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Money talks faster than reforms:
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| Residents
of Matsudo Nissei's Garden of Eden practice ikebana, one of the senior
citizen facility's many recreational activities. PHOTO COURTESY OF MATSUDO NISSEI'S GARDEN OF EDEN |
Matsudo
Nissei's Garden of Eden is a private seniors' home located in a natural
environment near Matsudo, Chiba Prefecture.
In addition to a small theater that shows classic films, a swimming pool and playrooms that offer more than 30 types of recreational events, its medical center is almost as well-equipped as a small hospital.
The facility provides both nursing care and "lifetime living rights." When a tenant's health deteriorates, he or she is moved into a special room and provided nursing care until the end.
But a quality environment like this has its price. On top of a lump sum ranging from 32 million yen to 63 million yen, residents must pay 6.8 million yen for future nursing services plus 200,000 yen or so a month to cover administrative, food, utility and other costs.
Amid the protracted economic slump, such facilities are becoming too expensive for most people. And some social welfare experts say privately run homes face the risk of bankruptcy due to unforeseen added costs, as the health of some tenants deteriorates faster than anticipated.
According to Chiaki Akaike, director of the Garden of Eden, the introduction of the nursing-care insurance system in April 2000 was a big plus for both homes and their residents.
Financed by taxes and premiums from people over age 40, the system gives financial backing to both private and public institutions to provide care-related services.
Under the system, the homes refund a portion of tenant fees, and in turn receive insurance money. While privately run homes used to depend fully on tenant fees for income, they can now receive up to 200,000 yen per month per caregiver, via nursing-care insurance.
"It used to be difficult to estimate the number of elderly people who would come to need advanced nursing care," Akaike said. "If our estimate was too high, it was reflected in the tenant fee. On the other hand, if it was too low, we had to cover the risk. Now planning is a lot easier."
Japanese facilities for senior citizens can be classified into about 20 types, depending on the needs of the residents and what entity operates them.
Government-run special nursing homes, commonly called "tokuyo," are currently the most popular alternative to private institutions.
They may be reasonably priced at 70,000 yen per month for a shared room, including nursing care, meals and general expenses, but critics say they leave much to be desired in terms of facilities and care in comparison with private homes.
Unlike private homes, tokuyo usually don't accept tenants until they are beyond the point where families can care for them, meaning relatives will probably shoulder the burden of caring for an elderly person for a long time. At present, there is also a waiting list of 230,000 people.
As of last July, there were 4,866 tokuyo nationwide, with their combined capacity of 320,000 filled to 97 percent. The remaining 3 percent is fluid, covering residents who have either left the facilities to enter hospitals, some temporarily, or those who have died.
Although many tokuyo are soundly managed, there have been reports of tenants being abused, including being bound to beds or given strong drugs to control them, especially when they get senile.
Board of Audit investigations have also turned up cases of shady management of money that had been entrusted to the institutions on behalf of the tenants.
"When it was not (socially) acceptable to put parents in an institution, families whose parents lived in such homes were made to feel bad," said Ikuko Honma, representative of The Citizen's Group to Improve Tokuyo Homes, explaining why abuses, money mismanagement and other issues have remained unresolved.
"Families were made to feel thankful just to be able to receive welfare, so they didn't feel they could comment on how the old were treated," Honma said.
Tokiko Mizuochi, chief researcher of the Information Center for Elderly Homes, run by a publisher of books on social issues, noted that many seniors now reaching the point when they need to enter elderly homes only receive about 50,000 yen in benefits per month, due to changes in the pension system.
"There is a shortage of good tokuyo, and private homes are too expensive," Mizuochi said.
The government hopes to use nursing-care insurance to improve the tokuyo, such as introducing single rooms. Currently, four to eight people share a room.
The government also hopes tenants will be able to select a tokuyo instead of being assigned to one, as has been the case.
While such changes are slow, and getting into a tokuyo itself is often difficult due to their chronic shortage, Honma said she wants the homes to become places where seniors can reap the benefits of the taxes and nursing-care insurance premiums they have paid throughout their lives.
"Authorities should be able to (monitor) tokuyo, which use more tax money than private homes," she said. "And taxpayers should know they are entitled to live in a tokuyo that charges a reasonable (monthly) fee of 120,000 yen for a private room."
Mitsuhiko Okada, deputy director of the health ministry's Health and Welfare Bureau for the Elderly, said that given the tokuyo shortage, the ministry is working to improve their nursing services both at home and at facilities such as care houses -- a simpler and less expensive version of private nursing homes -- so more elderly receive proper care.
The ministry plans to initiate a comprehensive five-year plan to improve the services and number of homes later this month, he said.
Akihide Matsuoka, an adviser at the Japanese Association of Retirement Housing, said the economic slump and introduction of nursing-care insurance are not the only changes affecting privately run homes for the elderly.
Luxury elderly homes featuring units costing as much as 100 million yen flourished during the economic bubble of the 1980s. Now, deregulation is paving the way for homes with a wider range of services and facilities, he said.
But while there is a growing number of options for elderly people, depending on their financial situation, deregulation has also caused problems.
The Japanese Association of Retirement Housing has compiled information about its member homes' facilities, including prices, services and even negative information, such as the number of tenants who have canceled contracts after moving in, to help consumers. It is also urging more home operators to become members.
To increase the number of homes for seniors, the government is easing its criteria to allow more parties to manage such facilities, according to Matsuoka.
In recent years, a growing number of corporate dormitories have been sold off and turned into senior citizens' homes, as companies shed employees amid the protracted economic slump.
These facilities have received government approval.
Although dormitories may not meet the necessary standards for caring for the elderly, recognizing their activities is one way to keep tabs on them, Matsuoka said. "Otherwise, no one would see what is going on inside."
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