Home helper - Home helper (English spelling)

Japanese: ホームヘルパー - ほーむへるぱー（英語表記）home helper

A professional who visits the homes of elderly people and people with disabilities who need assistance in their daily lives due to the decline or decline of physical and mental functions associated with aging, or due to physical and mental disabilities, and provides services to support their independence by providing physical care, assistance with housework, and various other types of consultation and advice.

Specifically, this includes (1) physical care such as eating, excretion, putting on and taking off clothes, bathing, cleaning the body, washing hair, and going to the hospital; (2) household assistance such as cooking, washing and repairing clothes, cleaning and tidying the residence, shopping for daily necessities, and contacting relevant agencies; and (3) consultation and advice on various worries and problems in daily life, such as personal care and money management.

[Masayoshi Kawamura]

History

For many years, care for elderly parents had been provided by family members or local volunteers, but in 1956, Ueda City and Suwa City in Nagano Prefecture launched a program to dispatch home caregivers to care for the elderly instead of family members or local volunteers. This was the first public system to do so.

However, as elderly care became a social problem year by year, the government enacted the Elderly Welfare Law in 1963, and in the following year, 1964, it implemented mainly facility welfare services, such as placing and caring for elderly people who needed care in special nursing homes for the elderly, and home welfare services, such as the home care worker dispatch program, which dispatches elderly home care workers to the homes of the elderly. At the time, the aging rate (the percentage of the total population aged 65 and over) was 6.1%, but the aging rate has since risen year by year, and the trend toward nuclear families has led to a decline in the ability to care for elderly parents at home, and caring for elderly people who are bedridden, have dementia, or are frail has become a serious problem.

In response, the national government formulated the "Gold Plan" in 1989, which set a goal of improving public health and welfare services for the elderly, such as increasing the number of home helpers from about 33,000 at the time to 100,000, and made it obligatory for local governments to formulate health and welfare plans for the elderly in order to implement the plan. At the same time, the government renamed and revised the name of the home helpers to home helpers and the home helper dispatch business to home help services in order to strengthen the business. It also decided to implement a day service business that provides day care at special nursing homes for the elderly who are receiving care at home, and a short stay business that provides care for the elderly in the same homes for about a week, and positioned these as the "three pillars of home welfare," and to place more emphasis on home welfare services than on the traditional institutional welfare services. Based on this, training courses were established for each level: Level 1, who acts as a chief helper and liaises and coordinates with Level 2 and 3 home helpers, Level 2, who engages in home help services focusing on physical care, and Level 3, who engages in household assistance and consultation/advice, and these services were entrusted to local governments, and those who completed the training courses designated by the prefectural governor were certified as home helpers. After that, the "New Gold Plan" of 1994 set a target of 170,000 people, and the "Gold Plan 21 (5-year plan)" of 2000 set a target of 350,000 people.

However, the supply of care services has not kept up with the ever-increasing demand, and the rapid increase in social security benefits due to the advent of an aging society with fewer children led the Ministry of Health, Labor and Welfare to enact the Nursing Care Insurance Act in 1997, which was based on the social insurance system and came into force in April 2000. When home helpers provide care for the elderly under this law, they are considered visiting care workers and are also called care helpers. For elderly people who have been certified as requiring care by the nursing care insurance certification committee of the city or town where they live, a care manager creates a home care service plan (care plan) according to the maximum amount of payment for that category, and visiting care workers provide care that consists of physical care, life assistance based on housework assistance, and a combination of these three types of care. Visiting care workers are qualified as persons specified in Article 3 of the Enforcement Order of the Nursing Care Insurance Act, and are persons who have completed a training course designated by the prefectural governor and received a completion certificate. Since then, in order to improve the quality of services, the Ministry of Health, Labor and Welfare has implemented career paths for care workers. Career paths are a system that was introduced in 2010 to provide appropriate treatment according to the abilities, qualifications, and experience of care workers so that they can continue working with hope for the future, but if certain requirements are not met, the amount of the subsidy for improving the treatment of care workers will be reduced. Furthermore, due to amendments to the Enforcement Regulations of the Long-Term Care Insurance Act, from April 2013, the home care worker second-class training will be transferred to "care worker initial training," and the home care worker first-class training and care worker basic training will be unified into "practitioner training," while the home care worker third-class training will be abolished. However, the current qualifications themselves will remain in place.

