightly appreciated

However, the salary system has been aggravated to personal care assistants. In the 2024 revision, in particular, a positive amendment was made in the payment by 1.59% on the entire care service industry, but the salaries for visiting caregivers have been reduced by 2% strong. The reason lies in an increase of the number of houses for the elderly which provide residents with care services.

In such a house a care managing company is located, which organizes services to the residents. They live in the same building, and so, business efficiency is higher since transfer time is not necessary.

The government office has concluded that profitability is proven good enough to make a minus amendment, after calculating profits of the above-said business performance to be added to those of the local care management business entities. Calculations must be made separately, but they were contrived.

More bankruptcies and closures

According to a survey announced by the Tokyo Shoko Research Ltd. (TSR) on April 16, the number of bankruptcies of visiting service management companies counts 86 during the fiscal 2024 (an increase by 21.4% compared with that of the previous year), and the number of suspension and closure counts 448 (over 70% of the 612 cases of the entire care management companies).

The official minus revision has severely hit smaller care service companies which have worked strenuously in local communities. And therefore, recipients of visiting care services count over one million people, but some faces a harsh fact that ‘insurance payments are made but no services.’ That occurs due to lack of personal care assistants.

According to a TV report cast by NHK on April 10, in the fiscal 2024 there were 109 towns and villages across the nation where no company works to send personal care assistants and there were 268 towns and villages where only one company exists to do the said business. Its total becomes 377, which represents over one-fifth of all the cities, towns and villages nationwide.

In the rural areas and population-decreasing countrysides, in which it takes longer to travel from one place to another, visiting caregivers cannot meet the costs at all with their paid salaries. Municipal governments send public workers to provide care services in such regions. This is the fact.

Municipal supports are also essential

Personal care assistants have been and are employed with lower wages. It is indispensable for the central government to allocate more fund to boldly improve salaries of caregivers, disregarding the rule of usual revision of salaries every three years.

At the same time, local government, too, should support elderly care service companies in the communities, for example, covering a cost of gas for travel.



May 21, 2025