Introduction
Let me introduce our honored guest this morning. This is
Professor Sodei from the Ochanomizu University in Tokyo.
Professor Sodei is a professor of gerontology with the
Department of Social Science and Family Studies, and that
department is located at the university in the School of
Human Life and Environmental Science. We are very
honored to have Professor Sodei today. The professor is
going to speak with us about changes in social policy in
Japan. I hope her comments will be very useful and
helpful to you. We are very honored to have you this
morning. Thank you so much for coming.
Good morning. Actually, this is my first visit to Kansas
City. I did not know where Kansas City was located. I
started my trip in Washington D.C., where I stayed for
four days, and then went to Miami to give a lecture
there. Miami was actually very hot, but the
air-conditioning was so cold that I caught a cold. I am
sorry if sometimes it makes it difficult to listen to my
lecture. I did not know where Kansas City was located,
and so I looked it up in the map. How many hours does it
take from Miami?
I would like to talk about some social changes and
some social security reforms in Japan. It is such a broad
subject, I would like to focus on long-term care,
especially the long-term care of the elderly at home.
If you have any questions, I will answer, if I know
the answers. I brought some data and statistics. I will
mostly talk about elderly care, but I can also explain
about pensions, disability, and such.
I. Socio-Economic Background
First I would like to explain how Japanese society has
changed and some of the socio-economic background of
social security reform. Now facing population aging, we
really need to change our forms of services, such as our
social security system. I would like then to explain the
present state of elder care in Japan, explain the reform
of, or a new, elder care system in Japan proposed by the
Ministry of Health and Welfare, and to predict the future
of elder care in Japan. (1) Population Aging
First I would like to explain the social change in
Japan, and to begin with, population aging. Population
aging is the most serious problem now facing the
Japanese. Now the Japanese life expectancy at birth for
males is a little over 76, and for women is 83, which is
the highest in the world, and still rising.
The proportion of the elderly, which means those 65
years or older, was 7% in 1970; 14% in 1994; and is now
15%, which is lower than most advanced nations. Of
course, it is lower than in the United States, but the
pace or speed of aging is particularly fast in Japan. The
rise in the proportion of the elderly population from 7%
to 14% took 115 years in France, 85 years in Sweden, 75
years in the United States, and 45 years in Great
Britain, while it took only 24 years in Japan. Recently I
found that the rate of aging population growth in Korea
or other Asian countries, such as Singapore or Hong Kong,
is much greater than in Japan. The next century's aging
problem will be quite serious in Asian countries. Also,
in China, because of the one-child policy, the growth of
aging is quite rapid in that country.
Based on the 1995 National Census, the Institute of
Population Problems, Ministry of Health and Welfare,
predicted that nearly one out of four will be over 65 in
2015. In 2050, one out of three will be over 65, which is
scary, to imagine that one out of three people will be
over 65. With population aging, the dependency rate has
also been growing. In 1970, nearly 10 working people
supported one elderly person, whereas this ratio was 5 to
1 in 1995, and will be 1.7 to 1 in 2050. In the middle of
the next century, fewer than two working people will have
to support one elderly and, plus, there will be children,
so the dependency rate including both children and the
elderly will be 1 to 1, or less than 1. The future will
be very difficult.
The rapid aging of the Japanese population has been
caused by sharp falls in the fertility and mortality
rates. Equally, the decline of fertility is a crucial
factor in population aging. The total fertility rate,
which means the average number of children born to a
woman who survives to age 50, was 5.1 in 1925 and 4.5 in
1947. The year 1947 started the baby-boomer generation.
Right after World War II, many people suffered from
unemployment, homelessness, and starvation. Reducing the
number of children was necessary to cope with these
difficult conditions. The government tried to introduce
birth control and legalized abortion. Abortion was
illegal before the war, but it was legalized after the
war. Thus the birth rate dropped drastically in the
1950s. The Eugenic Protection Law, which legalized
abortion, was enacted in 1948, and the number of legal
abortions in 1949 was about 250,000. It reached its peak
of more than 1 million in 1955, but it has dropped since
then. It was 390,000 in 1993. Of course, there must be
many illegal abortions, but in Japan, abortion is rather
easily available and very cheap.
The total fertility rate was 2.3 in 1955 and remained
a little over two until the middle of the 1970s. Then,
after middle of 1970s, the fertility rate dropped again.
