Japan has the worlds oldest population. One in three Japanese are aged 60 or older which is why it is considered a “hyper-aging” country. This will soon be a world-wide trend with much of Europe, Asia and the USA experiencing an aging population. Even here in New Zealand we are all preparing for the “baby boomer bubble”. So, what can we learn from a country who is already in the “future”?
Until 2000, publicly-funded social care was nonexistent in Japan; caring for the elderly was a family responsibility. There were two main consequences of this approach. First, there were many reports of neglect and abuse towards older people being looked after by family members. In a survey conducted by the Japanese government, a third of carers reported feeling “hatred” towards the person they looked after. Caring also restricted the employment options of a growing number of Japanese women. A second issue was the development of a phenomenon known as “social hospitalisation”. Historically, there was stigma attached to putting your elderly parents in a care home yet there was no stigma attached to admitting them to hospital as it was seen to be a medical issue. Therefore, older people had been being admitted to hospital for long periods – not for any medical reason, but simply because they could not be looked after anywhere else. This should remind us of the consequences of having a health and social system, which one being more accessible than the other.
In response, the Japanese government did something radical.
They introduced long-term care insurance, offering social care to those aged 65+ on the basis of needs alone. The system is part-funded by compulsory premiums for all those over the age of 40, and part-funded by national and local taxation. Users are also expected to contribute a 10% co-payment towards the cost of the service. The costs are seen as affordable and the scheme is extremely popular.
The result is that on turning 65, people become entitled to wide-ranging social care support, from home-based help with cooking and dressing to residential respite, intermediate and permanent care. Long-term care in Japan includes some nursing and medical care for long-term conditions. An individual’s needs are assessed and they are assigned a care level which determines their entitlement. Individuals are required to pay some co-payments and ‘hotel costs’ for residential services (means-tested). The oil in the machine is the care manager who holds the budget and puts together a package of care.
Long-term care services have developed to wrap around mainstream health services. A competitive market of provision has emerged and many thousands of providers offer services. Many established hospitals have branched out into social care provision, extending their services to include home-based support and residential homes for those with dementia.
However, it would be a mistake to see this as a problem solved. The Japanese scheme was introduced at a time of relative financial and political stability and in a very different cultural setting. The uptake of services has far outstripped expectations and the Japanese government is faced with spiralling costs. Their response has been to introduce higher co-payments for wealthier adults. There are definitely lessons to be learnt here.
Japan is leading in other areas, such as robotics. Long used in industrial settings, Japanese researchers are now looking at whether robots can help as the country ages, from robot suits that help rehabilitation to fully functional humanoid robots.
One of the best examples currently on the market is a robotic seal called Paro, invented by Takanori Shibata, the chief senior research scientist at Tsukuba’s National Institute of Advanced Industrial Science and Technology. The fuzzy seal has been proven in various settings to reduce anxiety, stress, depression and even patients’ perception of pain during chemotherapy treatments. Distributors in various countries (including New Zealand) have sold over thousands of seals in 30 countries and are deployed by 80 per cent of Denmark’s local governments in state-run nursing homes. Dr. Shibata says the seal is especially useful for calming dementia patients and stops them from wandering around. It has often replaced heavy doses of psychotropic drugs.
Robotics are also used to help reduce injuries in older workers, i.e robotic arms that allow elderly farmers to continue picking fruit in old age. There are also non-robotic, mecahnical aids that can ease the strain on nurses and caregivers; The hospital in Asuke, for example, has a mechanical swing that can help move patients from their bed or onto the toilet. Unfortunately the main barrier to these technologies is the price.
However, robotics are considered such an important part of Japans future that several experimental programs are now financially backed by Japan’s powerful Ministry of Economy, Trade and Industry. I am sure we will all benefit from the amazing advances made in this industry over the coming years.