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Staff writer

The last-minute hustle by lawmakers to revise the new public-care insurance system for the elderly is causing confusion and public outcry, especially with municipal officials who have been working for the last two years toward the system’s launch in April.

Spearheaded by Shizuka Kamei, policy chief of the Liberal Democratic Party, the tripartite ruling coalition agreed last week to provide cash allowances for families that care for elderly relatives at home, in addition to a six-month grace period on premium payments from those over age 64.

In response, the government reportedly started considering paying up to 100,000 yen a year, plus an unspecified amount of noncash contributions, to such families on condition that they do not receive public nursing care.

Criticized widely as pork barrel politics for the next general election, which must be held before October 2000, the measure angered many municipal officials, who fear the move could threaten the very spirit of the public-care insurance system.

“It is like taking away a ladder from beneath us,” said Sadanori Mori, mayor of Takahama, Aichi Prefecture. Last December, Mori announced that the city’s cash allowance of about 80,000 yen a year for ailing elderly and their families would be terminated once the public nursing-care system starts.

“In order to avoid a situation of ‘insurance without service,’ we have been working hard to secure proper services,” Mori said. “The (cash allowances) should instead be spent on building infrastructure for nursing-care services.” Mori said that such home-care allowances would work as a disincentive for municipal governments to develop infrastructure.

Under the public-care insurance system, people aged 40 or older pay premiums, and service recipients are charged 10 percent of the cost. The monthly premium for those over 64 is estimated at a national average of 2,915 yen at the start of the system, varying in accordance with the quality of services each municipality provides and individual income levels.

Under the scheme, services are available for elderly in one of six categories of nursing-care need. The quantity and quality of services differ according to the level of need, with the highest providing about 368,000 yen per month.

About 2.8 million elderly people, 16 percent of the entire senior population, are expected to become beneficiaries of some kind of nursing service at the start of the system.

Its advocates say the new system clarifies the relationship between what you pay and what you get.

The system will make it easier for recipients to claim their right to proper service, while municipal governments are obliged to ensure services worthy of the premiums their citizens pay.

Currently, there are various free welfare services for the destitute elderly. Because they are offered out of humanitarian concerns, however, it is difficult for recipients to demand better service.

The new system is also aimed at encouraging the participation of the private sector in providing care services.

Ensuing competition is also expected to enhance the quality of services and diversify choices while bringing down costs.

Kamei of the LDP, however, contends that a public-care service could destroy “Japan’s beautiful tradition of children taking care of their parents” and proposed the cash allowances in order to promote family care.

But Mayor Mori and others fear that such cash allowances will fuel a so-called nursing hell, the very situation the system was designed to alleviate.

Due to the rapid graying of the Japanese population, the burden on those caring for elderly family members has become heavier, with the elderly and women hardest hit. About 50 percent of care-givers are said to be age 60 or over and about 85 percent women.

The new public-care insurance system was designed to help free these people from their “hell.” But advocates of the system say the offer of cash allowances would bind family members, especially women, to caring for the old.

“The allowances kill the spirit of the public-care system,” said Keiko Higuchi, professor at Tokyo Kasei University. Higuchi is also a member of the Health and Welfare Ministry’s public-care insurance panel.

Higuchi argued that the idea of cash allowances ignores the reality of the power dynamics of Japanese families, in which women are often placed in a weak position, especially with respect to their in-laws.

“If money is given to family members taking care of the elderly, they will be required to take on a further burden,” she said.

Higuchi said many women, especially those caring for in-laws, fear they may be told by their relatives to take on a bigger burden because they are being paid for it.

Also, there is possible moral hazard in providing money for family care, which is often closed to outsiders, Higuchi said, pointing out the widespread abuse of the elderly by their kin.

“No matter how much they love their family members, there is a thin line between love and hate,” Higuchi said.

“First of all, the system is focused on providing care at home and designed to maintain family ties by reducing the excessive burden on those who take care of their elderly relatives,” she said.

Besides moral arguments, some lawmakers have voiced concern for their constituents in thinly populated, remote areas where the infrastructure for nursing care is lagging.

Still, Akira Mitsutake, mayor of Sasebo, Nagasaki Prefecture, opposes the cash allowance plan.

“If (the central government) disburses money for family care, it will further delay the building of necessary infrastructure for nursing care because municipal governments will become less pressured to secure services for their people,” he said.

According to Mitsutake, on Takashima, an island in Sasebo with a population of 180, there is still a strong custom of offspring caring for elderly parents.

However, he doubts the custom will last forever, because family care has its own limit, no matter how willing family members are.

While Mitsutake admitted the social infrastructure is lacking in some parts of the city, he is confident municipal government efforts will be able to improve the quality of services.

In this regard, Higuchi compared nursing-care to a school education.

“No one says we should give families money and let them educate their own children no matter where they live. Nursing-care has become a basic necessity and it should be supported by public services,” Higuchi said.

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