1. Requirements and Proposal of Guidelines by the Prime Minister's Office for Planning Services for People with Disabilities in Municipalities
Article 7, Clause 2, Term 3, of the Fundamental Law for People with Disabilities enacted in November 1993, contains a provision that requests that the municipalities should "make an effort to establish a basic plan about measures for people with disabilities."
Some of the contexts that contributed to the introduction of this regulation into the law include: (a) after the International Year of Disabled Persons, and following the United Nations Decade of Disabled Persons,in order to develop measures according to the principle of normalization, the role of the municipalities is considered to be important, and their active efforts are demanded: (b) historically, the municipalities -- the level of government most familiar to people -- have been obligated to make plans for the health and welfare of elderly persons, and have tackled such plan-making eagerly, and (c) it was admitted that in order to revise the Fundamental Law of Measures for People with Mental andlor Physical Disabilities after twenty-three years, and to make it the basis for measures for people with disabilities, a regulation should be established dealing with the obligations to make basic plans and present annual reports to the Diet.
However, at the present time, only one-tenth of all municipalities have made plans for people with disabilities. Recognizing this, in May, 1995, guidelines for municipalities making plans for people with disabilities were prepared as a measure to promote plan-making at the municipal level by indicating guidelines that could be the basis of the plan-making.
Because the focus of measures for people with disabilities is shifting to community services and home services under the principle of normalization, the role of the municipalities will become more important in the future.
The administrations supporting people with disabilities at the national, prefectural, and municipal level should be operated systematically and effectively, and in a consistent form, with the plans for people with disabilities that all municipalities make based on the guidelines and a clear understanding of the situation of people with disabilities in the community, and of the human and material resources relevant to measures for people with disabilities.
B. Health and Medical Care
1. Current Trends in Services for People with Severe Motor and Intellectual Disabilities (SMID)
In the population of people with intellectual disabilities, life-threatening health problems are found more frequently than in people without intellectual disabilities. Generally, a higher mortality rate is observed among people with severe retardation. It is also well documented that complications such as intractable pneumonia and gastrointestinal disorders are observed most frequently in persons with profound retardation, associated with severe motor disabilities such as inability to walk, scoliosis, spastic tetraplegia,and swallowing difficulties.
In the 1960's, two non-governmental hospital-homes were established in Tokyo which specifically aimed at medical care, nursing, and family support for children with severe retardation who had multiple physical impairments. These hospital-homes were greatly appreciated by the Parents' Association as well as by medical professionals who were taking care of children with severe disabilities. In 1967, the Ministry of Health and Welfare published guidelines for hospital facilities for children as well as for those for adults who had had severe motor and intellectual disabilities (SMID) since their childhood. Since then,special facilities for people with severe motor and intellectual disabilities have been opened nationwide,including special hospitals and special wards in government hospitals. In 1996,16,000 such beds are
