【田中紘太】広がったケアマネの業務範囲、負担軽減は実現するか　市町村主体の地域課題の検討がカギ！

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<div class="article-detail-thumbnail"> <figure> <img width="1024" height="614" src="https://www.joint-kaigo.com/wp-content/uploads/2024/05/93088acc6a690824880f5b7ec3ed4b59-1024x614.jpg" class="hidden md:block wp-post-image" alt="" decoding="async" fetchpriority="high" srcset="https://www.joint-kaigo.com/wp-content/uploads/2024/05/93088acc6a690824880f5b7ec3ed4b59-1024x614.jpg 1024w, https://www.joint-kaigo.com/wp-content/uploads/2024/05/93088acc6a690824880f5b7ec3ed4b59-600x360.jpg 600w, https://www.joint-kaigo.com/wp-content/uploads/2024/05/93088acc6a690824880f5b7ec3ed4b59-768x461.jpg 768w, https://www.joint-kaigo.com/wp-content/uploads/2024/05/93088acc6a690824880f5b7ec3ed4b59.jpg 1400w" sizes="(max-width: 1024px) 100vw, 1024px" /> <img src="https://www.joint-kaigo.com/wp-content/uploads/2024/05/93088acc6a690824880f5b7ec3ed4b59-1024x614.jpg" alt="" class="block md:hidden" loading="lazy"> <figcaption> 《株式会社マロー・サウンズ・カンパニー｜田中紘太代表》 </figcaption> </figure> </div> <div class="article-detail-content"> <p>ケアマネジメントをめぐる様々な課題を話し合う<a href="https://www.mhlw.go.jp/stf/newpage_39506.html" target="_blank" rel="noreferrer noopener">厚生労働省の検討会</a>で11月7日、これまでの議論を整理した「<a href="https://www.mhlw.go.jp/content/12300000/001327428.pdf" target="_blank" rel="noreferrer noopener">中間整理素案（たたき台）</a>」が示されました。【田中紘太】</p> <div class="py-8"> <div class="hidden md:block"> <script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-5747652352187221" crossorigin="anonymous"></script>  <ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-5747652352187221" data-ad-slot="3611677680" data-ad-format="auto" data-full-width-responsive="true"></ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> </div> <div class="md:hidden"> <script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-5747652352187221" crossorigin="anonymous"></script>  <ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-5747652352187221" data-ad-slot="4516570440" data-ad-format="auto" data-full-width-responsive="true"></ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> </div> </div> <p>まだ確定ではありませんが、施策内容のアウトラインは概ね示されたと考えられます。ここでは2つのポイントに絞って考察したいと思います。<br><br><strong>◆ 業務のあり方について</strong></p> <p><br>居宅介護支援のケアマネジャーが現に実施している業務について、今回の素案では、</p> <div style="height:40px" aria-hidden="true" class="wp-block-spacer"></div> <p class="has-background" style="background-color:#0792e324">①法定業務<br>②保険外サービスとして対応し得る業務<br>③他機関につなぐべき業務<br>④対応困難な業務</p> <div style="height:40px" aria-hidden="true" class="wp-block-spacer"></div> <p>の4つに分類されました。詳細は表の通りです。</p> <div style="height:30px" aria-hidden="true" class="wp-block-spacer"></div> <figure class="wp-block-image size-large"><img decoding="async" width="1024" height="986" src="https://www.joint-kaigo.com/wp-content/uploads/2024/11/8187e37da16dee4fb14790d05a55a11c-1024x986.png" alt="" class="wp-image-31278" srcset="https://www.joint-kaigo.com/wp-content/uploads/2024/11/8187e37da16dee4fb14790d05a55a11c-1024x986.png 1024w, https://www.joint-kaigo.com/wp-content/uploads/2024/11/8187e37da16dee4fb14790d05a55a11c-600x578.png 600w, https://www.joint-kaigo.com/wp-content/uploads/2024/11/8187e37da16dee4fb14790d05a55a11c-768x739.png 768w, https://www.joint-kaigo.com/wp-content/uploads/2024/11/8187e37da16dee4fb14790d05a55a11c.png 1400w" sizes="(max-width: 1024px) 100vw, 1024px" /></figure> <div style="height:30px" aria-hidden="true" class="wp-block-spacer"></div> <p>また素案には、こうした業務分類について次のように記載されています。