Abuse at nursing care facilities

The shocking murders of three elderly residents in a nursing care home in Kawasaki — allegedly by a care worker at the facility — should also shed light on the growing problem of abuse of elderly residents by care workers at such facilities, often blamed on a chronic manpower shortage due to low wages, the tough workload and high turnover of employees. While more details of the case need to be exposed in the criminal investigation of the 23-year-old care worker, including his motives behind the killings, efforts to prevent the recurrence of such acts cannot bypass scrutiny of the working conditions of care workers.

As Japan’s population rapidly ages, demand for care workers is expected to outstrip supply. The Abe administration seeks to increase the capacity of nursing care homes to accommodate 500,000 more people by the early 2020s. But such a move without sufficient manpower could make matters worse. The government should face up to the need to improve the conditions of, and support for, care workers.

Hayato Imai was arrested this week on suspicion of killing an 87-year-old male resident of the elderly home with nursing care services in November 2014 by throwing him off the veranda of his fourth-story room. He has also reportedly confessed to similarly killing two others — women aged 86 and 96 — the following month. The suspect has been quoted by police as saying that he had been “offended by the remarks and behaviors” of residents at the facility and he had various troubles on the job. In May, Imai had been arrested and convicted of stealing the wallet of one of the home’s residents and was subsequently fired.

A recent Health, Labor and Welfare Ministry report shows that there were 300 confirmed cases of senior residents at nursing care homes being abused — physically or otherwise — by workers at the facilities across the country in fiscal 2014. The record figure, double that of 2012, is believed to represent just the tip of an iceberg because many cases go unreported to local municipalities. There were more than 1,100 cases where abuse was suspected but could not be confirmed.

The operator of the Kawasaki facility — a major nursing care service firm based in Okayama — admitted in November that over the past two years abuse by care workers had taken place in about 20 percent of the facilities it runs across the country, including cases that had not been reported to the authorities.

About 80 percent of the victims of abuse at nursing care facilities suffer from senile dementia. The three victims at the Kawasaki facility reportedly suffered from senile dementia and memory disorder. Physical violence accounts for the largest number of abuse cases, followed by psychological abuse, theft and embezzlement, and neglect. The problem is that such abuse mostly takes place behind closed doors where only the caregiver is present with the victim — and may not be discovered unless family members pay a visit to the facility and learn of the abuse from the victim.

The largest group of care workers accused of abusing elderly residents of the nursing care facilities — or 22 percent of the total — were younger than 30. According to the health ministry, workers at nursing care facilities quit the job after an average of 5.7 years — less than half the all-industry average of 12.1 years. The high turnover of workers is attributed to low wages — ¥100,000 lower than the all-industry average — and the physically demanding work. The Kawasaki facility, which accommodated 70 residents, including some who required help eating and going to the bathroom, had 41 care workers — more than half of whom had less than three years of experience on the job.

In December, there were 3.06 job openings in the nursing care service sector per each job seeker — way above the national average of 1.27. The chronically acute staff shortage is said to lead many operators of nursing care facilities to turn to people with little or no experience or training in the job to fill manpower needs. Many of them quit after a short period, increasing the already heavy workload on the staff who remain. It is reported that such staff, who eventually can feel cornered and isolated, may subsequently vent their frustration by abusing their charges. The health ministry report cites problems in the care workers’ education, knowledge and technique, their mental stress, as well as their character and qualifications.

It is not clear what triggered the suspect in the Kawasaki case to kill the three elderly residents. But there are clues to what prompts many care workers to abuse the elderly residents of their facilities — and those causes should be addressed.