Meanwhile, home help service businesses targeting people with disabilities were defined as home-based care (physical care and household assistance) under the Act on Services and Supports for Persons with Disabilities enacted in 2005, but in April 2013 the Act was renamed and amended to the Act on Comprehensive Support for Persons with Disabilities, and new provisions were added, including home care for those with severe disabilities.

[Masayoshi Kawamura]

Current situation and issues

With the aging rate set to peak between 2055 and 2060, and the baby boomer generation expected to reach their late senior years and the number of people requiring care expected to increase by 2030, the Ministry of Health, Labor and Welfare has implemented various measures, such as amending the Nursing Care Insurance Act, raising nursing care compensation, and providing subsidies to improve the treatment of nursing care workers. However, the supply has not kept up with the demand, and the working conditions of home helpers, which are the key to this, have not been fundamentally improved.

In fact, a total of 2,673,000 people have completed the Level 2 home care worker training course, and although the majority of them wish to work, only 385,000 (15.4% of the total) are employed due to poor working conditions and other reasons (estimated for 2011). 87.8% of employed people are women, the average age is 50.9, and about 80% are full-time staff, with an average monthly salary of just 188,975 yen and an average hourly wage of just 1,235 yen (according to a survey by the Care Worker Stability Center in 2011). The main reasons for the shortage of workers are the low wages given the harsh work conditions and the difficulty in predicting the future.

Therefore, future issues include not relying too easily on foreign workers to secure human resources, but rather improving social status and guaranteeing employment through drastic increases in wages, applying social insurance, introducing a retirement age, etc. To achieve this, shouldn't we seek a fundamental solution through true administrative and financial reform, rather than opportunistically raising taxes such as the consumption tax and social insurance premiums as a source of national revenue?

[Masayoshi Kawamura]

Yasuoka Atsuko, How to Get Along Well with Home Helpers (1999, Jichi Kenkyusha) ▽ Kawamura Masayoshi, editor, 21st Century Social Welfare 1: Social Security Theory, 5th Edition (2005, Minerva Shobo) ▽ Kawamura Masayoshi, editor, 21st Century Social Welfare 8: Care Welfare Theory (2011, Minerva Shobo)

Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend

Japanese:

加齢に伴う心身の機能の低下や減退、あるいは心身の障害などのため、日常生活を営むうえで援助を必要とする高齢者や障害者を自宅に訪ね、身体の介護や家事の援助、その他各種相談や助言などを行い、自立支援のためのサービスを提供する専門職。

　具体的には、(1)食事や排泄(はいせつ)、衣類の着脱、入浴、身体の清拭(せいしき)、洗髪、通院などの身体介護、(2)調理や衣類の洗濯・補修、住居などの掃除・整理整頓、生活必需品の買い物、関係機関との連絡などの家事援助、(3)日常生活における身体の監護や金銭の管理などさまざまな悩み事や困り事に対する相談・助言、である。

［川村匡由］

沿革

老親の介護は長年、家族や地域の住民の有志によって行われていたが、1956年（昭和31）長野県の上田市や諏訪(すわ)市などが家庭養護婦派遣事業として取り組み、家族や住民の有志にかわり、高齢者の介護が行われた。これが公的な制度としては初めてのものであった。

　しかし、高齢者の介護は年々社会問題となったため、国は1963年に老人福祉法を制定し、翌1964年、介護が必要な高齢者を特別養護老人ホームなどに入所・保護する施設福祉サービス、および老人家庭奉仕員を高齢者本人の自宅に派遣させる家庭奉仕員派遣事業などの在宅福祉サービスを中心に施行した。当時、高齢化率（65歳以上の人口が総人口に占める割合）は6.1％であったが、高齢化率はその後、年々上昇するとともに、核家族化によって家庭における老親の介護機能が低下し、寝たきりや認知症、虚弱などの高齢者の介護が深刻な問題となった。