It was 1.43 in 1995, meaning an average woman would have
fewer than two babies. This figure is lower than that of
the United States, which is a little over two, and a
little higher than that of Italy and Germany. The figure
of Italy and Germany is 1.3. We are not sure why. As you
may know, Japan, Germany, and Italy were united and
fought against the Allied Forces, including the United
States. Why did Japan, Germany, and Italy's birth rates
drop so drastically? One demographer said it may be a
rebellion of women against the patriarchal power, because
these three countries have a tradition of a patriarchal
family.
The first drop occured, in the 1950s. After the
baby-boom, the birth rate dropped suddenly, mainly caused
by married couples having fewer children because of
financial difficulties. However, the second drop, after
the middle of the 1970s, has been caused by a decline in
the marriage rate among young people. In 1980, about one
half of men and a quarter of women in their late twenties
were unmarried. But in 1995, two-thirds of men and
one-half of women in their late twenties were unmarried.
Twenty years ago, 25 years old of age was the deadline
for women to get married. Thus, women over 25 years old
were often called "left over Christmas cake,"
which means nobody wants to buy it. Since 25 years was
the deadline for women, they were in a hurry to get
married before they reached 25.
Now we say the deadline is around 30. We call it
"noodle of the New Year's Eve." In Japan,
traditionally we celebrate New Year's Eve eating Japanese
noodles, not spaghetti. The Japanese noodle has to be
eaten as soon as it is cooked. If it stays longer, it
spoils the taste. New Year's Eve is on December 31, and
women over 31 would be "spoiled." Of course,
this is a kind of sexual harassment. Yesterday I met a
Japanese gentleman, and he was serious when he said that
he had to be very careful when he talks to women. I
understand that in this country, it is very difficult for
Japanese men. Fortunately or unfortunately, Japan is a
still a male chauvinistic country. Now we put 30 or 31 as
the deadline for women to get married. However, there is
no limit for men. It is discrimination, I think.
There are not many who stay single for life, but many
postpone marriage in order to enjoy single life. When
society allowed women little capability for economic
independence, marriage meant a lifetime career. Recently,
however, the career opportunities for women have
increased together with their opportunities for hobbies,
sports, and travel abroad, resulting in a large number of
women choosing to delay marriage. In addition to that,
the opportunities for arranged marriages, which were
common before the war, declined, together with the number
of persons who help young people to find a mate. If you
saw the musical or movie "Fiddler on the Roof,"
there was a scene saying young girls should get married
by arrangement. Understanding the role of elders, in any
society, there were many so called
"go-betweens," but in Japan now there are not
too many who try to take the role of
"go-between." So the chances are getting fewer
and fewer. Moreover, the new norm of love marriages
causes free competition in the marriage market, and those
who lack ability to compete are excluded from the
competition as well as the opportunities for marriage.
(2) Changes in the Family
Now I would like to talk about changes in the family.
Many seem to believe that the Japanese elderly still
live with their children and grandchildren. However, the
ratio has been decreasing steadily. The proportion of
shared living arrangements was almost 90% in 1960, 80% in
1970, 70% in 1980, and 60% in 1990. Now it is a little
over 50%, gradually declining year by year. Of those
living with their children, the majority used to live
with their first son's family, but those living with
their daughter's family and those living with unmarried
children have been increasing. For those living with
unmarried children, the children are usually the
breadwinners. Thus, when elderly parents need care, they
face difficulties in accommodating both care and work.
Older married couples and single-person households have
been increasing, also. Of single-person households, the
gender ratio is nearly two males to eight females. More
female elderly are living alone.
The drop in the proportion of shared living
arrangements has been caused by first, a decrease in the
number of children per family; second, an increase in
geographical mobility from rural to urban areas
(especially in the 1960s, the period characterized by
technological innovation and high economic growth, many
young people moved from rural areas to urban areas, and
they got married in urban areas, so their old parents
were left behind); and third, changes in attitudes toward
living arrangements.
The traditional Japanese family was a patrilineal and
patriarchal stem family, in which the first son lived
with his parents. The first son has the right to inherit
the entire family property. In turn, he was obliged to
support his parents financially as well as physically
when they became old and weak. He (actually his wife) was
obliged to take the role of caregiver in the spirit of
filial piety. The wife had to take care of them, and she
had to be very obedient to them, be very nice and very
kind to them. After World War II, however, the
patriarchal stem family system changed to the more
egalitarian conjugal family system under the guidance of
GHQ (General Headquarters Office, headed by General
MacArthur). After the war, American military operations
took over the country, Japan, and they had control.
