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There are three systems currently used to provide home-visit nutritional and dietary guidance. The first offers home-visit guidance through health care projects for the elderly, the second provides guidance to patients receiving home care through medical care insurance, and the third is provided by an administrative dietitian to homecare patients using long-term care insurance. The amount of home-visit nutritional and dietary guidance decreased after the introduction of the long-term care insurance system, even though the calculated limit of expenditure for care services was increased. The reasons for this decrease may be that the service for which the limit of expenditure was calculated does not meet the needs of users, that nutritional guidance is not exclusively the work of administrative dietitians, and that dietitians are not uniformly distributed among the clinics. Considering the combination of medicine and welfare, which is the purpose of long-term care insurance, the present system attaches too much importance to medical effectiveness and lacks consideration of other issues in the welfare of patients.

Long-term Care Insurance and Home-visit Nutritional and Dietary Guidance.