A hospital stay is a common starting point for care. If you only start preparing once discharge is set, the first weeks at home often have nothing in place. There is a lot you can do while the person is still in hospital.
First, tell the hospital's advice desk
Tell the ward nurses, or the hospital's advice desk, that you are worried about coming home. Hospitals have staff (medical social workers and others) who help plan life after discharge. The desk goes by different names — a medical welfare consultation room, a community liaison office, a discharge support office.
While the person is in hospital, the hospital itself is the way in, before the Community Care Plaza.
When to apply for a care-level certification
You can apply while the person is in hospital. Apply at the Elderly and Disability Support Division (高齢・障害支援課 介護保険担当) of your ward office, or ask a Community Care Plaza to apply on your behalf. See Applying for a care-level certification for the steps.
But sooner is not always better. A Yokohama ward office page explains that an application can be withdrawn if the person's condition is too unstable for the assessment visit, or if they are in hospital under health insurance and cannot use care services for the time being. In other words, care-insurance services are not used while in hospital.
Decide the timing with the hospital's advice desk. Once the condition has settled and discharge is in sight is a reasonable guide.
Services can sometimes start before the result
For a new application, the certification takes effect from the date of application, not from the date of the result (Long-Term Care Insurance Act, Article 27(8); the Yokohama ward office page says the same).
The result normally arrives within 30 days, but can take longer where the assessment needs more time, in which case the city tells you the expected period and the reason (Article 27(11)). Discharge may come first.
Where the city judges it necessary, a provisional care plan can be drawn up and services started before the result (Ministry of Health, Labour and Welfare notice). Starting equipment rental or home help on the day of discharge avoids a gap.
If the result is "not eligible", or a lower level than expected, services already used may not be paid by the insurance. Check this with the care manager before starting provisionally.
What to settle before discharge
- Equipment for home — a care bed, wheelchair, walker. But at Support Levels 1–2 and Care Level 1, care beds and wheelchairs are in principle not covered; there is an exception where the city accepts it on the basis of a doctor's findings → Renting and buying assistive equipment
- Handrails and steps. Home modification must be applied for before the work starts; work done first is not covered → Home modification
- A way for the family to rest → Short stays, so the family can rest
If the person is in hospital with cancer
Two things are different with cancer.
Between 40 and 64, there is a condition
People aged 65 or over can apply whatever the cause, including weakness after surgery.
People aged 40–64 can use the insurance on account of cancer only where a doctor has judged that the cancer has reached a state with no prospect of recovery (Enforcement Order, Article 2). After surgery expected to cure the cancer, the insurance does not apply on account of the cancer even if the person is weak (another qualifying condition, such as cerebrovascular disease, is a separate matter); ask the hospital's advice desk what other support is available.
For people aged 40–64 the diagnosis is written on the doctor's opinion form, and the national notice asks for care over what the patient has been told. Talk to the doctor before applying about how much the person knows.
Time can be short
For people with terminal cancer and similar conditions who suddenly need care, the national government asks municipalities to draw up provisional care plans quickly and to decide certifications quickly. Some municipalities carry out the assessment on the day of application.
We could not confirm on Yokohama City's pages how it handles these cases. Tell the ward office clearly, when you apply, that it is urgent.
Even if the result is Support Level 1–2 or Care Level 1, where terminal cancer or a similar condition means the person's condition is certain to worsen quickly, the city can allow a care bed and similar equipment to be rented. This needs a doctor's findings and a decision through the care manager, so ask the care manager.
If the condition changes and the care level no longer fits, you can apply for a change of care level, as many times as needed; the government asks that these be handled promptly.
If you are starting to think about how the person wants to spend their time at home, see Where the last days are spent.