</p> <div style="height:40px" aria-hidden="true" class="wp-block-spacer"></div> <p class="has-background" style="background-color:#00d18424"><strong>■ 中間整理素案（たたき台）のポイント</strong></p> <p class="has-background" style="background-color:#00d18424"><br>◯ 上記②や③の業務については、地域の多様な主体が役割を担うことが考えられる。また、民間の事業者がサービスを提供しているケースもあるところ、「<a href="https://www.moj.go.jp/content/001420018.pdf" target="_blank" rel="noreferrer noopener">高齢者等終身サポート事業者ガイドライン</a>」の周知も含め、こうしたサービスを安心して活用できる環境を整備することが重要。</p> <p class="has-background" style="background-color:#00d18424"><br>◯ 利用者、家族、関係職種、市町村の共通認識づくり、理解の促進が必要。国や関係団体を中心として、関係者の啓発を行っていくことも重要。</p> <p class="has-background" style="background-color:#00d18424"><br>◯ 法定業務以外の業務については、基本的に市町村が主体となって関係者を含めて協議し、必要に応じて社会資源の創出を図るなど、利用者への支援が途切れることのないよう、地域の課題として対応すべき。その際、地域の実情に応じた対応ができるよう幅広く関係者の意見を聞いて検討することが適当。</p> <p class="has-background" style="background-color:#00d18424"><br>※ 分かりやすさの観点から、Joint編集部が一部修正・編集。</p> <div style="height:40px" aria-hidden="true" class="wp-block-spacer"></div> <p>今回の素案では、法定業務と法定外業務とがしっかり分類されました。この点は前進と言えるのではないでしょうか。</p> <p><br>法定業務は運営基準で位置付けられており、ケアマネジャーが必ず対応しなければならない業務、質の向上に努めるべき業務となります。一方の法定外業務は、必ずしもケアマネジャーが対応しなくてもよい業務、他機関につなぐべき業務を指します。</p> <div class="mt-8"> <div class="hidden md:block"> <a href="https://robotcare.jp/jp/seminar/13?type=top" onclick="gtag('event','link',{'event_category':'pwc-2024.11','event_label':'pwc-2024.11-article-lplink-banner01'});"><img decoding="async" src="https://www.joint-kaigo.com/wp-content/uploads/2024/11/f67f59d4277657abc2c19f394956d78f.jpg" alt="pwc-2024.11-article-lplink-banner01"></a> </div> <div class="md:hidden"> <a href="https://robotcare.jp/jp/seminar/13?type=top" onclick="gtag('event','link',{'event_category':'pwc-2024.11','event_label':'pwc-2024.11-article-lplink-banner01'});"><img decoding="async" src="https://www.joint-kaigo.com/wp-content/uploads/2024/11/f67f59d4277657abc2c19f394956d78f.jpg" alt="pwc-2024.11-article-lplink-banner01"></a> </div> </div> <div style="height:40px" aria-hidden="true" class="wp-block-spacer"></div> <p><strong>◆ 広がる保険外サービスの可能性</strong></p> <p><br>法定外業務の②保険外サービスとして対応し得る業務には、書類の作成・発送や代筆・代読なども含まれています。実際に対応したことのあるケアマネジャーも少なくないことでしょう。もっとも、今は書類の作成料などを徴収しているケアマネジャーはほとんどいません。</p> <p><br>ただ今後は、ケアマネジャーが利用者の手続きの代行などを行うにあたって、1通いくら、1回いくら、1時間いくら、といった料金を設定する方法も選択しやすくなります。その際は、契約書・重要事項説明書などに記載しておくことも重要になるでしょう。</p> <p><br>③他機関につなぐべき業務については、例えば部屋の片付けやゴミ出し、買い物といった生活支援サービスなどが例示されています。自費サービスは居宅介護支援事業所が担うべきか、あるいは訪問介護事業所が担うべきか解釈が分かれますが、今後はケアマネジャーが料金を徴収するケースが増えてくるかもしれません。</p> <div class="py-8"> <div class="hidden md:block"> <script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-5747652352187221" crossorigin="anonymous"></script>  <ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-5747652352187221" data-ad-slot="3611677680" data-ad-format="auto" data-full-width-responsive="true"></ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> </div> <div class="md:hidden"> <script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-5747652352187221" crossorigin="anonymous"></script>  <ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-5747652352187221" data-ad-slot="4516570440" data-ad-format="auto" data-full-width-responsive="true"></ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> </div> </div> <p><strong>◆ 拭いきれない懸念</strong></p> <p><br>課題は他機関につなぎたくてもつなげず、結果的にケアマネジャーが無償で対応しなければならないケースが減らないことです。