Welfare policies for persons with physical disabilities are implemented by prefectures and municipalities in accordance with central government statutes. A large number of professionals and relevant organizations/agencies are involved in the process. The chart below illustrates how the system is organized.
- 2. Rehabilitation and Care Services
- 3. Welfare Services to Support Persons with Disabilities Living at Home
- 4. Measures to Promote Social Participation
- 1. Independent living support programs and comprehensive programs to promote social participation
- 2. Municipal programs to support the daily activities of persons with disabilities
- 3. Management of welfare homes for persons with physical disabilities
- 4. Sheltered workshops for persons with physical disabilities living at home
- 5. Peer counseling services
- 6. National Athletic Games for Persons with Disabilities
- 5. Institutional Services
2. Rehabilitation and Care Services
1. Certificate of Persons with Physical Disability
(1) Overview of the System
Under the Law for the Welfare of Physically Disabled Persons, welfare measures are planned for persons with physical disabilities, who are issued Certificate of Persons with Physical Disability. In order to receive a certificate, an application must be submitted and the applicant must be deemed to have a physical disability in accordance with the law.
The certificate takes the form of a small handbook (and is thus called Shintai-shogaishatechoin Japanese) and carries the name of the person with the disability as well as the type and degree of disability. The certificate entitles holders to use designated rehabilitation and care services, receive prosthesis and orthosis, and take advantage of other systems formulated in accordance with Law for the Welfare of Physically Disabled Persons. It also entitles bearers to benefits outside the scope of the law, such as railroad fare reductions.
An application for the certificate must be submitted to the head of the local Welfare Office, or to the municipal mayor in cities and towns with no Welfare Office, together with a medical certificate, a letter of doctor’s opinion (diagnosis), and a photograph of the applicant. The application and necessary materials are subsequently sent to the prefectural governor. There are no fees for applying.
By definition, “Person with Physical Disability” must be 18 years of age or over and possess a Certificate of Persons with Physical Disability. There are 6 grades depending on the severity of disabilities under the certification system, with the most severe comprising the first two and moderate and mild disabilities comprising the remaining four. The same requirements for eligibility are applied to children under the age of 18. The followings are disabilities regulated under the Law for the Welfare of Physically Disabled Persons.
1) Permanent visual impairment as listed in the following: a. Visual acuity (as measured in accordance with the International Vision Test Chart and measured degree of correctibility; hereinafter the same) of 0.1 or less in both eyes b. Visual acuity of 0.02 or less in one eye and 0.6 or less in the other eye c. Visual field diameter of 10 degrees or less in both eyes d. Visual field defect more than 50% in both eyes 2) Permanent hearing impairment and impairment of balance function as listed in the following: a. More than 70 decibels in each ear b. More than 90 decibels in one ear and 50 decibels in the other c. Less than 50% of hearing capability d. Severe impairment of balance function 3) Impairment of voice, speech and mastication function a. Total loss of voice, speech or mastication function b. Severe and permanent impairment of voice, speech or mastication function 4) Impairment of the limbs or trunk as listed in the following: a. Severe and permanent impairment of one upper limb, one lower limb or trunk b. Loss of thumb of one upper limb upward of the knuckle joint or loss of two or more fingers of one upper limb including the forefinger upward of the knuckle joints c. Loss of one lower limb upward of the lisfranc joint d. Loss of toes from both lower limbs e. Severe impairment of the thumb of one upper limb or severe and permanent impairment of three or more fingers of one upper limb including the forefinger f. In addition to the factors as listed in the foregoing, other impairments that are acknowledged to be of degrees higher than the impairments as listed in a. through e. of the foregoing
5)Impairments of the functions of the heart, kidney, respiratory organs, bladder, rectum and small intestine, that are permanent, and acknowledged as being of a degree to cause extreme limitations in daily living.
2. Diagnosis and consultations for rehabilitation
Medical assessment to determine the degree of physical disability, needs of rehabilitation and medical care, and the need for prosthesis and orthosis, as well as consultations on rehabilitation, are designed to provide the guidance necessary for enabling persons with physical disabilities to live independently and take an active part in society. The services are provided when necessary and implemented by municipal governments.
3. Provision of rehabilitation and medical treatment
All necessary medical treatment, including surgery to alleviate and reduce the degree of the disability or enable recovery, is entrusted to and performed at designated medical institutions. The fees are free or borne in part or fully by the user or the person of whom he or she is a dependent in line with the amount of taxable income. No fee is charged to households who are covered by public assistance (livelihood protection) or that are exempt from municipal taxes.
