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Gray of Japan: Choju Shakai
By: Sue E. Levkoff
Aging International / Summer-Fall 2000
Population Aging
Lower fertility rates translate into lower rates of population growth. Experts predict that by the year 2007, Japan will have 127.8 million inhabitants, but that the population will diminish to 100.5 million by 2050 (Japan Aging Research Center, 1999). This anticipated lack of population growth translates into a larger elderly percentage of the total population and subsequently, a declining number of potential care givers. By 2050, a projected 34.6 percent of Japan’s elderly will belong to the “oldest old,” those individuals more than 80 years of age. In order to maintain the level of the elderly percentage of the population at its 17 percent, the age that defines rojin(the elder) would have to rise from 69 as of 2010 and to 73 by 2025.
Elder Care
Children’s obligation of providing care for their elder parents is fundamental aspect of Japanese culture. “Oyakoko” meaning respect for parents reflects this Japanese traditional value. Therefore, multigenerational housing is a significant source of economic support to elders as well as for increased interactions with family members and visitors Ikegami, 1998). In 1996, between 55 and 60 percent of the elderly liveed with their children, as opposed to less than one in ten in the
US.(Naohiro). While preference of elderly for independent housing are still low relative to American numbers, they are rising as Japanese culture becomes less rooted in tradition (Watts, 1998).
Japanese elders themselves still strongly prefer that health-related caregiving be provided by family members. However, the increasing number of women entering the workforce have made potential caregivers less interested in providing care to their parents. Also expanding life expectancy has caused the situation in which caregivers are themselves past retirement age.
Other evidence that supports a weakening of filial responsibility, particularly upon the eldest son, is the erosion of the traditional primogeniture inheritance pattern, leaving all assets to the eldest son, which has persisted despite legal provisions for equal inheritance in the 1984 revision on the Civil Code (Sugawara, 1989). Parents increasingly tend to pass on their property and assets to the child who provides care and/or co-reside with them. The 1988 Family Survey found that nearly a half of respondents believed that parents’assets should be inherited by the primary
caregiver(Suragawa, 1989). Only a quarter of people aged 60 and over reported that they intended to pass on any assets to their children in a 1986 survey(Prime Minister’s Office, 1986). Fifty-six percent of individuals aged 60 and older reported that they preferred to spend their assets on themselves rather than leave them to their children (Mainichi Newspaper Opinion Survey Department, 1993).
Elderly Housing
Because these more traditional expectations of family support continue, few nursing homes exist. Even in the early 1990s, 33.4 percent of seriously ill, bedridden elderly persons were cared for by spouses or their children. The number of beds for long-term institutional care was projected to increase from 189,830 in 1989 to 570,000 in 1999, with the proportion of institutionalized elders being 2.6 percent, compared to 5 percent in Western Europe and North American
countries(Maeda, 1998).
Three major types of government-subsidized non-profit institutional facilities for older people exist: (1)”Home for the Aged,” for elders who are independent and modest, but insufficient means; (2) “Nursing Homes for the Elderly,” for those who are bedridden and or mildly mentally impaired; and (3) “Home for the elderly with Moderate Fees” for elders who are independent and have sufficient means.
In addition to the need for institutional care facilities, there is growing demand on the part of relatively well-off elderly persons who desire to stay in the community. The “Care House,” the equivalent of assisted living facilities in the United States, has emerged as an alternative housing option that allows elders with mild physical impairment to continue to lead relatively independent lives, with meals, social services, and other services provided on site (Maeda, 1998;Shimizu and Wake, 1994). In cooperation with the Ministry of Health and Welfare, “Silver Housing” model projects have begun to be built since 1986. This is congregate housing for either the elderly living alone or elderly couples, equipped with an emergency alarm system, and personnel to coordinate health and social services (Shimizu&Wake, 1994).
Community-Based Health Services for the Elderly
Long term care to the aged is often provided in hospitals due to the few long-term care facilities and limited availability of in-home care services. This phenomena of “social hospitalization” is consistent with the Japanese value of loss of face and stigma associated with institutionalization (Maeda, 1998; Shimizu and Wake, 1994). The tendency for medical practice for the elderly to emphasizes ‘passive care (e.g., bed rest)’ also supports the practice of “social
hospitalization”(Rodwin, 1994).
In response to increasing interests and concern regarding the creation of public services for the older population, the Japanese government revised the 1990 Gold Plan in 1994, now called the “New Gold Plan,” to achieve the goals before 1999. The New Gold Plan placed a special emphasis on increasing community-based geriatric health service through various training programs that would help develop the necessary manpower for services such as home helpers, Day Service Centers, Short-Term Stay Service, and visiting nurse services (Maeda, 1998). The government also increased the number of intermediate nursing homes where frail elders can stay before their hospital admission in order to lessen the heavy burden on hospitals (Ogawa and
Retherford, 19917).
Retirement
Many elderly face inadequate retirement income. [T]he financial assistance portion of Japan’s social security program is insufficient to cover the needs of many elderly.
In 1990, the Law Concerning Stabilization of Employment for Older Persons was revised with the Ministry of Labor offering age in order to keep older workers on the payroll up to age 65 (Ogawa, 1998). There are increasing resources for reemployment among the elderly. Some firms are instituting programs to transfer retired workers into different division, occupations, or even industries. Firms whose workforce is 6 percent or more elderly employees(age 60-64) receive subsidies from the government, as do those that retain workers until age 65 or help to re-train workers who are approaching retirement. Part -time work is common, but so are extended periods of
unemployment(Ogawa, 1998).
The role of public pensions in Japan is growing in importance, while private sector pensions and personal saving mechanisms are declining. The percentage primarily relying on earnings also fell from 31 percent to 25 percent(Japan Aging Research Center, 1999). Between 1981 and 1995, the percentage of individuals over 65 who reported that a public pension was their major source of support for living expense increased from 35 percent to 63 percent(Japan Aging Research Center, 1999). The decreasing number of elders who rely on savings can probably be linked to falling labor force participation, as well as persistence of the age 60 mandatory retirement in many
companies(Ogawa, 1998). The Japanese government has stepped in to support Silver Manpower Centers-agencies that attempt to match retirees with paid or voluntary work, encourage participation in community life, and support elders in the transition from work to retirement with leisure activities (Maeda, 1998; Strom, 2000). They have experienced limited success, however, as only approximately 60 percent of elders enrolled in their programs have found paid work (Maeda, 1998, Rowe and Kahn, 1997; Storm, 2000).
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