Caring for Japan's elderly

Professor Manami Hori, of Tokai University explains how they approach care for the elderly in Japan

In Japan, care and support were long considered a family responsibility. In fact, it has been generally expected that daughters-in-law would take care of parents, and wives would care for their husbands. However, as Japan’s elderly population is growing at an unprecedented pace, it has become difficult to rely solely on families.

Japan has the world’s highest longevity and average life expectancy increased by more than 30 years between 1947 and 2005. While longevity is desirable, it has resulted in a new phenomenon called “elderly-to-elderly care” where the elderly have to care for one another.

Moreover, since the late 1970s, the average number of people per household has decreased. At one end of the age spectrum, more elderly people live alone. At the other end, birth rates have declined, exacerbating the problem of a shrinking labour force. Women are now expected to work rather than care for family members.

Prior to 2000, eligibility for care was based on household means testing. With limited resources, only high-priority, low-income elderly people received services.

Some elderly people who did not qualify underwent lengthy hospitalisation. Compared to other countries, Japan has many more hospital beds per capita, and “social hospitalisation” (a sort of delayed discharge) became an issue. Patients were staying in hospital for long periods, not for medical care, but because they had nowhere else to go.

In 2000, Japan introduced Long-Term Care Insurance (LTCI) as a way of combating this growing challenge. LTCI is a form of social insurance, half funded through insurance premiums and half funded through general taxation. People aged 40 or older and the elderly (65 plus) are covered.

LTCI provides services irrespective of income or family circumstances. Users pay a flat 10 per cent of the expenses incurred.

While there is room for improvement, LTCI has been received mostly favourably in Japan, and the majority of users are satisfied. In particular, improving access to and choice in care and support for people who did not qualify for welfare services, or could not afford private nursing care services, has led to human rights being secured for many individuals.

However, for low-income earners, the introduction of a 10 per cent contribution increased the burden on them for receiving the same service. Although there are measures to reduce this, some people decline care and support for financial reasons.

There is also much debate around the contribution made by families. There is no system of compensation for care given by family members and it is not easy to define family care. With the number of single-person households rising rapidly, benefits based on family care may not be realistic in the future.

Unfortunately, it is very difficult to design a system where all groups are 100% satisfied. Equality for all is an ideal but it is not easy to achieve. In any case, it will be important to establish a system where people can receive the necessary care while striving to live independently.

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