Like many older Japanese, 90-year-old farmer Heidemi Miyahiro has become a caregiver to his 87-year-old wife. If the latter can stay at home with him, it is thanks to the services paid for by public disability insurance, a model that has already been proposed in Quebec.
Despite his venerable age, the fruit grower still goes every day to pick the lemons and juicy tangerines that grow on his small patch of mountainous land. Mr. Miyahiro finds it more difficult to take care of his wife, Yoshie, who struggles to move about due to leg pain. His autonomy wavers. She needs his help to know what medicine to take.
“This task is new to me. Without the help of a home nurse, I wouldn’t be able to do it,” says the farmer from Osaki-Shimojima Island.
The place was formerly nicknamed “the golden island” for the quality of its citrus fruits, grown even in winter. However, the fall in prices has led to the devitalization of this island community of 1,700 inhabitants. Few vehicles now cross the bridge that leads to this island, whose cliffs seem to float on the Seto Inland Sea. The COVID-19 pandemic requires that the few pedestrians and cyclists wear face coverings. Some have hunched backs. All obviously belong to the third age.
To get to the Miyahiro couple, you have to park near the quay in the village of Kubi and continue on foot. The narrow streets are lined with traditional two- or three-storey wooden houses. We pass stone stelae and a torii of concrete, the characteristic portal of Shinto shrines. The town surrounded by imposing mountains has 420 souls, nearly three quarters of whom are over the age of 65.
“Since last year, the nurse has come to help my wife take a bath. Someone also comes to help with the cleaning. As long as it is possible, we would like to stay here, ”says Mr. Miyahiro, through our interpreter.
We are all seated on a tatami floor, in front of a coffee table, in the common room of the couple’s small house. Many books, clothes and objects of all kinds are piled up in the room, where there is a large adapted bed, lent by the local care centre. The television is on. A portable electric heater next to his wife is working at full speed. Yoshie half-opened his oversized fleece jacket to let the nurse, present during the visit of the Dutytake his pulse.
Private care, public insurance
Although Japan is a rich country, its government realized, shortly before the turn of the 2000s, that it would hardly have the means to take care of all the elders who were going to find themselves in the situation of the Miyahiro couple. . It therefore replaced the public financing of this care with a new hybrid public-private model, called “Kaigo Hoken”, based on long-term care insurance. Other countries have also adopted this system, such as Germany, France or South Korea.
Compulsory from the age of 40 and for life thereafter, the insurance costs 6,000 yen per month (about $60) per person and is deducted from the paycheck or old-age pension. For those most in need, the amount is included in social assistance benefits. Unlike Quebec, where the bill is borne by the public system, Japanese long-term care is paid for equally (45% of the cost) by the government and by the benefits of this insurance.
The patients themselves have to pay the rest out of pocket, ie 10% of the price of the service, or more for wealthier older people. Patients choose the service they want from a private provider, which incentivizes cheaper care, often at home.
savings for the state
“When a caregiver comes to visit at home, this patient does not have to be accommodated in a center. This allows the state to save money, ”explains Yuki Yasuhiro, professor at Shukutoku University in Tokyo and specialist in social protection for the elderly. In short, the model transfers part of the costs to the workers and the patients themselves and relieves the public finances of a country which accumulates world records for longevity (see box).
Japanese society is still aging, however, and its long-term care system, although effective, is compromised by the expected decline in the number of workers.
Insurance inspired by the Japanese Kaigo Hoken has already been proposed in Quebec, and was the subject of a Parti Québécois bill in 2013. The project died on the order paper when elections were called the following year. Its author, former Health Minister Réjean Hébert, still believes that it is “extremely urgent” for Quebec to adopt such a system. ” [Ce modèle] is expensive, that’s for sure, but it’s absolutely necessary if we want to avoid what is currently happening in Quebec, in Canada. That is to say that, not having good access to home care, it is the even more expensive solution of CHSLDs that is used, with all that that implies, waiting lists and costs enormous for the healthcare system. »
In March 2022, the Premier of Quebec, François Legault, mandated the Commissioner for Health and Welfare, Joanne Castonguay, to study how to improve the offer of home care. The publication of an interim report, initially scheduled for last December, has been postponed twice, and is now scheduled for the week of March 20.
This report was made possible with financial and logistical support from the Foreign Press Center of Japan.