日本在宅醫療中居家護理的角色

Role of Visiting Nursing Care in Japanese Home Healthcare

台灣將在2026年邁入超高齡社會，人口結構急速高齡化，是台灣未來難以避免的課題。2016年日本高齡化率已經達到27.3%，推估2060年台灣將和日本同樣，趨近總人口的40%。2025年開始，日本戰後嬰兒潮世代邁入75歲大關之後，將衍生出長期照顧及臨終安排的問題。自1976年以降，日本人在家死亡逐漸被在醫院死亡取代，經過這幾年在宅醫療的努力推動，2016年，「在家死亡」的比率已達12.7%。然而，日本將在2040年迎接死亡海嘯，到達「多死社會」高峰，屆時每年有167萬人死亡，因此，2012年日本政府確立推動「社區整體照顧系統」，在宅醫療中居家護理是不可或缺的角色。本文整理日本過去居家護理發展經驗，作為借鏡。目前居家護理的給付財源是來自醫療保險與介護保險的混合。2016年，日本有8,613間居家護理所，搭配1萬4千家在宅療養支援診所，照顧57萬在家療養患者。未來台灣的居家護理，如何建構我國在宅醫療的基盤，將扮演重要的角色。

Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare ‘tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future