Staff writer When the government first announced its planned public nursing-care insurance program, group homes were to be covered. The definition of "group homes," however, is causing problems for some small operators, including the Tanoshiya nursing home in Urawa, Saitama Prefecture. When the system goes into effect in April, the facility will continue to be ineligible for government subsidies due to the regulation that recipient care homes give each resident a private room. Tanoshiya is a group home, a style of nursing care facility that was launched in the late '80s in Scandinavian countries. They have become popular in Japan in recent years as a viable alternative to full-scale welfare facilities. They usually care for a small number -- 10 or less -- of elderly citizens with senile dementia in relatively stable physical condition. While the guidelines for group homes set by the ministry last year cover 90 percent of the cost of nursing services provided for eligible elderly citizens, residents of Tanoshiya are ineligible for the subsidy. "The Health Ministry's regulations say that each resident must be provided with a single room," said Kazuko Yamanaka, a staff member at the house, adding that residents here share a room divided by a curtain. The plight of Tanoshiya, or "Joy House," is far from unique. The six women who reside here, ranging between 75 and 92 years old, face a risk that is shared by residents of other small-scale facilities. "It is difficult to meet the single-room condition in remodeled houses," Yamanaka said. "But only these types of facilities can provide the family-like environment that residents enjoyed before they arrived here." Currently, each resident pays a monthly fee of 180,000 yen plus a 500,000 yen initial payment. It's not enough, according to staff members, who say the house needs at least double that amount to provide its services without additional funds, such as the hoped for public subsidies. Since the house opened in November 1998, the staff and the residents' families believed that the new public nursing-care insurance program would make their lives easier. The Health Ministry's announcement of the single-room requirement, however, has dashed those hopes. "We were working hard to keep the operation going by raising funds through various ways, including bazaars, until the system started in April," said Kazuko Nire, from Omiya, Saitama Prefecture. Her 83-year-old mother-in-law, who suffers from Alzheimer's disease, was admitted to Tanoshiya in April. Nire said her mother-in-law's condition has improved since then. "But if we are denied nursing insurance, we cannot afford to let her stay here any more." The reasoning behind the government's introduction of the single-room requirement is not without merit. The very nature of group homes is of concern to the ministry. They are worried about the potential risk of abuse and other human rights violations. Officials say they are concerned about the possible entry of profit-oriented, low-quality operators into the field following the introduction of the new insurance system, which will open the potentially lucrative nursing care market to private business. "We get inquiries from people who intend to start group homes, and I am often surprised to find how many of them don't know anything about welfare," one official said. "Some are simply trying to launch group homes as a lucrative business." Experts say the family-like environment and personal care provided in group homes has proven beneficial in slowing the progress of dementia -- more so than at bigger nursing homes. A further benefit is the freedom permitted to residents, which is possible because of the smaller number of occupants, Tanoshiya Director Hiroyuki Watanabe said. "Here, they can live their own lives," he said. "If they did the same in regular nursing homes, they would be accused of 'problematic behavior.'" While Watanabe says he understands the necessity of basic rules to ensure the rights of residents, he questions the wisdom of strictly implementing the single-room policy. "Some of the residents here want a roommate, saying they become anxious at nights if they go to bed alone." With the prospect of a bureaucratic about-face slim, Tanoshiya began searching for an alternative location. After considerable effort, they have secured a candidate site. The estimated cost of remodeling the new facility, however, is 16 million yen. Consequently it will be a long time before operations can shift to the new location. Concerned family members of Tanoshiya residents filed a petition with the Saitama Prefectural Government in December, asking for coverage from April at the current facility as a stopgap measure. Meanwhile, Nire criticized the ministry's strict rules, saying those motivated by bad intent will find loopholes in the system anyway. "Instead, authorities should place more stress on monitoring to ensure appropriate practice," she said. Seiichi Takahashi, an associate professor of economics at Tohoku Fukushi University, is also worried that the ministry's single-room rule might eliminate the merits of group homes, which utilize existing homes in the community. Under the new rule, he said, group house operators must build facilities to meet the conditions. Moreover, the new facilities will probably be in remote places. Despite this, the Saitama Prefectural Government said the single-room policy is one condition that must be met. "Don't we need space to be alone even among family members?" one official said. According to the Health and Welfare Ministry, the number of elderly people suffering from dementia is estimated at 1.6 million and is forecast to reach 2.3 million by 2010. While the exact figure is unknown, there are about 600 group homes nationwide, with many more scheduled to open in the near future. The ministry has set a goal of creating 3,200 group homes as part of its five-year plan for building welfare infrastructure for senior citizens. While ministry officials recognize the positive mental effects of group homes, the real reason behind the ministry's policy is the perpetual shortage of publicly subsidized nursing homes. As of fiscal 1998, about 47,000 people were on the waiting list for nursing homes nationwide. The nationwide capacity was 280,000, according to the Health and Welfare Ministry.