Examples of available medical treatment (1) Visual impairments: surgical removal of the crystalline lens and surgery for a detached retina (2) Hearing impairments: surgery to close a perforation (3) Speech impairments: plastic surgery, medication, speech therapy (4) Physical disorders: joint replacement and reconstructive surgery after an amputation (5) Internal organ impairments: dialysis (impairment of kidney function), surgery to implant a pacemaker (impairment of heart function), central venous dietary therapy (impairment of small intestine function), anti human immunodeficiency virus therapy (impairment of immune function by HIV), and etc.
4. Provision of prosthesis and orthosis and repairment
Prosthesis and orthosis that compensates for lost body parts and functions and supplementary devices are provided to persons with physical disabilities.
Examples of equipments (1) Visual impairments: Cane for the blind, artificial eye, spectacles, Braille typewriter (2) Hearing impairments: hearing aids (3) Voice and speech impairments: artificial larynx (4) Orthopedic disabilities; prosthesis and orthosis, sitting-position-keeping device, wheelchair, electric wheelchair, walker (standing frame for walking), etc. (5) Internal organ impairments: devices for stoma
3. Welfare Services to Support Persons with Disabilities Living at Home
The needs for services go beyond the scope of basic measures, since the activities of persons who live in community is substantial. Therefore welfare measures in this area are growing in importance.
1. Home help services
Home helpers visit the homes of persons with physical disabilities and provide help bathing, toileting, house cleaning, and other activities that enable them to live at home.
2. Short stay programs
Facilities can be used for short-term stays of up to a week when family caregivers for persons with severe physical disabilities fall ill, give birth, attend a funeral, or take care of another social obligation, or when they make a trip or need respite for other personal reasons. The facilities for care and rehabilitation for persons with disabilities (medical care, rehabilitation and sheltered workshop) provide services of taking care of their everyday needs.
3. Day services
Day programs are offered to promote creative activities and provide functional training at non-residential facilities so that persons with physical disabilities can live independently, enjoy their lives, and maintain or improve their living skills. Services provided;
(1) Assistance for bathing and offering meal (2) Artistic activities: handicrafts, painting, calligraphy, and pottery (3) Functional training: ADL, walking, and housework (4) Guidance in personal care: instruction in care techniques to family members (5) Social adaptation training services: conversation, sign language, and Braille (6) Rehabilitation consultations: medical, welfare, and daily life (7) Recreation
4. Provision of technical aids and equipments for daily living
Technical aids and equipments are supplied or leased to persons with severe physical disabilities so that they can complete routine activities as smoothly as possible.
Below are some examples of the types of technical aids and equipments supplied or leased.
(1) Impairments of lower limb and trunk: bathtubs (including water heating equipment), toilet facility, bathing stretcher, special type bed, special type urinal, posture-changing device, other auxiliary equipments needed for bathing, lift for mobility, assistive devices for walking, equipment to support daily activities, and subsidy for reform. (2) Upper limb impairments: personal computers (3) Visual impairments: tape recorder, watch for the blind, braille typewriter, braille books, CCTV (Closed Circuit Television), the aid to extend the time of traffic crossing, and OCR (optical character reader) (4) Hearing impairments: indoor light signal system: alarming with light/vibration, and decoder for receiving broadcasts by Communication Satellite (CS) (5) Visual and hearing impairments: Braille display (6) Respiratory impairments: nebulizers, and electric phlegm suction devices (7) Kidney impairments: dialytic liquid heater (8) Common for persons with various disabilities: fire alarm device, and automatic fire extinguisher (9) Items for lease: welfare telephones, and facsimiles (10)Group use: word processors for persons with visual impairments
5. Home visit and guidance for persons with severe physical disability living at home
Doctors and other professionals are dispatched in cases where a person with a severe physical disability lives at home but has difficulty to come to hospital or rehabilitation center. The visit can include a physical assessment, consultations on daily living, welfare, medical treatment, and work, and referral to appropriate facilities.
4. Measures to Promote Social Participation
To realize “Full participation and equality” and “Normalization,” it is very important to make the environment accessible for persons with physical disabilities to live independently in their community and participate in society.
1. Independent living support programs and comprehensive programs to promote social participation
The following programs are aimed at realizing the concept of normalization so that persons with various disabilities to live independently as full-fledged members of their community, enhancing public awareness concerning persons with disabilities, and creating a society in which everybody can achieve happiness.