According to the revised civil code, not only the first
son but also other children, regardless of their sex or
birth order, have equal right to inherit family property,
as well as an equal obligation to support elderly
parents.
In addition to institutional changes after the war,
industrialization, modernization, urbanization, and the
influence of American democracy changed people's
attitudes from an extended-family orientation to a
nuclear-family orientation. Firstly, the younger
generation preferred more privacy and chose to live
separately from their parents after they got married.
Later, the older generation has voluntarily come to
choose separate living arrangements when both husband and
wife are in good health. However, when they become sick
or one dies, they prefer to live with their children.
Though shared living arrangements have been decreasing,
the number of elderly living close to their children is
increasing. They seem to prefer "intimacy at a
distance," rather than interfering with each other.
(3) Changing Roles and Attitudes of Women
Next I would like to talk about the changing roles
and attitudes of women.
Today nearly 90% of caregivers at home are females.
If the frail elderly is male, his wife is the primary
caregiver, while if the frail elderly is female, her
daughter-in-law or daughter takes on the role of
caregiver. Most caregivers are middle- aged housewives.
However, greater labor force participation by middle-aged
married women and changes in their attitudes toward the
family and the elderly make home-care difficult.
Our female labor force used to be characterized as
young and single, but it is now characterized as
middle-aged and married. The proportion of married
females to total female employees was nearly one-third in
1962, a little over a half in 1975, and nearly two-thirds
now. Now two-thirds of employed women are married. This
figure includes divorcees and widows. Those over 40 years
old accounted for less than one-third in 1970, but
reached one-half now. Among women aged 15 years and over,
the proportion of the employed was 30% and that of
full-time homemakers was 40% in 1975, but both figures
were 32% in 1984, and since then the proportion of the
employed has exceeded that of full-time homemakers. Now
most of the middle-aged married women are employed.
Many middle-aged women work as part-time workers. The
Bureau of Statistics, Management and Coordination Agency,
defines part-time workers as those who work no more than
35 hours a week regardless of their status or their term
of employment. The number of female part-time employees
was 1.3 million in 1970, 2.6 million in 1980, and 5
million in 1990. Of female part-time workers, one-third
were aged between 35 and 44, one-third were between 45
and 54; 15% were over 55. So most of the part-time
workers are over 35.
Middle-aged married women prefer to work part-time
because they wish to work without cutting back their
household duties, and they want to be home before the
children come back from school. Moreover, if their annual
income does not exceed 1,030,000 yen, which is a little
less than 10,000 U.S. dollars, they do not have to pay
any tax; they can be covered by their husband's health
insurance and can receive their old-age basic pension
without contributing to the system. When their husband
dies, they will receive two-thirds of their husband's
old-age pension as their survivor's benefit, which often
is higher than the old-age pension for working women
because of the income difference between men and women.
The average income difference between men and women is
one-half, which is worse than that of the U.S. Moreover,
their husbands can qualify for a special tax deduction
for full-time homemakers and can also receive a spouse
allowance from their employers. The number of such women
is estimated to be a little over 12 million now. Many
working women are trying to abolish this type of system,
not because they feel it to be unfair, but because if
these married women pay their premium, it would solve the
financial difficulties of the social security system, or
at least postpone the arrival of higher premiums and
lower benefits. Many Japanese housewives are enjoying
this privilege as full-time homemakers. Actually they are
not full-time homemakers, but called full-time homemakers
if they do not earn much money.
II. Present Status of Elder Care in Japan
Next I would like to explain the present status of elder
care in Japan. (1) Care Recipients
First, the care recipients.
In advanced industrial societies, women live longer
than men. Thus, there are more women in the older
population. Because women live longer than men, they have
a higher risk of becoming senile or bedridden.
Additionally, women usually marry men older than
themselves, and their chances of being institutionalized
are higher than men, whose spouses generally outlive
them.
