Taiwan-Japan Occupational Therapy Joint Symposium

The Role of Occupational Therapists
in the Post-Acute Care Program
3 rd December 2022
Managing Director & General Manager of Policy Department
Japanese Association of Occupational Therapists

Yasutoshi SAKAI

Occupational Therapists in Japan

Occupational Therapy in Japan andhistory of JAOT
• １９６５• １９６６• １９６６• １９７２• ２００８• ２０１２• ２０１８The Physical Therapists and Occupational Therapists Act

The 1st National Exam for Occupational Therapists（20 people passed）
JAOT Establishment
Joined WFOTThe 1st Five Year Strategy for Occupational Therapy
Launch of MTDLP Promotion Project
Change in definition of Occupational Therapy• 5th President Haruki Nakmura 2009-PresentOccupational Therapists Qualified OTs 104,286
JAOT Members 64,230（61.6%）Today
No. of schools 204 schools
as of 31st March 2022
(No.)

(No.)

FFM
M
FM

N/A

Over

Members by Year qualification obtained
Members by Age groupOccupational Therapists
Disability
Today

Other

2%

Education
4%

4%

Area

No. of JAOT
members

Medical31,241

Nursing

8,533

Disability

1,609

Other726

Education

1,606

Nursing
19%
Medical71%

1st five year strategy 2008-2012
Promoting Community Integration〜OT５(GO!)・５ (GO!)Plan〜
2nd five year strategy 2013-2017
Promoting Community Integration and continuation of community living〜OT５(GO!)・５ (GO!)Plan〜
3rd five year strategy 2018-2022
Contributing to Comprehensive Community Care System〜OT５(GO!)・５ (GO!)Plan〜

OT５(GO!)・５ (GO!)Plan
It aimed to expand the areas of occupational therapy and tocreate a shift between fields of practice by reducing theratio of occupational therapists in hospital environments tohalf and increasing the number of occupational therapists inthe community, which includes health, welfare, andeducation.

MTDLP
People become healthy by participating in meaningful occupations

MTDLP：
Management Tool for Daily Life Performance• Management of daily life performance• A management tool which explains
therapist’s clinical reasoning focusing on
daily activities clients “want to do”

Self care

Socialactivities

Leisurehouseholdchore

Work

Symbol sign of Management of Daily Life Performance

Definition of Occupational Therapy〜Japanese Association of Occupational Therapists〜
Occupational Therapy is occupation-focused therapy, guidance andsupport provided in fields such as medical care, public health, welfare,education and employment, with the aim of promoting human health andwell-being. “Occupation” refers to daily activities that are purposeful andmeaningful to each person. (May 26, 2018)（Note）•

Occupational therapy is grounded on the fundamental principle and academic evidence that “people’s health and well-being can bepromoted throughoccupation.”•“Clients” are individuals or groups of people who have or aredevelopmental, or age-related disabilities or•

expected to have difficulties in their daily activities as a result of physical, mental,difficulty adjusting to their environment.

“Occupations” include daily activities such as activities of daily living, housework, work, hobbies, play, interpersonal interaction, and rest; and are founded on
physical and mental components for each activity.

•“Occupations” are activities that a person wants to, needs to, or is expected to do, and have purpose and meaning for each person.

•Occupation-focused practice involves using occupations as ends to restore, maintain, or prevent the decline of physical and mentaloccupations as means to practice and achieve occupational engagement, and modifying environment to support its achievement.

function, andChanges in Japanesedemographic structure andintroduction of Long-Term CareInsurance

The trend of population over 65 years oldKorea

Ratio of people over 65 Yeas oldJapan

FranceGermanySwedenUKUSA(Yr)

MHLW： https://www.mhlw.go.jp/stf/newpage_21481.html

The trend of population in Japan
Japanese population is facing a declining phase.
It is expected that the total population will go under 90million and aging rate will reach 38% by 2065.
population
140 milRatio of working age (15-64)
120 milRatio ofworking age

100 mil

Population over 65
Aging rate
15-64 population
Aging rate (ratio of over 65 yrs old)

Total fertility rate
Total fertility rate
Under 14 population

MHLW： https://www.mhlw.go.jp/stf/newpage_21481.html

Change in Demographic Pyramid (1990-2060)
Looking at changes in Japan's population growth, an elderly person is supported by 2.6 persons. It is assumed when thebirthrate declines and the population ages further, an elderly person will be supported only by 1.2 persons by 2060.

