地方都市における地域特性を考慮した地域包括ケアシステムの構築へ向けた取組み一徳島県鳴門市の事例一

摘要

Based on a case study in Naruto City, Tokushima Prefecture, the structure of a comprehensive community care system for small provincial cities is investigated. Initiatives using community networks of each comprehensive support center, which take account of the diverse characteristics of individual communities, are compared. To establish a comprehensive community care system tailored to the diverse conditions of its local communities, Naruto City established daily living zones and several comprehensive community support centers offering better care than that available in other similarly sized provincial cities in Japan. Within each community, center operations were outsourced to contractors that had provided community support before the long-term care insurance system was introduced. Each center used community networks tailored to local characteristics and sought to resolve problems within the community, thereby building a comprehensive community care system for each zone. The volume of work undertaken has increased since the comprehensive community support centers were established in 2006,and the city hall cannot address problems at each center through policy measures. So, a centralized comprehensive community support center was established in September 2015. As a result, Naruto City seeks to develop and adjust its policy on two scales:(1)micro-policies that account for the diverse characteristics of each community and (2) a macro-policy that addresses problems comprehensively at the city-wide level. Consequently, Naruto City is now in the process of transitioning to a comprehensive community care system based on a new system of governance. Nevertheless, the system faces problems due to the low level of recognition of the comprehensive community support center by the public and the weakening of community organizations responsible for building community networks. Consequently, investment is needed to build strong community organizations in which people of all ages can participate.