Many people, including the Japanese themselves, still
believe that the Japanese elderly are taken care of by
the family at home, but today more bedridden elders are
in institutions. In the United States, among the elderly
who needed long- term care, 80% were at home, while in
Japan the ratio of bedridden elders at home is 40%, in
nursing homes 20%, and in hospitals 40%. Among the
bedridden elderly in Japan, about 60% are in
institutions. However, nearly two-thirds of the senile
elders are at home. Taking care of senile elders is much
more difficult than that of the bedridden elders, thus,
many nursing homes do not accept severely demented
patients.
Why are there so many older people in institutions,
especially in hospitals? First of all, the financial
burden to the family is less than home care and nursing
home care. Actually, the hospital care costs about
500,000 yen, a little less than 5,000 U.S. dollars, a
month. Nursing home care costs about 300,000 yen, a
little less than 3,000 U.S. dollars, a month, and home
care costs less than 100,000 yen, a little less than
1,000 U.S. dollars, a month. This figure does not include
caregivers' labor costs. If the labor cost of caregivers
is not counted, home care is the cheapest. However, the
cost of hospital care is covered by the national health
insurance, and costs of nursing home care are subsidized
by the government (central and local). The average
payment for hospital care is about 30,000 yen, a little
less than 300 U.S. dollars, a month, and that for nursing
home care is about 40,000 yen, a little less than 400
U.S. dollars, a month. Nursing home care used to be free,
but now the elderly and their families have to pay a
certain amount in accordance with their income. If the
elderly receive only the welfare pension for the elderly,
(which means pensions for those who were too old to
contribute to the system when the national pension scheme
was started in 1961) and have no family to depend on,
they are not required to pay. If the elderly lived alone
before they were institutionalized, often children are
not asked to pay for their parents. Thus, obedient
children who live with their parents have to bear more
financial burden. For instance, my mother is now in a
nursing home, and my elder brother is paying for her care
because he used to live with my mother before she moved
to the nursing home.
Compared with institutional care, the financial, as
well as the physical and psychological, burden of home
care is much heavier. If we include the health care cost
for caregivers and the opportunity cost of caregivers who
cannot work due to elder care responsibilities, the gap
between institutional care and home care expands further.
The Ministry of Health and Welfare has set the
ceiling for government subsidies for elderly patients so
that after a three-month hospital stay, the hospitals
receive a flat rate regardless of treatment. However,
there is always a way around such measures. After three
months, elderly patients are transferred to the next
hospital and stay three more months. Then they are
transferred to another hospital. This process is repeated
again and again. Now the Ministry of Health and Welfare
is trying to reform the whole medical system drastically
so that the ever-increasing medical expenditures will be
reduced. Otherwise, the same process is repeated again
and again, and the government will lose a big amount of
money.
Secondly, many Japanese still feel that it is
shameful to send elderly parents or parents-in-law to a
nursing home. Generally speaking, hospital care is
inferior in terms of living conditions. Usually rooms are
much smaller in hospitals than in nursing homes.
Moreover, many hospitals use restraints such as
overmedication and binding. However, many people are
still prejudiced against nursing homes because before the
1963 Welfare Law for the Aged, they used to be
institutions for poor elders with no family. Many
Japanese people still think it is a place where only
those poor elderly go.
Thirdly, although people have gradually come to
understand what a nursing home is and want to send their
parents or parents-in-law there, there are not enough
nursing homes. The nursing home shortage is crucial in
urban areas, where the cost of land is quite expensive,
and sometimes there is a two-year waiting list.
Fourthly, housing shortages are another reason why so
many old people cannot stay at home. If they are living
in a three-generation household, they often have to
vacate their room to provide a study room for
grandchildren. In Japan, the competition for entrance
examinations is quite tough. They have to start studying
at an early age. Getting into college used to be
difficult. Now they have to start earlier, sometimes in
elementary school and also sometimes before elementary
school or before kindergarten. There are special
preparatory schools for kindergartens. Children have to
study, study, and study, so they need their own rooms. In
addition to the housing shortage, poor housing conditions
make it difficult for the impaired elderly to stay at
home. Because Japanese houses have a lot of barriers,
such as stairs and tatami floors (which are very
slippery), it is dangerous for the impaired elderly.
