In recent weeks, there have been two major news stories related to the issue of senior nursing care. In one, the Supreme Court reversed a Nagoya High Court ruling that ordered a 94-year-old woman to compensate JR Tokai for damages caused in 2007 by her then 91-year-old husband, who, suffering from dementia, disrupted train service when he wandered onto the company’s railroad tracks and was killed. In the other, a former nursing home employee in Kawasaki is suspected of having thrown three residents to their deaths.
Due to the sensational nature of these two items, the media has covered them in detail. However, not all have connected them to current debates taking place in the Diet that bear directly on nursing care. For instance, a Lower House panel is now discussing revisions to a law for kaigo kyūgyō, or paid leave for the purpose of taking care of an ill family member. One of the new touchstones of Prime Minister Shinzo Abe’s economic recovery policy is making sure that no one has to quit their job in order to care for an incapacitated parent full time. According to government surveys, about 100,000 people a year resign or retire to do just that.
Anyone who needs time to take care of a family member can get up to 93 days of paid leave. The revised version of the law proposes that employees be allowed to divide this period into three isolated blocks of time, so that if the employee returns to work before the 93 days are up, they can later take more time off as the need arises. Welfare minister Yasuhisa Shiozaki says that studies show that 90 percent of workers who take time off for elderly nursing care do so three times.
According to the Asahi Shimbun, the opposition has complained that the revisions won’t solve the real problem, which is that companies often ask employees who request such leaves to quit since it’s difficult to determine how much time they will need in the long run. The 93-day limit might be suitable for maternity leave, but a chronically ill parent, even one with dementia, could live for a number of years. Mitsubishi Research Institute conducted a study in 2014 that found the average amount of time taken off to care for a loved one was 45 months. Under such circumstances, it’s no wonder employers prefer to let them go.
Exacerbating the incoherence of the policy is the fact that the government, in a bid to save money, is cutting its outlays from the kaigo insurance fund, which suggests it wants more families to accept the burden of caring for sick elderly relatives at home. This policy clearly contradicts — or, at least, complicates — the purport of the kaigo kyūgyō law: On the one hand, families are encouraged to take care of their elderly members at home and, on the other, workers are encouraged to retain their jobs when they have elderly relatives in need of care. The woman in the JR Tokai suit was 85 and napping when her husband wandered off and got hit by a train. Her 65-year-old son, who didn’t live with his mother, was originally a defendant in the case since JR said he shared liability because he hadn’t sufficiently monitored his father. For this family, home care didn’t work.
Rational thought is also lacking in nursing home policy. In line with kaigo cutbacks, the government has slashed payments to these facilities, while at the same time promising to give nursing homes more money for staff wages so as to address the high turnover rate. As it stands the average salary for a full-time caregiver is about ¥1 million less per year than the national average for all workers. The government’s wage subsidy will only increase it by ¥144,000, and it isn’t clear if this money actually reaches the intended workers.
A two-part Asahi article that appeared on March 2 and 3 explained the employment situation for nursing home workers. The suspect in the Kawasaki deaths told police he was frustrated by the constant calls from residents, many of them senile, on long night shifts during which he was required to follow a strict manual of operations mandated by management. Asahi describes in horrific detail one night shift at a different nursing home in Tokyo where only two workers are responsible for 47 residents. The men are constantly answering calls by residents who need to use the toilet or have their diapers changed. When one user falls down, the supervisor has to accompany him to the hospital, leaving his colleague to fend for himself, and he can’t keep up with the demand on his time.
The Nippon Careservice Craft Union reports that 80 percent of nursing care workers are dissatisfied with their work, with most toiling overtime for no additional pay. And as the Kawasaki incident suggests, abuse is rampant and almost impossible to control. Some facilities have implemented anti-abuse training sessions, but few workers can attend them because they’re offered during working hours and everyone is too busy. Part 2 of the Asahi series explains examples of new equipment and programs that should alleviate much of the pressure, both physical and mental, that employees put up with in the course of their work, but these facilities are still being run mostly by profit-making organizations — many are franchises — that have bottom lines to maintain. And as demand for workers increases in other industries, more and more caregivers opt out of the occupation, even if they have a nursing care credential and a dedicated spirit of altruism.
The high turnover rate is self-perpetuating, because nursing homes are staffed by people who don’t stay long enough to gain meaningful professional experience. The government’s nursing care policy is driven not by social need but by political convenience and the good graces of businesses and the public. Statistics say that after 2025, when the last of the baby boomers turn 75, the demand for nursing care will start decreasing. Until then everyone will just have to do the best they can.