yrs old

total pop

2025

2010

1990
yrs old

yrs old

total pop

128million

123million

total pop

2060
yrs old

total pop

86million

120million

Baby boomer
generation(born 1947~49)

Baby boomer
junior generation(born 1971~74)(ten thousand)(ten thousand)Over 65 population
20~64 population

1 persons
5.1persons

1 persons
2.6persons(ten thousand)1 persons
1.8persons(ten thousand)1 persons1.2persons

厚労省： https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcisj_j.pdf

Baby Boom
1st Phase Baby Boom
• Born between 1947 - 1949
• They are called “baby boomer generation” in Japan
2nd Phase Baby Boom
• Born between 1971 - 1974
• They are called “baby boomer junior generation”

Basic principles of introduction ofLong-Term Care Insurance• With the aging of the population, the number of elderly people requiring
nursing care is increasing and the days of nursing care they receive is
now longer, resulting in ever-increasing nursing care needs.
• The situation surrounding families that have supported elderly people inneed of care is also changing, with the shift to nuclear families and theaging of family members who provided care to their elderly.
• Limitations of the current welfare and medical care system for the elderly.
• Long-term care insurance, a system in which society as a whole supports
the care of the elderly, was established and began to be in 2000.

Establishment of Comprehensive
Community Care Systems• Percentage of population over 75 years old is expected to continue to increase.
• After 2025 when the baby boom generation will be 75 years old or older, thedemand for medical and long-term care services will increase further.

• Promotion of the establishment of a community support and service provisionsystem (comprehensive community care system) by 2025 to enable the elderly
to continue to live their own lives to the end of their lives in their familiar
neighborhoods as long as possible, with the aim of preserving their dignity
and supporting independent living.
• Given the expected increase in the number of elderly people with dementia, it
is important to support elderly people with dementia living in the community.

• This system was started to address the elderly, but it is important to continuebuilding it with various disabilities and generations in mind

MedicalLong term careComprehensive community Care System
When you need a care

When you are sick/ill

Nursing
Care

MedicalOutpatient/inpatient・Acute hospital・Post-acute hospital・Rehabilitation centers

Daycare/admission

Daily health:・Primary contact doctor
・Affiliated hospitasl

Living••Comprehensive community care
support CenterCare Manager■Home-based services
・home care, home nursing, daycare
・Small-scale multifunctional inhome nursing care・Short-term inpatient care
・24hr visiting services
・Combined services■Preventive care services■facility living services
・Geriatric welfare
services facility・ Geriatric healthservices facility
・Dementia group
home
・Certified group home

・Own home
・Senior residence with services
We will provide consultationand coordinate support

To stay health and live long

Daily Living Support & Preventive Care

Self-help
Mutual aid

A comprehensive community care system isassumed to be a unit of daily living area
where necessary services are provided
within approximately 30 minutes.

Community supportSocial clubs, community association, volunteering, NPOs etc

厚労省： https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/chiiki-houkatsu/

Post- Acute Care andOccupational Therapy

Role of Rehabilitation
リハビリテーションの役割分担

中 医 協

総 － 1 - 1

２ ３ ． １ ２ ． ７ 改

Onset of stroke 症
etc
脳卒中等の発Living
生活期
維持期・

Recovery
回復期

身体Physicalfunction
機能

Diagnosis
診断・・治療treatment

安定化stabilization

Day
service

Hospitalization
入院Acute
急性期

Mainly主に医療保険
Medical Insurance

Aim
役割分担
Acute
急性期

老人保健施設、病院、診療所等

訪問Hospital,clinics, geriatric care services
病院、診療所、介護老人保健施設

visiting

Outpatient
外来

Geriatric welfare service facility, hospital,
clinics etc

通所

Visitingnursing station
訪問看護ステーション

主に介護保険
Mainly Long-TermCare Insurance

生活期
維持期・
LivingRecovery
回復期

Body Functions
心身機能Improvement
改善

Improvement
改善

Maintenance・Improvement
維持・改善

ADL

Improvement
向上

Improvement
向上

Maintenance・Improvement
維持・向上

Activities・Participation
活動・参加

Reconstruction
再建

Reconstruction
再建

Reconstruction・Maintenance・Improvement
再建・維持・向上

QOLThings to do
内容－－

Maintenance・Improvement
維持・向上

Preventing disuse
早期離床・早期syndrome by early
用リハによる廃mobilization and症
候群の予防
rehabilitation

集中的リハによる機能回復・ADL向上
Improving body functions and ADL skills
by intensive rehabilitation