Fifth, poor community service is also an important
factor which makes it difficult for old people to stay at
home. Although the Ministry of Health and Welfare
promises to subsidize the salary of home helpers or home
attendants, local governments are expected to be
responsible for half of the salary, and some have little
financial funds. In some areas, also, it is not so easy
to find persons to work as home attendants. There are
many depopulated villages where nearly half of the
residents are over 65. In those areas, it is very
difficult to find a person to work to care for elderly
people.
(2) Caregivers
Next is about caregivers.
As is common all over the world, caring for babies,
the sick, the handicapped, and the frail elderly is
almost always the role of women. In contrast to most of
the Western nations, where daughters are usually primary
caregivers, in Japan daughters-in-law are usually the
primary caregivers. This is common in countries with the
tradition of a patrilineal stem family system, like Korea
and Taiwan.
Although daughters-in-law still form the core of
caregivers, the number who want to be cared for by
daughters-in-law in their old age has been decreasing.
Many women now want to be cared for by their husbands,
though it seems to be difficult. With increase in labor
force participation by middle-aged married women, more
women face difficulties in accommodating both work and
care- giving. The Survey of Working Caregivers by the
Ministry of Labor in 1991 shows that, of 1,400 full-time
employees who had care recipients in their family for the
previous three years, 44% were females and 56% were
males. Although 43% of females who had care recipients
were primary caregivers, only 7% of males in the same
situation were primary caregivers. And 64% of females and
27% of males took leave, with average length being 138
days. Apparently women were more affected by providing
care than men.
Now most of the big firms have the family care leave
system with no salary. I think you have the same system
in this country. It is mostly women who take the family
care leave. The family care leave law was enacted in June
1996, but the application of the law to every firm is
postponed until 1999 because it will burden small firms
with weak financial bases too much in such a financially
difficult time.
III. A New Elder Care System
I will now explain a new elder care system, a reform of
the elder care system. The Ministry of Health and
Welfare has been trying to establish a new elder care
system in order to overcome the difficulties each family
as well as the society will face in the society with
fewer children. It is very difficult for each family, or
society as a whole, to take care of the elderly. Until
the middle of the 1980s, most services to the elderly
were free. For instance, the cost of a hospital stay for
people over 70 used to be free, but became 400 yen a day
in 1987 and 800 yen in 1995. But I think it is still
cheap, only about 7 U.S. dollars. Meals in hospitals used
to be free, but 600 yen a day has been charged since
1994. It is still cheap, only about 5 U.S. dollars. The
new elder care system asks the elderly to be more
independent physically, psychologically, and financially,
which means that they are asked to pay for medical and
welfare services. The sole purpose is to establish
generational equity so that the younger generation will
not have to suffer burdens to support the older
generation.
Everyone is likely to face the question of elder care
in the aged society, and once it happens, no one knows
how long it will last and how much it will cost. The
elderly person may die tomorrow, or he may live for more
than 10 years. (I know of one case. She is my friend. She
took care of her mother for 26 years. It is amazing. She
said she could do it because it was her mother. She said
she might have given up if it was her mother-in-law. She
was lucky that her daughter took care of her; 26 years is
too long.) Different from child care, the
unpredictability of elder care makes the burden much
heavier. In order to share such a burden socially, the
Ministry of Health and Welfare is planning to introduce a
new social insurance system for elder care. They call it
"public insurance for elder care." The idea
came from a German system started last year, but it is
not the same. There is no government fund in the German
system, but in Japan, a half of our system will be funded
by both central and local governments. The premium of
those over 65 will automatically be deducted from their
pension, and that of those between 40 and 64 will be
deducted from their salary, together with the premium for
health care insurance. You might wonder why the age range
between 40 and 64 was chosen. At the beginning , they
planned for 20 to 64, but the plan got a lot of
criticism. Young people may not want to pay premiums for
elder care, because elder care for them is a long time
away. The Ministry of Health and Welfare changed the age.
Those over 65 will be qualified for such in-home services
as visiting nurses and home attendants, as well as
day-care services, when they are in need. (The amount of
services will be based on their physical conditions
judged by a special committee.) But those between 40 and
64 will be qualified only when their symptoms are solely
caused by aging, like stroke, dementia, and osteoporosis.
But it may be a problem: Nobody knows if the specific
problem or the specific symptom is caused by aging or
not. When this system starts, there may be some confusion
or forgery. The recipients will pay 10% of the cost of
services they receive.
