However, institutional care is not easily accessible in Japan either. Public facilities such as special nursing homes generally require a care level of 3 or higher, meaning that priority is given to individuals with severe care needs. Due to population aging, workforce shortages and long waiting lists, access is effectively restricted. Although private facilities are available for individuals with lower care needs, they are often expensive, sometimes exceeding £750 per month. As a result, institutional care in Japan is also becoming increasingly difficult to access, both financially and structurally. Thus, while both countries face constraints at both the individual and state levels, these constraints manifest differently. In Japan, limitations appear primarily as supply shortages, such as insufficient facilities and workforce, whereas in the UK, they are more directly reflected in the financial burden placed on individuals through means-tested systems. Looking ahead, Japan may face increasing pressure to introduce more selective benefits due to fiscal constraints, while in the UK, reducing the financial burden on middle-income groups is likely to remain a key policy issue. The difference in long-term care systems between Japan and the UK are clearly reflected in the role of institutional care.In Japan, institutional care is positioned as part of a “continuum of care”. A wide range of home-based services such as day care, home help, and short-term stays are available, allowing individuals to receive support according to their level of need. Institutional care such as special nursing homes for the elderly is located at the end of this continuum, enabling a gradual transition from home-based to residential care. In contrast, in the UK, institutional care is more limited and is typically considered a last resort. Facilities are broadly categorized into residential care homes, which provide assistance with daily living, and nursing homes, which offer is subject to means testing, and individuals with moderate levels of wealth often face substantial out-of-pocket costs. For example, individuals with assets exceeding £23,250 may be required to pay the full cost of care, which can amount to approximately £1,500 per week. This system discourages institutionalization and aligns with policies prioritizing home-based care. This comparison highlights that both Japan and the UK, institutional constraints, particularly fiscal limitation, prevent the full realization of policy ideals. In both cases, there is a gap between the principles underlying the system and its actual implementation. In Japan, although the long-term care system is based on the principle of collective support, shortages of facilities and care workers mean that services are not always accessible to those in need. Similarly in the UK, while policies emphasize independence and community-based care, the high costs associated with means-tested services can limit individuals’ freedom of choice. Therefore, both countries face a fundamental challenge; how to reconcile normative goals with practical constraints. Ensuring the sustainability of long-term care systems requires not only well-designed institutional frameworks but also adequate financial and human resources. medical care with qualified staff. Access to these services 13The Role of Institutional CareChallenges Revealed by the Comparison
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