There is a daughter who called the community service center on behalf of her mother, who has trouble getting around. She applied for a home visit in which a doctor comes to the house, and the waiting period she was told about was one month. Thirty days lie between saying a system exists and saying care has arrived.
Integrated care has started as a system. It was a promise to tie medical care, long-term care and living support into a single window so that people could leave hospitals and facilities and grow old in the homes where they had been living, and on paper that design is close to complete. The problem begins after the window opens. The time it takes for a person who has filed an application to actually meet a doctor is written nowhere in the design.
Women are overwhelmingly the majority both among those who receive care and those who provide it, yet a gender perspective is rarely visible in the language of integrated care. Things like the burden on an older woman living alone of letting a stranger into her house, or the weight of nursing quietly passed on to daughters-in-law and daughters, disappear from the plans. When people are set down as a genderless average, policy looks precise, but it goes wrong the moment it crosses the front door.
The integrated care pledges of the new local government heads should be judged as promises about how soon care will arrive. A sentence about cutting the number of days from application to first visit changes residents' lives more precisely than a sentence about how many centers will be built. Now, with the terms under way, is the time to demand that sentence.
Arrival time does not shrink because a local government decides it should. There are not enough doctors willing to make home visits, the central government holds the fee schedule and staffing standards, and in rural areas the travel distance itself becomes the waiting period. Demanding that the head of a basic local government cut thirty days to ten can amount to telling them to take responsibility for something outside their authority.
Even so, there is a reason to use time as the standard. The moment waiting periods are disclosed and measured, it becomes clear whether the bottleneck comes from staffing, from budgets or from a failure of coordination. If the authority lies with the central government, taking that evidence and pressing the central government is also part of a local government head's job. Without measurement no one takes responsibility, and without responsibility the thirty days quietly harden.
The people who receive care are citizens who have decided to go on living in their own homes. They are not something to be handled as objects of charity. Supporting that decision is the administration's part, and whether the decision has been kept is confirmed in units of a single day.
Some things are changing now. As a number of local governments merge their care windows into one, application records that were scattered have begun to pile up in one place. Those records make it possible, for the first time, to count who waited and how long. If a local government head says they will take the first year's report card in those waiting days rather than in photographs from a completion ceremony, integrated care starts working from that point.