According to the Ministry of Health and Welfare,
local governments will be responsible to manage the whole
system, but small towns and villages are rather reluctant
to take responsibility because of the shortage of funds
and staff. The employers' association is also strongly
against the system, because employers have to be
responsible for a half of the premiums of their
employees, which will be a burden in this financially
difficult time. The employers are responsible for so
much. For instance, they are now paying a half of the
premiums for pensions and paying some portion of child
allowance. Also, companies have to pay penalties if they
do not hire a certain percentage of elderly workers (over
55) and handicapped. Since employers are paying so much,
they are saying, "No! No! No more!" They are
refusing to join this system.
The Ministry of Health and Welfare hoped that a law
for the social insurance for elder care would be enacted
last year, but it failed. It will take more time until a
new system is introduced, though many admit something
should be done in order to solve the problem of elder
care. The Ministry of Health and Welfare, is hoping to
start this system in the year of 2000, but nobody knows.
Many people are still against it or discussing this
problem.
IV. The Future of Elder Care in Japan
Lastly I will explain about the future of elder care in
Japan. Looking over the past and present state of the
elder care system in Japan, the following characteristics
should be mentioned:
(1) From Institutional to Home Care
First, from institutional care to home care.
Home care has been stressed, not because of financial
reasons, but because of welfare for the elderly
themselves. The government has just recently realized
that housing is an important factor in improving home
care. If housing conditions are poor, rehabilitation
cannot be effective. Many elderly patients just go back
and forth between the hospital and their home because
their conditions deteriorate when they stay at home with
so many barriers. Thus, both national and local
governments are now trying to put more money into
constructing or renovating housing for the elderly.
In addition to housing, living environments for the
elderly are full of barriers. Even if the elderly can
move in a wheelchair, Japanese causeways are not safe
because of the many steps and holes, and many roads are
without sidewalks. In addition to improving the quality
and quantity of home care services, living conditions
should be improved in order to promote the well-being of
the elderly.
(2) More Independence of the Elderly
Second, more independence of the elderly.
Both home care services and institutional services
were free when they began. However, payments for services
have been required since the 1980s because (1) both
national and local governments suffered from financial
difficulties, (2) the needs for services expanded with
population aging, and (3) the financial ability of the
elderly improved as a result of higher pension benefits.
In addition to the requirements of financial
independence of the elderly in the 1980s, psychological
independence is required in the 1990s. In the new elder
care system, decision-making by the elderly themselves is
emphasized. From the outset, elder care programs, as well
as other welfare programs in Japan, were created from a
supply side perspective; that is, the Ministry of Health
and Welfare ordered local governments; and welfare
agencies of local governments decided to whom, how much,
how long, and in what way services should be provided.
With the expansion of service recipients, the
requirements on the demand side should be respected more
in return for payment for services.
Independence of the elderly is required not only for
their well-being, but also for alleviating the burden on
their families, as well as the younger generation.
Securing equity between generations is the most important
purpose of social security reform in order to keep the
younger generation in the system. (Now, I think it is the
same in this country, many young people saying that there
will be no pension when they get old. We have to reform
the social security system so that the younger generation
will not lose their hope for their future.)
(3) More Independence of Local Governments
Third, more independence of local governments.
Different from the United States, Japan has been a
nation with a strong centralized government. Although GHQ
(headed by General MacArthur) tried to decentralize, it
did not work. Both decision-making power and money were
concentrated in the national government, which has
deprived local governments of the ability for
self-management. In 1989 the Ministry of Health and
Welfare asked local governments to take responsibility
for health and welfare services for the elderly. Each
local government was asked to make its own plan for
promoting health and welfare services to the elderly by
the end of fiscal 1993. Each local government organized a
special committee consisting of government bureaucrats;
specialists, such as doctors, nurses, and journalists;
and community representatives. In addition to that, a
special committee to promote decentralization of the
governmental power was started in 1995, two years ago. (I
happened to be a member of this Special Committee for
Daily Life and Welfare.) The committee plans to establish
a basic rule of decentralization in areas related to all
ministries. Decentralization of government authority
seems to be related to the deregulation of governmental
control over economic activities, now that the Japanese
government is being pressured by the U.S. government.
Through these measures, a nation with centralized power
will eventually come to an end, I hope.
(4) More Privatization in Elder Care
Fourth, more privatization in elder care.
