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For elderly residents, city life doesn't get old

by Philip Brasor and Masako Tsubuku

The government in Japan is facing an immediate demographic crisis with regards to seniors, whose numbers relative to the general population are increasing rapidly. One of the main problems is where they are going to live out their lives.

According to a 2015 report by the Japan Policy Council, Tokyo anticipates a deficit of 130,000 “caregiving slots” by 2025, an estimate that assumes that a good portion of the elderly are going to require some level of nursing care. Both the private and public sectors are trying to create nursing facilities, but the endeavor may not be sustainable: Once the baby boom generation starts dying at the end of the 2020s, many of the facilities will become redundant and expensive to maintain.

Nevertheless, local governments in Tokyo and other densely populated areas are making arrangements to have their poorer elderly residents shipped off to nursing facilities in the countryside, where the problem at the moment tends to be a lack of human resources.

But what if you didn’t send people off to the sticks? What if you did the opposite: Persuade the elderly to stay in the cities or, if they live in rural areas, move to cities, where they can live longer on their own thanks to a greater concentration of public services and amenities?

A recent series in the weekly magazine Aera told the story of a 70-year-old Tokyo woman who, when she was 50, built a house with her older husband in the mountains of Tochigi Prefecture after his retirement. For years the couple enjoyed rural life without any special assistance. They drove everywhere and went skiing in the winter. After a time, however, the woman’s husband became ill and she had to drive almost an hour each way to the hospital where he received care. After he died, she realized that living alone in such an isolated place would become more difficult as she aged, so she sold the house and moved back to Tokyo.

She now lives in the large apartment complex in Takashimadaira, built by Japan’s former national housing authority. Two years ago, the management of the complex established a system that provides special staff who cater to the needs of elderly residents, a service for which residents pay an additional fee to their rent. At the moment, though, the woman does not need any special attention, such as ongoing medical assistance. In fact, she has become more active since moving back. The subway is a 10-minute walk from her apartment, and because of her age and financial situation, she can use a free pass that takes her anywhere in Tokyo. She’s even gotten a job.

The Takashimadaira program, called Yuimaru, presumes that the more active an elderly person is, the longer he or she can live without care. As a number of experts have pointed out, the idea of sending elderly city people out to depopulated areas inadvertently mimics an old rural practice known as ubasute, in which infirm senior family members were carried to the tops of mountains and left to die. A more practical and humane policy would be to encourage older people to remain in the city, where they don’t have to drive and amenities, including retail outlets and hospitals, are much easier to access.

The main obstacle to this approach is cost. Cities are expensive and an increasing portion of old people are classified as impoverished. Even those who have some savings and a decent pension may not be able to survive comfortably in the big city without help from the public sector.

But even when the public sector acknowledges the practicality of the back-to-the-city scheme it doesn’t always know how to implement it. Several public and semi-public housing complexes in Tokyo have prioritized space for elderly tenants, but the result has been an over-concentration of old people that tends to exacerbate their special difficulties.

The city-run Toei apartment complex of 16 buildings along the Sumida River contains a total of 2,312 housing units. About 38 percent of the households are headed by people over 65, compared to 22 percent throughout the surrounding Sumida Ward. Last year, about a dozen people died alone in the complex and weren’t discovered for some time, because there is no system in place to check up on them.

Similarly, Shinjuku Ward has designated its Toyama Heights apartment complex near Takadanobaba Station as a place where elderly residents receive priority housing, and the Tokyo government is renovating units in the complex in order to accommodate the increasing number of single-person elderly households. As a result, however, the complex has become an old people’s home, except without the nursing facilities. Fifty-three percent of the residents are over 65 and all are, by definition, poor, because that’s how you get a slot in the complex. It’s become a kind of slum for the old and infirm.

According to Aera, a university research group has set up an office in the Toyama complex to monitor the situation, a survey of the elderly residents found that 92 percent want to live there until they die. This situation is known as “aging in place,” and has become the preferred model for elderly living. It means that instead of moving people to nursing facilities, services need to be provided so that they can live out their days in familiar surroundings. The problem in the case of Toyama Heights, however, is not just money. It’s also the nature of a collective housing community.

What’s needed is “informal care”—neighbors looking out for one another. The neighborhood association chief for Building 35 of the complex is an 85-year-old man who told Aera that last year 10 people living along died in the building, and more than half of them were not discovered for several days. He can’t keep tabs on everyone because of his age and the lack of manpower. He has to rely on other residents.

In response, the Tokyo Metropolitan Government has initiated an outreach program called kōreisha mimamori sōdan (elderly monitoring advice), wherein civil servants and neighbors check up on older residents on a regular basis. The director of a foundation for elderly housing issues told Aera that the biggest barrier to such monitoring is the most obvious one — the metal front door to an elderly person’s apartment.

“We have chosen a lifestyle where we are isolated from our communities because we desire privacy,” he says. “So we have to figure out how to care for one another by taking this reality into consideration.”

Takashimadaira’s Yuimaru system removes some of the need for monitoring by purposely placing elderly residents in buildings with younger families and couples, a mixture that makes for a greater degree of openness among neighbors. Reportedly, the semi-public housing corporation UR is looking at a similar system for its rental housing properties, where vacancies are on the rise. In addition, more physicians are branching out into zaitaku iryō, meaning “at-home medical care.” The trend is obvious: Rather than make old people adjust to the current social situation, make the social situation adjust to old people’s welfare.

Philip Brasor and Masako Tsubuku blog about Japanese housing at www.catforehead.wordpress.com.