《 Program menu for prefectural governments 》
(1) Comprehensive programs for persons with disabilities to promote social participation 1) Establishment of prefectural centers for persons with disabilities to promote participation in society 2) Management of a disability hot line for consultation 3) Development of peer counselor activities 4) Training of assistance dogs for persons with physical disabilities 5) Training of daily living skills
- Instruction in daily living skills
- Speech therapy for persons with voice impairments and therapist training programs
- Family workshops
6) Information service programs
- Building of networks to provide prompt information by Braille
- Training of helpers for Braille translation, reading and summary writing
- Training of sign language interpreters
- Training of interpreters and guide helpers for persons with visual and heari
- Placement of sign language interpreters at public institutions such as Welfa
- Establishment of rental libraries for closed captioned video for persons with hearing impairments
- Publication of Braille and tape-recorded versions of public relation materials
7) Mobility assistance programs
- Provision of information on guide helpers
- Network for dispatch of the sign language interpreters
8) Promotion of sports and artistic activities
- Organization of sports and recreational workshops/classes
- Training of sports instructors
- Organization of courses on arts and culture
9) Awareness programs
- Information services on social resources
- Awareness raising activities to avoid prejudice and discrimination towards persons with disabilities
10) Municipal programs to promote social participation
- Helper dispatch services
- Sign language interpreter dispatch services
- Assistance for obtaining a driver’s license, vehicles renovations subsidy
- Assistance for community living
- Support for individual activities
- Family counseling service referrals
- Support for volunteer activities
- Peer counseling
11) Dispatch guide and interpreter for persons with deaf-blindness Programs to dispatch interpreters and personal assistants who can help persons with deaf-blindness so that they can live independently and participate in society are being offered. 12) Comprehensive programs to promote information technology
- Management of information technology support centers for persons with disabilities
- Recycling of personal computers
- Program to support access to information
- Training and dispatch of volunteer computer teachers
- Promotion program to use personal computers
(2) Comprehensive programs to promote independent living 1) The System to Support the Fees to Purchase the Services 2) Issuing the Certificate
- Provision of Certificate for Persons with Intellectual Disability
- Provision of Certificate for Persons with Psychiatric Disability
3) Employment promotion programs by applying job in the open labor market on trial basis. 《Program menu for municipal governments》
Municipalities level of government with which persons with disabilities have the most contact, implement programs that meet their needs and promote their participation in society for realizing the concept of normalization. Many services are executed by municipal governments, but some are entrusted to local welfare organizations for persons with disabilities. (1) Municipal programs for persons with disabilities to promote social participation 1)Services for living in the community
- Instruction in daily living skills
- Assistance for community living
- Support for individual activities
- Family counseling service referrals
- Support for volunteer activities
- Peer counseling programs
- Recycling of technical aids and equipments
- Helper dispatch service
- Placement of sign language interpreters
- Dispatch service of sign language interpreters
- Publication of Braille and tape-recorded versions of public relations materials
- Assistance for obtaining a driver’s license, vehicle renovations subsidy
- Mobility service for persons with severe physical disabilities
4) Promotion of sports and arts activities
- Organization of sports and recreation classes/workshops
- Organization of arts and culture courses
5) Programs to promote coordination among municipalities 6) Programs to run accessible buses equipped with lifts 7) Programs to create barrier-free communities (2) Municipal programs for persons with disabilities to support independent living 1) The System to Support the Fees to Purchase the Services 2) Mobile bathing service 3) Program to support independent living 4) Provision of expense
- Provision of allowance for rehabilitation training
- Provision of allowance for persons with disabilities who have completed rehabilitation services and are starting work in company.
5) Apprenticeship on commission
2. Municipal programs to support the daily activities of persons with disabilities
Through a comprehensive implementation of the services listed below, municipalities seek to provide support for persons with disabilities living at home and promote their independence and social participation.
Types of services : (1) Subsidies for welfare services for the homebound (2) Support for the use of social resources (3) Enhancement of community life skills ability (4) Peer counseling (5) Referrals to professional organizations
3. Management of welfare homes for persons with physical disabilities
Welfare homes for persons with physical disabilities, which are mainly run by local public entities and social welfare corporations, provide private rooms and technical aids and equipments for persons who are unable to live at home because of their disabilities and offer other services necessary on a routine basis.
4. Sheltered workshops for persons with physical disabilities living at home
Light work at small-scale sheltered workshops, which are run by social welfare corporations or the Japanese Federation of Physically Disabled Persons, is made available to persons with severe disabilities who would otherwise have difficulty finding employment.
5. Peer counseling services
Peer counselors are posted to provide consultations and guidance to persons with physical disabilities to promote their active participation in the community and public awareness for their community cooperate with Welfare Office or administrative organizations.
6. National Athletic Games for Persons with Disabilities
Athletic games at the national level are organized every year for the purpose of letting persons with disabilities enjoy and experience sports through actual participation, promoting their participation in society, and enhancing understanding of disabilities among all persons.