　そこで、国は1989年（平成1）、「高齢者保健福祉推進十か年戦略（ゴールドプラン）」を策定、当時、約3万3000人しかいなかった家庭奉仕員を10万人に増やすなど、高齢者を対象とした保健福祉の公的サービスの整備目標を掲げるとともに、その具体的な実施のため、地方公共団体に老人保健福祉計画の策定を義務づけた。同時に、従来の家庭奉仕員をホームヘルパー、また家庭奉仕員派遣事業をホームヘルプサービスに改称・改正し、事業の強化を図った。そして、在宅で介護を受けている高齢者を特別養護老人ホームなどで日帰りで介護を行うデイ・サービス事業、および同ホームなどで1週間程度預かり介護を行うショートステイ事業を実施することにし、これらを「在宅福祉三本柱」と位置づけ、従来の施設福祉サービスよりも在宅福祉サービスのほうに力を入れることになった。そのうえで、主任ヘルパーとして2～3級のホームヘルパーの連絡・調整などを行う1級、身体介護を中心としたホームヘルプサービスに従事する2級、家事援助や相談・助言などに従事する3級の、各養成研修講座を設け、その事業を地方公共団体に委託、都道府県知事が指定する研修課程を修了した者をホームヘルパーとして認定した。その後、1994年の「新ゴールドプラン」で17万人、2000年（平成12）の「ゴールドプラン21（5か年計画）」で35万人の整備目標をたてた。

　しかし、増え続ける介護サービスへの需要に供給が追いつかないうえ、少子高齢社会の到来に伴う社会保障給付費の急増のため、厚生労働省はそれまでの措置制度から社会保険方式による介護保険法を1997年に制定、2000年4月に施行させた。ホームヘルパーは同法に基づいて高齢者を介護する場合、訪問介護員とされ、介護ヘルパーともよばれる。居住する市町村の介護保険認定審査会で要介護認定を受けた高齢者を対象に、介護支援専門員（ケアマネージャー）がその区分支給限度額に応じて居宅介護サービス計画（ケアプラン）を作成するが、訪問介護員はこれに基づき、身体介護、家事援助を基本とした生活援助、およびこれらの介護の複合型の三つからなる介護を行う。訪問介護員は介護保険法施行令第3条で定める者に該当する資格で、都道府県知事が指定する研修課程などを修了し、修了証明書の交付を受けた者とされる。その後、サービスの質の向上のため、厚生労働省は介護職員のキャリアパスの実施などを行っている。キャリアパスとは、介護職員が将来的に希望をもって就業し続けられるよう、その能力や資格、経験などに応じた処遇を適切に行うため、2010年度に導入された制度であるが、所定の要件を満たさない場合、介護職員処遇改善交付金の助成額が減額されることになっている。なお、介護保険法施行規則の改正により、2013年4月から訪問介護員2級養成研修は「介護職員初任者研修」へ移行、訪問介護員1級養成研修および介護職員基礎研修は「実務者研修」へと一本化されるのに対し、同3級養成研修は廃止されることになった。もっとも、これまでの資格そのものは今後も存続される。

　一方、障害者を対象にしたホームヘルプサービス事業は、2005年に制定された障害者自立支援法では居宅介護（身体介護および家事援助）とされたが、2013年4月に障害者自立支援法が障害者総合支援法に改称・改正され、新たに重度訪問介護なども追加されることになった。

［川村匡由］

現状と課題

高齢化率は2055～2060年にピークを迎えるほか、団塊の世代が後期高齢者になり要介護者の増加が予測される2030年が目前なだけに、厚生労働省はこれまで介護保険法の改正や介護報酬の引き上げ、また介護職員処遇改善交付金の支給など、さまざまな措置を講じてきた。しかし、その需要に供給が追いついていないうえ、肝心のホームヘルパーの労働条件も抜本的な改善とはなっていないのが実情である。

　現に、これまでの訪問介護員養成研修2級課程の修了者は計267万3000人で、その大半は就業を希望しているものの、労働条件が悪いなどの理由で38万5000人と全体の15.4％しか就業していない（2011年推計）。就業者の87.8％は女性であり、平均年齢は50.9歳、また、常勤職員は約8割で、平均月収は18万8975円、平均時給は1235円（平成23年度財団法人介護労働安定センター調査）にとどまっており、過酷な労働の割に低賃金で、将来の見通しがたてにくいなどの実態が、供給不足のおもな理由となっている。

　そこで、今後の課題として、人材の確保にあたっては安易に外国人労働者に頼るのではなく、賃金の大幅な引き上げや社会保険の適用、定年制の導入など社会的身分の向上や雇用の保障があげられる。そのためには、国の財源として消費税などの租税や社会保険料を便宜的に引き上げるのではなく、真の行財政改革によって抜本的な解決を図るべきではないだろうか。

［川村匡由］

『安岡厚子著『ホームヘルパーと上手につきあう』（1999・自治体研究社）』▽『川村匡由編著『21世紀の社会福祉1　社会保障論』第5版（2005・ミネルヴァ書房）』▽『川村匡由編著『21世紀の社会福祉8　介護福祉論』（2011・ミネルヴァ書房）』

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