リハ専門職のみならず、多職種によって構成されるチー
Maintenance and improvement of functioning, independent
living, and minimizing 生
careburden and facilitating QOL by
生活
ムアプローチによる活機能の維持・向上、自立
team approach consisted of multi-professions.の推進、介護負担の軽減、QOLの向上（資料出所）日本リハビリテーション病院・施設協会「高齢者リハビリテーション医療のグランドデザイン」（青海社）より厚生労働省老人保健課において作成

3

中央社会保険医療協議会 総会 （第２１１回） 23年12月 資料

Image of geriatric rehabilitation<Role making, social participation>
・Supporting to create environment and opportunities to find meanings and roles intheir own community・Supporting role making at home

Approach to participation

Functioning<Encouraging IADL improvement>
Encouragement and environmental
modifications to be able to clean,
wash clothes, cook and go out etc<Encouraging ADL improvement>
Encouragement and environmental
modifications to be able to eat, toilet,
change clothes, and take a bath etc

Approach to activities<Functional recovery training>
Training to be able to sit, stand, andwalk etc

Approach to body functions
timeframe

ExamplesSocialwithdrawal

Stroke, fracture etc(stroke model)

Acute and recovery phases rehabilitation

Frail seniors(disuse syndrome)

Living phase rehabilitation

平成28年版厚生労働白書－人口高齢化を乗り越える社会モデルを考えるBasic concept of assessment of inpatient care

Medical needs(diagnosis, care contents)

Providing acuteinpatient care

Providing intensive
rehabilitation andsupporting discharge
Providinginpatient care forpatients requiringlong-term careAmount of medical resources inputs(workers・medical services etc)

Medical ward

General ward
参照 2021.8.25 中央社会保険医療協議会 総会（第486回）
https://www.mhlw.go.jp/stf/shingi2/0000212500_00101.html

2019

2015
1.251 million beds

1.233 million beds

Severe acute
169 thousands bed
(14%)

896
tho.

Acute
596 thousands bed(48%)

Recovery
130 thousands bed (10%)

Chronic
355 thousands bed(28%)↓20 thousands

Severe acute↓11thousands

766
tho.

↓43
thousands

Number of beds required in 2025

FY 2019 Hospital Bed Function Report

FY 2015 Hospital Bed Function Report

158 thousands bed
(13%)

897
tho.

↑2
thousands

711
tho.
Acute
553 thousands bed
(45%)

912
tho.

↓9thousands↑56thousands

Recovery↓20thousands

Chronic

186 thousands bed (15%)

335 thousands bed(28%)↑22thousands

2025
1.213 million beds
Severe acute

Severe acute

160 thousands bed(13%)

131 thousands bed (11%)

Acute

704
tho.
Acute
544 thousands bed(45%)

RecoveryRecovery

208 thousands bed (17%)

Chronic↓33
thousands

1.191 million beds

302 thousands bed(25%)

401 thousands bed
(34%)

907
tho.

RecoveryRecovery
375 thousands bed(31%)

Chronic
284 thousands bed(24%)

532tho.

Community Based-Care unit
hospital fee (specific hospital fee,comprehensive Ax)

Recovery phase rehabilitation unit
hospital fee (specific hospital fee,comprehensive Ax)

Accepting patientsfrom home etc

Rehabilitation
functional recovery
performance etc

Percentage ofpatients in medical
category 2・3
RecoveryPhase
Rehabilitation

Nursing
staffing
20 : 1Long-term care

7:1
Rate of patientsin acute phase 10 : 1

ComprehensiveCommunity
Care
Rehabilitation

13 : 1

Nursing
staffing
15 : 1
Average length ofhospital stay

Acute care ~ Long-term care

Nursing staffing
10 : 1

Applying the
13:1
equivalentrequirement
prior to the
FY 2008
revision.

Average length of hospital stay

Applying the7:1equivalentrequirement
prior to the
FY 2008
revision.