Emphasis on contractual relationships, rather than
orders by governmental authorities, will inevitably
exclude bureaucratic intervention. Today the so- called
"silver service market," which aims at selling
such goods and services for promoting the health and
welfare of the elderly as wheelchairs, lifts, special
beds for nursing care, home care services, and retirement
homes, is expanding. Some local governments entrust the
private sector with home care because they are more
effective and cheaper than services provided by
government employees. Recently there was a study
comparing the cost of services between the public sector
and private sectors. They found that the private sector
is cheaper. In the private sector, the cost is one-third.
Although most services are still expensive and not many
people can afford them, costs will be reduced if a new
social insurance can be used to buy such services.
Needless to say, for those who are unable to afford them,
governmental assistance is necessary.
(5) From Household to Individual
Lastly, from household to individual.
In Japan the unit of social services is the household
rather than the individual. Therefore, eligibility for
receiving services or payments for services is based on
household income. In the case of elder care, their
children's family income is counted. So it happens that a
daughter with no income would be asked to pay for her
mother in a nursing home because her husband is earning
handsome salary. Sometimes this causes some conflict
between man and wife. The new elder care system clearly
mentions that everyone can receive service whenever one
needs it regardless of one's income or living
arrangements. In order to achieve this ideal (this is an
ideal), the service unit should change from the household
to the individual.
If the individual is to be the unit of the social
security system as well as the tax system, the elderly
should contribute to the system in accordance with their
income, even if they are receiving pension benefits.
Also, full-time homemakers should also contribute to the
system if they earn any money. This is my opinion, as
well as that of many professional women in Japan.
However, many male economists and older male politicians
are still against this idea. Some of them still insist
that the family should be the unit of the society. We
have to evaluate important issues, such as the so-called
family values in this country. Some older politicians and
elder scholars are still hoping that the traditional
Japanese family will be back again. I think that is
impossible.
Questions and Answers
Q: In the old system, you talked about how the eldest son
and his family received the property and he is
responsible for taking care of the elderly. In the new
program, does he still get all the property, or does it
get to be divided between all of the children in the
family Does the family get to decide that, or does the
government decide that?
A: The family decides. It's divided equally among the
children, as a rule, but there are some conditions. Some
of the children may have special contributions to
increase the family property. He will receive a little
more than others' share. Basically, it is divided among
them equally.
Q: Does the Japanese medical care system keep
terminally ill patients on life support?
A: We do not have the law to allow discontinuing
resuscitation. Thus, care for terminally ill patients
costs a lot. That is why our government is trying to
reform our medical system. It costs too much to just keep
on going for elderly persons, to stay in hospital, and,
especially when they are dying, it costs too much money.
Now we are discussing it, but it is quite difficult to
reach consensus about when to stop treatment.
Q: Would you repeat the difference between pension
for widows and working women? Is it true that widows can
receive more than working women?
A: A surviving widow receives two-thirds of the
husband's pension. A working woman can receive her own
pension. Average pension of working women is about
one-half that of a man, which is less than a survivor's
pension a widow gets. When a husband dies, the wife can
choose whether to receive her own pension or two-thirds
of the husband's pension. Usually two-thirds of the
husband pension is higher, and the wife gives up her own
pension. We protect married women more than single women.
Q: You mentioned the competition to enter
universities. I am curious to know why? Is that due to
lack of space? Isn't there enough openings? Why is that,
especially if the birth rate is decreasing?
A: Of course, we have a lot of universities if you
don't care which university you go to. In Japan, if you
want to be an employee at a big company or in a
prestigious company, or have a job in central government,
you have to graduate from a certain university, like
Harvard or Yale. If you don't care, there are many
openings for junior colleges and community colleges. If
you want to go to a specific university, the competition
is quite tough. The most difficult university to enter is
Tokyo University, and the next is Kyoto University. It is
very tough. Children have to start very early. My
university has a very prestigious kindergarten. My school
is very old, more than one hundred years old. We have
from kindergarten to university. The most difficult part
to get in is the kindergarten. Once you get in to the
kindergarten, you can go up to the university. There is a
special preparatory school to get into the kindergarten.
Q: What type of test for kindergarten?
A: They will be asked certain questions and just
play, with some toys, find same shapes, colors, etc. They
are just like games, but they are special tests.
Q: Japan and the U.S. seem to have similar social
problems. Are there any?
