Experts debate pitfalls of nursing care plan

Many Japanese who go into a blue funk over the rapid aging of society may see a silver lining with the Lower House’s approval May 22 of key social-welfare bills.

But while they welcome the passage of the set of three bills, which will clear the way for the establishment of a public nursing care insurance system for ailing elderly people, social welfare experts say that a heap of problems need to be resolved before the system can become as effective as expected.

Yuzo Okamoto, a professor of geriatrics and health science at the Kobe City College of Nursing, said passage of the bills by the House of Representatives is “epoch-making” in Japan’s history of social welfare. “It showed that the ailing elderly should be taken care of by society and not just by individual households, as is traditionally done in this country,” Okamoto said.

Keiko Higuchi, a professor of social studies at Tokyo Kasei University, echoed this view. “The task of looking after elderly people has been left mainly to the women in families with such people. But the nation has started to recognize the issue as a social one that should be tackled by politicians,” Higuchi said. “It is a big historical change.”

A 1992 survey by the Health and Welfare Ministry showed that about 90 percent of those looking after Japan’s approximately 900,000 bedridden elderly were women, and that 50 percent of them were 60 or older. Many experts say the ongoing dramatic demographic change has made it almost impossible for individual nuclear families to take care of ailing elderly people by themselves.

The health ministry’s Institute of Population Problems has predicted that people aged 65 or older, who currently make up about 15 percent of the population, will represent about 26 percent in the early 2020s, and that the number of senior citizens in that age bracket will peak at 32.75 million in 2021, when the post-war “baby boomers” enter their 70s.

Meanwhile, the number of newborns has been gradually decreasing year after year since the late 1970s, from about 1.9 million in 1975 to approximately 1.2 million in 1992. “The need for social support for the ailing elderly and their families is so imminent that the system should be started anyway and improvements made while it is in operation,” said Shozo Ikeda, secretary general of the 10,000 Citizens’ Committee to Realize a Public Elder-Care System, based in Tokyo. “The public should not just wait and see what administrators do for them. Instead, people should take part in the administration more actively to make a better society,” he said.

Ikeda stressed that people should at first call on the government to review one provision in the bills, which states that the system will take care of those aged 65 and over and those aged between 40 and 64 who need care due to senility-related disorders. “It means that when people in the younger age bracket become invalids due to accidents and many diseases that are not related to aging, they will not be eligible to obtain services, although they will still have to pay for the insurance system. It will constitute serious discrimination against them,” Ikeda said. “A review should be made to cover all people who need care, regardless of their ages and the causes of their condition.”

Yasuki Kobayashi, a professor of medical economics, pointed out that prefectural governments, instead of municipalities, should be made responsible for operating the system. The bills state that each of the 3,255 municipalities across the nation, ranging in size from a small 198-resident village to a big city of 3.3 million people, is required to operate the system and handle its financial matters. “It would be almost impossible for small villages to organize all the necessary things and deal with the financial matters related to the system without inviting bankruptcy,” Kobayashi said.

Through the introduction of the nursing insurance system, the government hopes to suppress skyrocketing medical costs, one-third of which are spent on those who are 70 or over. The problem is that the medical costs for senior citizens include expenditures on so-called “social hospitalization,” in which those who need nursing care, not medical treatment, are hospitalized because of the shortage of nursing homes and other care facilities.

Yoko Kimura, an associate professor of social welfare policies and finance at Nara Women’s University, warned against the government’s optimism. She pointed out that the expected effects of cost-reduction would be limited once infrastructure preparation, including building facilities for the nursing care system, does not progress as scheduled. Kimura said that what is important is to provide the elderly with necessary medical treatment and nursing care in an appropriate manner, regardless of where the elderly live.