(1) participants: persons with physical disabilities and intellectual disabilities 13 years of age or more. (2) Venue and time: The prefecture that hosts the National Athletic Game in the autumn takes charge of this event, which is held after the close of the National Athletic Game (3) Events: track and field, swimming, archery, table tennis, flying disk, bowling, basketball, wheelchair basketball, softball, grand softball, volleyball, soccer and foot baseball
5. Institutional Services
A variety of facilities exist to provide medical treatment and therapy, training in daily living, for those who want to work but have a hard time finding employment or rehabilitation services for those who have difficulties in living independently at home.
Rehabilitation and care facilities for persons with physical disabilities are classified as the following four categories, depending on their function. The first type, rehabilitation facilities, where training and therapy are mainly provided. The second, residential facilities, where care services and help for everyday activities are offered. The third, day activity facilities, where training in life and work skills are provided for those who have difficulty in finding employment opportunities. The fourth, community centers which is available for persons with disabilities living in the communities. Persons with disabilities can choose the type of facility depending on their needs.
1. Rehabilitation and care facilities for persons with physical disabilities
(1) Rehabilitation facilities
|a. Rehabilitation facilities for persons with orthopedic disabilities||Functional training is provided for persons who have a possibility of regaining a sufficient degree of work skills, regardless of the degree of his or her disability.|
|b. Rehabilitation facilities for persons with visual impairments||Training and knowledge on massage therapy, acupuncture and moxa therapy are provided.|
|c. Rehabilitation facilities for persons with hearing and speech impairments||Treatment and training needed for rehabilitation are provided.|
|d. Rehabilitation facilities for persons with internal organ disorders||Guidance and therapy necessary for rehabilitation are provided under medical supervision.|
(2) Residential facilities
|e. Nursing institutions for persons with physical disabilities||Medical treatment and nursing care are provided for those who need 24 hours personal assistance and who have difficulties to have personal assistance at home.|
|f. Welfare homes for persons with physical disabilities||This is housing for persons with physical disabilities who want to live independently in community.|
(3) Day Activity facilities
|g. Sheltered workshops for persons with physical disabilities||Vocational training and job opportunities are provided for those who have difficulty in finding employment opportunities so that the users can have working opportunities and live independently. (Training is geared toward employment in a company or self-employment, and the length of stay thus depends on the individual.)|
|h. Non-residential sheltered workshops for persons with physical disabilities||One type of sheltered workshops. Services provided are the same as g. Users|
|i. Small-scale sheltered workshops||Sheltered workshops with 20 or fewer users. Services provided are the same as h.|
|j. Industrial workshops for persons with physical disabilities||Facilities for wheelchair users, who have work skills but cannot be employed due to inaccessible work place and transportation.|
(4) Community Centers
|k. Type A Welfare centers for persons with physical disabilities (Type A is established at prefectural level)||Facilities that provide consultations and services designed to promote good health, lifelong learning, sports and recreational activities.|
|l. Type B Welfare centers for persons with physical disabilities (Type B is established at municipal level)||Facilities that promote creative activities, skills trainings, and social adaptation through day programs for those who have severe physical disabilities living at home, and who have limitation in going out and job opportunities.|
|m. Day services for persons with physical disabilities||Facilities that promote creative activities, skills trainings, and social adaptation through community day programs as well as offer bathing and meal services for those who have severe physical disabilities living at home and are not able to find work.|
|o. Holiday centers for persons with disabilities||Accommodation facilities where persons with disabilities, their families, and volunteers can stay and relax are provided.|
|p. Braille libraries||Libraries where persons with visual impairments can use and borrow Braille publications and voice books|
|q. Braille publishing facilities||Facilities where Braille materials are published.|
|r. Information centers for persons with hearing impairments||Facilities where captioned videocassettes are produced and lent, sign language interpreters are dispatched, and information devices are leased.|
|s. Manufacturing Facilities for prosthesis and orthosis||Facilities where prosthesis and orthosis are manufactured and repaired.|
|t. Guide Dog Training Facilities||Facilities where guide dogs are trained and persons with visual impairments receive instruction on the use of a guide dog.|
|u. Homes for the Blind||Facilities where persons with visual impairments use facilitating their vocational life in massage techniques, acupuncture, moxa treatments, and other occupations including training.|
2. Measures for residents of institutions
(1) Allowance for rehabilitation and training Allowance covering the purchase of stationery and other goods needed for training are provided to persons with physical disabilities at rehabilitation and care facilities or residential facilities where vocational training programs are provided. (2) Allowance for preparation to be employed Allowance are provided to persons with physical disabilities who are starting working life after completing rehabilitation services to achieve independence through employment.