Japanese society realizes with anguish that it has not finished aging. So much so that it worries that it no longer has enough staff, or even taxpayers, to operate its long-term care system on which many seniors rely.
During her studies, nurse Ryoko Nakamura dreamed of traveling and international aid. She finally decided last year to quit her job at a Tokyo hospital to care for seniors at home on the island of Osaki-Shimojima in south-central Japan, home to 1,700 residents.
“Society here is already old. There is no secondary school, and most young people leave the island”, testifies the 39-year-old carer, that The duty accompanied during his round of visits to senior patients. It is professionals like her that small private care companies have difficulty recruiting, and this, everywhere in the Japanese countryside.
The society here is already old. There is no secondary school, and most young people leave the island.
The company that employs him bears the English name of Nurse&Craft. She settled three years ago in an old wooden building, which once served as a hospital in this small village on the borders of Hiroshima prefecture. In the vicinity, there is a small Shinto shrine and a monument to Japanese soldiers who died in the war. A mandarin tree grows right next to it. You have to take off your shoes to enter the offices.
“In municipalities where the population is declining, it does not attract staff. In town, it’s easier,” says his boss, Fukasawa Hiroyuki.
Low salaries, even in the private sector
Mr. Hiroyuki had to innovate to attract candidates by offering a four-day-a-week schedule and allowing his employees to take on second jobs, which is exceptional in Japan. The problem remains low wages: home health aides — they are mostly women — earn 200,000 yen a month (just over $2,000).
“Young girls who are still single and who work in this sector, who only have this income, do not want to marry a man from the same field. Even doubled, this salary is not enough,” says the entrepreneur. Her employee, Ryoko Nakamura confirms that the move and integration into the village were more difficult for her husband, a computer scientist who works from home.
“In the Japanese long-term care system, the benefit ceiling is low. It is the state that decides the price of services, how much it is worth to visit a patient. The amount of money that goes to staff is miniscule,” criticizes Mr. Hiroyuki. He hands out brochures of the high-end services he offers to wealthier seniors, helping his company to be profitable.
The private sector has established itself at unequal speed in Japan during the two decades following the entry into force, in 2000, of the new Japanese long-term care system, named Kaigo Hoken : care is provided by the private sector, but is partly paid for by the government (45%), by compulsory public disability insurance (45%), and by the provider’s own wallet (10%). This system is now experiencing its golden age, favoring the least expensive care, most often at home.
Almost everywhere, private care companies or non-profit associations have taken over from the municipalities, which were once responsible for providing care to the elderly on their territory. From now on, the role of local governments is limited to validating, with a specialized investigator, the need for patient care, on a scale of 1 (slight physical limitation) to 5 (heavy cognitive impairment).
Shortage of workers
We still need personnel to take care of the 20 million Japanese who have passed the age of 75. The country saw nothing less than the decrease in the number of workers. The country has already experienced its population peak, in 2010, with 128 million people. It has since lost one and a half times the population of Montreal (2.5 million people), and expects to lose more than the entire population of Quebec by 2030 (9.4 million).
We are on the verge of no longer being able to keep society running
For lack of children, more than 8,500 schools have closed in Japan since the year 2000. Japan’s declining birth rate means that children under the age of 15 formed the smallest proportion of its population in 2021. never recorded at less than 12% (compared to nearly 16% for Quebec in 2022). Even though immigration is increasing slightly from one year to the next, it represents just over 2% of the total population. Foreigners, for the most part, are only accepted on a temporary basis.
“We are on the verge of no longer being able to maintain the functioning of society”, declared bluntly the Prime Minister of Japan, Fumio Kishida, during a major speech on January 23, on the occasion of the Japanese parliamentary return.
The leader, however, promises to increase the birth rate, which has been falling for fifty years. His plan includes measures for education, childcare and parental leave. Details are to be debated in Parliament this spring.
Anticipated malfunction
Social work professor Yūki Yasuhiro of Tokyo’s Shukutoku University fears the government is cutting budgets for seniors to fund its promises to young people. “I am 53 years old, but I believe that when I am 85 the system will be in total dysfunction. »
In Tokyo, the headquarters of Japan’s Ministry of Health, a modern concrete building a stone’s throw from the Emperor’s palace, is guarded by a dozen uniformed security guards, most of them very old. In the morning, they greet each employee who comes to the office with a short bow.
In a small, neon-lit room cluttered with filing cabinets, four civil servants armed with a printed and attached presentation of complex organizational charts on the system Kaigo Hokenare made available to the Duty. The government is well aware that funding will become a major challenge, they say, as fewer and fewer workers contribute. Expenses will only continue to grow.
The ministry does not know exactly how it will save its model, for the moment very effective. It provides for a new plan for 2024, which should tie an increase in the price of contributions to a strategy to reduce the cost of care, while entrusting prevention mandates to community groups or automating certain tasks thanks to robotics.
The future of the system also worries nurse Ryoko Nakamura. On the doorstep of her client’s house, she philosophizes, however: “We have less to fear from the lack of staff if we manage to live independently until the end, and die without being bedridden for too long. That’s a good life! »
This report was made possible with the financial and logistical support of the Foreign Press Center of Japan.