Long-term Care Insurance in Japan: How physicians are involved in providing rehabilitation for the elderly.

For many years, ease of falling and fatigability are considered part of the aging process. However, it was recently revealed that with some training to increase musculoskeletal functions the elderly can improve in muscle strength. Accordingly, the national long-term care insurance in Japan, which takes effect after the day limit for rehabilitation expires under the national medical insurance, also emphasizes the principle of putting rehabilitation first. Under the national long-term care insurance in Japan, there are 2 types of rehabilitation services available: patients may either live at home or stay in a facility or hospital. The former type includes in-hospital/in-facility day care rehabilitation and home-visit rehabilitation, as well as individual rehabilitation programs available during short-stays at medical long-term care institutions and long-term care health facilities (also called "rehabilitation camp") that meet the insurance policy. On the other hand, the latter includes rehabilitation programs at medial long-term care institutions and long-term care health facilities. These rehabilitations covered by the long-term care insurance include not only physical rehabilitation but also address cognitive impairment, which is the major feature of the long-term care insurance. People who wish to apply for these rehabilitation services require prescriptions (or written instructions) by physicians in advance.