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Kaigo hoken throws spotlight on life in ‘nursing care hell’


A few weeks ago I submitted a proposal for an April Fool’s story to a local publication. The piece would have been a news report about Japanese airline companies taking advantage of “Japan’s rapidly aging society” by offering “nursing care miles” to frequent flyers in order to attract middle-aged travelers. The joke was supposed to coincide with the start of the new kaigo hoken (nursing care insurance) system that, coincidentally, went into effect April 1.

Some people at the publication expressed interest in the piece, but it never got a go-ahead, which is understandable. In order for the joke to have any resonance, readers would have to understand the kaigo system, and, according to the media, they don’t.

An article in the April 23 issue of Sunday Mainichi reported that “newspapers and TV” haven’t sufficiently covered the public’s “unease” and “dissatisfaction” with the new system. I think the media has done a fairly conscientious job of trying to explain the details of the plan — the Asahi Shimbun, for one, has done numerous series in the past year. So if the public is uneasy and dissatisfied with the plan itself, it’s likely the media has made them that way.

The authorities say that about 2.8 million elderly people require some kind of nursing care right now, and that this number will increase to 3.9 million in 10 years. Medical costs are rising but the population isn’t, so the government will have to pay out more in benefits for national health insurance while taking in less in the form of premiums. In the past, nursing care was earmarked as welfare. Turning it into “insurance” that everyone over 40 has to pay into takes some of the financial pressure off the government. (Most people have forgotten, however, that the consumption tax was originally sold as a palliative for the “aging society,” but turned into something else.)

At the same time, benefits are graded in terms of the type of care needed, and for the most part, the media tend to focus on the worst cases, meaning bedridden people who cannot possibly take care of themselves. It is this sector that has given rise to the phrase “nursing care hell,” which usually refers to caretakers — almost exclusively women — who tend to elderly family members at home.

Like “commuter hell” and “exam hell,” “nursing care hell” is not a natural phenomenon but rather something that is socially or culturally imposed, and therefore theoretically avoidable. In Japan, it is “traditional” for women to take care of their elderly parents, in-laws or husbands. Women who complain about it are considered cold and ungrateful.

If the kaigo issue has done anything, it has made people re-evaluate the “tradition” in more ways than one, and in this regard, the media has done much to elucidate inequalities, albeit inadvertently.

NHK has aired a number of kaigo-related special reports since the beginning of the year that attempt to come to grips more with the reality of the situation than with the nuts and bolts of the new system. Two weeks ago they broadcast one that dealt exclusively with men taking care of their elderly, incapacitated wives.

In the three cases shown, the men all entered into their caretaking roles willingly, even enthusiastically, the idea being that “she took care of me for so many years, so it is only right that I pay her back.” But there’s more than a feeling of reciprocity involved. These men feel redeemed when they change their wives’ diapers and get up in the middle of the night to turn them so that they don’t get bedsores. They feel they are doing something good.

It’s touching, but also self-centered in a way. One of the wives was not yet bedridden. She had suffered a stroke and could only walk and talk with difficulty, but she could still use the toilet herself and her mind was obviously unaffected. She understood that her condition was likely to deteriorate, and though her husband pledged to take care of her regardless of how bad she got, she told the camera that she would prefer a professional caregiver. “I don’t want him carrying me into the toilet,” she said.

The other two women were too far gone to offer an opinion. Nevertheless, women’s feelings about kaigo, whether giving it or receiving it, seem to be different from those of men, and for obvious reasons. An article in the April 10 issue of Aera recounted several horror stories of women who care for family members.

One woman talked about taking care of her father-in-law for a number of years because her mother-in-law didn’t want to do it, then taking care of the mother-in-law, and now her husband. Another woman, in her 60s, recounted how she has been caring for elderly relatives since she was 25. None of these women feel redeemed. They simply feel tired. Nursing care is not a noble cap to their lives, but a neverending chore they feel they must carry out.

If the government really wants to improve the lives of future old people, then they should start by promoting better housing and city planning that doesn’t trap them in their homes, where they are more likely to be inactive and thus become invalids. Secondly, they have to somehow battle the stigma attached to outside care.

It is entirely possible that the kaigo hoken system will not only make it financially easier for families to use outside care providers, but emotionally easier as well, simply by its very existence. With yen signs in their eyes, related companies are already scrambling to provide kaigo products and services. They’re buying time on TV for commercials that inevitably feature happy elderly people lying in bed. And that’s not a joke. In a capitalist society, if you want to alter a tradition, the first thing you do is commercialize it.