This series of blog posts by author Patti Digh will focus on aging in the countries whose wines we will taste at our Wine Around the World event on Thursday, October 12, 2017. Purchase tickets here! Wine Around the World 2017.
Lessons from an elder-care approach gone wrong
Japan is a country that combines the oldest population in the world with levels of public debt to match Zimbabwe. Their experience illustrates the consequences of retracting state support for eldercare too far and relying on individual and familial support.
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.” Older people were being admitted to hospital for long periods–not for any medical reason, but simply because they could not be looked after anywhere else.
The response from the Japanese government was 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 older people in Japan can access a wide range of institutional and community-based services.
However, it would be a mistake to see this as a problem solved. 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, but the challenges continue. Other countries would be well-served to study the long-term impact of Japan’s decisions in order to course correct.