市町村や地域包括支援センター、社会福祉協議会などに任せようとしても、利用者本人が同意しない、拒否するなどで話が先に進まないことも少なくありません。</p> <p><br>例えば公共料金の振込。水道光熱費の支払いが滞ったり、入院中に支払えなかったりして、ライフラインが止まってしまう事態も時折みられます。</p> <p><br>ライフラインは日々の生活や介護、身体機能などに直結するため、一刻も早く復旧しなければいけません。結果として、ケアマネジャーが無償で対応しているケースも少なくないのが実情です。</p> <p><br>今後、関係者の理解促進に向けた通知などが国から発出される見通しです。ただ、肝心の市町村の対応次第では、引き続きケアマネジャーが今と変わらない対応を強いられるのではないか、という懸念が拭えません。</p> <p><br>今回の素案には、ケアマネジャーの法定外業務について、「市町村が主体となって地域課題として対応すべき」「広く関係者の意見を聞いて検討すべき」という趣旨が明記されました。</p> <p><br>ただし、地域課題の抽出や新たな社会資源の創出は簡単ではありません。既に様々な制度がありますが、地域によっては形骸化している、またはほとんど機能していないのが実情ではないでしょうか。</p> <p><br>緊急時や土日祝日、年末年始なども含め、高齢者の支援ニーズに誰がどのように対応していくのか − 。市町村が音頭を取って関係者間でしっかりと検討し、イレギュラーなケースも想定したフローを地域ごとに確立しなければいけません。</p> <p><br>そうでないと、今まで通りケアマネジャーが仕方なく対応することになってしまうでしょう。市町村によって対応に差が生じることも予想されます。居宅介護支援の事業者やケアマネジャーも、地域課題の検討にしっかりと関与していく必要があると思います。</p> <div class="mt-8"> <div class="hidden md:block"> <a href="https://robotcare.jp/jp/seminar/13?type=top" onclick="gtag('event','link',{'event_category':'pwc-2024.11','event_label':'pwc-2024.11-article-lplink-banner01'});"><img decoding="async" src="https://www.joint-kaigo.com/wp-content/uploads/2024/11/f67f59d4277657abc2c19f394956d78f.jpg" alt="pwc-2024.11-article-lplink-banner01"></a> </div> <div class="md:hidden"> <a href="https://robotcare.jp/jp/seminar/13?type=top" onclick="gtag('event','link',{'event_category':'pwc-2024.11','event_label':'pwc-2024.11-article-lplink-banner01'});"><img decoding="async" src="https://www.joint-kaigo.com/wp-content/uploads/2024/11/f67f59d4277657abc2c19f394956d78f.jpg" alt="pwc-2024.11-article-lplink-banner01"></a> </div> </div> <div style="height:40px" aria-hidden="true" class="wp-block-spacer"></div> <p><strong>◆ 介護難民対策が喫緊の課題</strong></p> <p><br>今回の素案には、ケアマネジャーの人材確保に向けて処遇改善、業務負担の軽減を図る考えが記されました。足元では既に、人材不足でケアマネジャーが何ヵ月経っても見つからず、必要な介護サービスを受けられない「介護難民」が生じている地域も出てきています。</p> <p><br>大きな問題の1つは、実務研修受講試験に合格した人材がケアマネジャーの仕事に就かないことだと思います。その一番の要因は、「処遇改善加算」がないことによる介護職員との賃金の逆転現象ではないでしょうか。</p> <p><br>処遇改善加算などの手当をしっかりと行い、初任者研修→実務者研修→介護福祉士→ケアマネジャー→主任ケアマネジャーといったキャリアアップに応じて、賃金が順当に上がっていく仕組みを作らなければいけません。</p> <p><br>確かに財源の問題などもあるでしょう。ただ事態は深刻です。ケアマネジャー不足が要因で既に介護難民が増え始めていますので、その対策を講じることが急務だと考えます。</p> <div style="height:45px" aria-hidden="true" class="wp-block-spacer"></div> <hr class="wp-block-separator has-alpha-channel-opacity"/> </div> </div> </div> <div class="main-two-column-right"> <div class="ad-04"> <script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-5747652352187221" crossorigin="anonymous"></script>  <ins class="adsbygoogle" style="display:inline-block;width:300px;height:250px" data-ad-client="ca-pub-5747652352187221" data-ad-slot="7540878633"></ins> <script> 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【田中紘太】広がったケアマネの業務範囲、負担軽減は実現するか 市町村主体の地域課題の検討がカギ！ | 介護ニュースJoint

【田中紘太】広がったケアマネの業務範囲、負担軽減は実現するか　市町村主体の地域課題の検討がカギ！ | 介護ニュースJoint