TOYAMA – Sitting around a table, a dozen elderly women watch affectionately as small children play next to them. When one opens her book, a little boy runs up and asks, “What are you reading?”
It’s a typical scene at Konoyubi Tomare, a day care facility in the city of Toyama. The elderly women are being cared for because they have dementia, and the children because their parents are at work, explained Kayoko Soman, one of the facility’s founders.
“We see no need to separate the elderly from the children, or the disabled from the able-bodied,” Soman said.
“The children’s presence alone is enough to make the old ladies smile,” she added. “At the same time, the grannies will also reprimand the kids if they become too rowdy. That’s all natural, since this is how we normally live in our own homes.”
Soman and two former colleagues launched the first Konoyubi Tomare house in 1993 under the principle of keeping its doors open to all: children, the elderly, the disabled and everyone else — all under one roof. This unique system, which later came to be dubbed the “Toyama style,” has had such a great impact that more than 1,400 nursing and day care facilities across Japan have adopted such a policy.
What initially inspired Soman, who spent 20 years as a nurse at Toyama Red Cross Hospital, to enter the nursing care business was her encounter with an elderly woman who had been hospitalized by a stroke.
As the woman’s condition improved, she was given permission to be released and wanted to return to her home. But due to family constraints, she ended up being transferred to another hospital instead.
“I want to make wishes come true for the elderly who want to go home, and to enable them to live their last moments happily,” Soman said. “I also want to help families whose members are too busy with work and cannot care for the elderly.”
Soman and her partners decided to open a facility just for that purpose. But during consultations with city officials, they were told the facility must narrow its services to one particular kind of clientele — the elderly, disabled or children — to qualify for subsidies.
“If that’s the case, we don’t want the subsidies,” Soman recalled thinking.
Pooling together their retirement funds with some loans, the three forged ahead with their project.
On the first day of business, a young mother came in with her 3-year-old son, who had cerebral palsy. Soman said she still remembers the smile on her face when she returned that afternoon to pick him up. She said it was the first time she’d been able to go to the hairdresser’s since he was born.
The following year, in 1994, Japan entered its “aged society” era as people 65 or older surpassed 14 percent of the population. Along with the rise in working women, the nation as a whole began to see the need to shift nursing care responsibilities, traditionally the family’s domain, toward specialized facilities and other support frameworks at the community level.
The Toyama Prefectural Government began making subsidies available for Soman’s day care services in 1996. Two years later, it went further by offering subsidies to all such facilities that care for both the elderly and disabled under one roof, giving the Toyama style nationwide legitimacy.
In 1999, the facility was recognized as an incorporated nonprofit organization. By coincidence, the day on which they were certified at City Hall — May 12 — was Florence Nightingale’s birthday, which is marked by International Nurses Day.
Thanks to the subsidies, they were able to ease the financial burden on some clients. As the business grew, they hired more staff and opened a facility for overnight stays.
In time, as they addressed customers’ needs, Soman and her co-founders saw the business expand to six different areas, including employment support for the disabled.
“We aspire to be a foothold for the community, to be right there when the need arises, just like convenience stores,” Soman said.
The future of Japanese nursing care is not without challenges, however. The national labor shortage is a particularly grave issue, with experts estimating that Japan will be about 1 million employees short in a decade’s time.
One solution is to fill the gap with foreigners. Of the roughly 1.68 million nursing care workers in Japan, according to health ministry estimates, only 200 are foreigners who came to Japan under economic partnership agreements or other arrangements and are still working in the field.
Until about 10 years ago, Soman was against the idea of employing foreigners as caretakers. Back then, the labor shortage was not as serious and she felt that “responsibility for the care of Japanese people should be borne by the Japanese people.”
But then the day came when reality hit, and Soman realized that less than half of the seats were being filled at her recruitment events. After seeing foreign workers contributing actively in other industries, she now thinks it is only reasonable to seek their help in the field of nursing care, too.
“I’m confident that we can move forward by breaking down the barriers and not discriminating against anyone, not only on the side of those being cared for, but also on the side of the caregivers,” Soman said.
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