Acute care

参照 2021.8.25 中央社会保険医療協議会 総会（第486回）
https://www.mhlw.go.jp/stf/shingi2/0000212500_00101.html

Average length of hospital stay(days)

Acute phase
general hospital fee 1 (n=412)
Acute phase
general hospital fee 2~3 (n=44)

Length of hospital stayduring acute phase
12〜18days

2019/8~10
2020/8~10

Acute phase
general hospital fee 4~7 (n=331)

Special hospital basic fee (n=8)

Advanced treatment hospital basicfee (n=44)
Community general hospital fee 1~2(n=96)
Community general hospital fee
3 (n=124)

Length of hospital stayduring recovery phase
Average 68 days

Community Based-Care unit
hospital fee・management fee(n=350)
Recovery phase rehabilitation
unit hospital fee (n=269)

参照 2021.8.25 中央社会保険医療協議会 総会（第486回）
https://www.mhlw.go.jp/stf/shingi2/0000212500_00101.html

2 units responsible for post-acute care
Recovery Rehabilitation Unit

Community Comprehensive
Care unit

PurposeReturning home after acute care

Returning home after acute care and managing
patients whose conditions got worsen during homecare

Target patients

Patients with the following disease・cerebrovascular disease, SCI, heady injury
・severe cerebrovascular disease with higher brain
disfunction
・femoral fractures
・after hip or knee replacement etc

Patients with no target diseases

Maximum length ofstay

180 days（depending on a disease）

60 daysRehabilitation

Up to９units/day（3 hours）
Fee is based on work (sharing expenses otherthan hospital fee）

Average 2 units/day（40minutes）
Hospital fee includes rehabilitation fee

Total number of patients with psychiatric disorders(in millions)

4.5
43.532.5

No.of outpatients
2No.of inpatients

1.5
10.5

2002
2002年

2005
2005年

2008
2008年

2011
2011年

2014
2014年

2017

参照 2021.11.5 中央社会保険医療協議会 総会（第494回）
https://www.mhlw.go.jp/stf/shingi2/0000212500_00116.html

Number of Inpatients in Psychiatric Beds
（by lengths of hospitalization)
2002
2005
2008
2011
2014
2017
50

100
Less thana year150
1~4 years

200
More than
5 years

250

300
Unknown

350(in thousands)

参照 2021.11.5 中央社会保険医療協議会 総会（第494回）
https://www.mhlw.go.jp/stf/shingi2/0000212500_00116.html

Future image of hospitals achieved through structural reform
Strengthening by
integrating manpower andfinancial resources

Strengthening by
integrating manpower andfinancial resources

Enrichment by diverting
manpower and financial
resources to community support

building

Beds to strengthencommunity transition
support functions

Eg., mental clinics(outpatients・day care,outreach etc）

Medical and welfare
services that support
community lives(Reduction in the future)

Outpatients・day care, outreach,department of visiting treatment・
visiting care

Severe and chronic

Emergency・Acute・Recovery Phases

Beds no longer neededin the future due tooptimization

Eg., Rehabilitation Training
lodge, group home

Downsizing beds as a result ofpatients’ community transition

Manpower, facilities etcsite
2014.7.14 「長期入院精神障害者の地域移行に向けた具体的方策の今後の方向性」とりまとめについて
https://www.mhlw.go.jp/stf/shingi/0000051136.html

The Role of Occupational Therapists
in the Post-Acute Care
Acute Phase• To support client to improve function and ADL for their new life. And to prevent
other functional decline

Recovery Phase• To provide the client with a concrete image of living at home after discharge
from the medical facility. In addition, we evaluate the living environment of client.
Based on the results, we will provide the program to improve the necessaryfunctions and ADL
Living Phase• To solve the various difficulties client faced in actual living situations

JAOT pamphlet for general public
Recovery phase

Mastery of a way of life

Practising
wearing on/off
clothes and shoes

Once the disease/injury has
stabilized after occupational
therapy during acute phase, ,the client’s functions andabilities are improved byimaging their actual lifestyle.
Clients will learn how to live
according to their individual
needs by developing theabilities and acquiring themeans necessary to live theirown life.

Practising cooking

Practising bathing with the use of aids

Practising goingout using public
transportPost-acute care programs towards Activities and Participation
Support Driving

Activities to give an image of “Work”
in the hospital setting

Activities in the environment similar to actual workin order to return to work

医療の現場でできる就労支援の場を、作業療法士がつくる
https://www.jaot.or.jp/ot_job/to_live/detail/9/「働きたい人」を、周囲の環境も含めて支援する
https://www.jaot.or.jp/ot_work/place/detail/88/
運転支援は、生活支援。クルマが、その人の世界を広げる
https://www.jaot.or.jp/ot_job/sugoude/detail/51/

JAOT’ activities• Review of Occupational
Therapy Definition• Promotion of MTDLP• Promotion of OT ５・５Plan• Supporting clients’participation and activities• Considering a mechanism fortherapists to go community
while working in hospitals