A: Most Japanese women are still very
family-oriented. They would like to stay at home, or they
do not want to disturb their family life because of their
employment. They get so much benefit for being so-called
full-time homemakers. In Japan, the most difficult
situation is for single women. In Japan, usually in the
government sector, women are promoted, and the salary
goes up. However, in the private sector, women's salaries
stop rising at 30 years old or 35 years old, and they do
not go up much higher after that. Of course, a single
woman does not get the full-time homemaker tax deduction
or allowance. In Japan, as I told you, still they protect
full-time homemakers.
Q: Would you explain the status of single women and
single mothers?
A: The percentage of unmarried mothers is about 1%.
Only about one percent of babies are born from single
mothers because of social pressure. We have a funny
system, which I should not say is funny. In Japan, family
registration is very important. If you do not get married
legally, which means your marriage is not registered in
the family registration, you will be deprived of so many
previleges, including the special tax deduction. One
would lose so many privileges. Therefore many women do
not want to be a single mother.
Q: Who takes care of people such as the mentally ill
or homeless?
A: The government takes care of them. Usually the
local government.
Q: Are they institutionalized or put in residential
care?
A: Usually they are put in a nursing home. The cost
is paid usually by the local government. No specific
institution is defined for such cases.
Q: How is the amount of the contribution to the
public pension plan determined? Is the premium for the
insurance based on the salary?
A: They have not decided yet. In Germany it is 1%.
Our government has not decided yet.
Q: Does this pension go to the individual account?
A: I do not know. They have not started yet. It may
be individual.
Q: Is the tax rate high in Japan?
A: I think they are about the same. The social
security premium is combined. The percentages for the
U.S. and Japan are about the same.
We have to thank your people. We did not have this
system before. The U.S. Occupation Forces introduced the
social security system to Japan and liberalized the
country. Before World War II, women could not get higher
education and we did not have any pensions or health
insurance. American people tried what they could not do
in the U.S. Now we have a very good system, similar to
the Canadian system. We must thank your people. For
instance, ERA. According to our constitution, men and
women are equal under the law. At the beginning, there
was some confusion over men and women being equal under
the law. One of the troubles we are facing is due to
being too good. The government is paying too much. Just
like Santa Claus. For people over 70, everything used to
be free. Now our government is facing a huge amount of
debt. That is why they want to reform. Actually the
national health insurance works well as long as the
economy is good and as long as population is not aged.
Q: Has the feeling of respect or the attitude toward
the elderly people been changing?
A: Recently there was an interesting study conducted
by the Youth Bureau of the Management and Constitution
Agency in Japan. They asked a question to youngsters aged
18 to 24: "Would you take care of your parents when
they become old and weak?" The percentage of
"yes" in Japan was lower than that of the U.S.
It was unbelievable. Many people were shocked. The
highest was Korea. I can understand that. In Korea, more
than 70% of people said they would take care of the
elderly. I do not remember the figure, but the lowest was
Sweden. I can understand that, too, because they have a
quite good social service system. The second lowest was
Japan. Japanese young people are not willing to take care
of the elderly, but many of them answered, "It
depends," so they are very smart about it. They are
not willing to. Many people said this is maybe because we
have so few children, usually one or two children per
family, and they are spoiled. They depend so much on
parents. They do not want to try by themselves. They
think everything comes from heaven. This made many people
worried. They spend so much money on children. In Japan,
when they send their child to college or university, the
family pays one-quarter to one-half of their household
income. This type of things happens only in Japan and
Korea. In Korea, it is more extreme. Sometimes they sell
their house in order to send their child to school. In
Japan, children have not been taught anything about
social security and aging until recently. Now they are
learning how important this issue is. Maybe, I hope, the
attitude will change.
Q: Is there any racial problem in Japan?
A: Basically our government does not allow too many
immigrants. There are some. We have many Korean people.
During wartime, we took them and brought them to Japan
for cheap labor. Now their second generation, third
generation, and maybe even fourth generation are living
there. Sometimes there are some conflicts among
teenagers, because they do not know the history; they may
say, "Why don't you go back to Korea?" It is
not their fault. They did not want to come to Japan.
Sometimes this type of things happens, but not so often.
Q: Do they consider that more immigrants to Japan in
the future will contribute to the social security program
to keep it running?
A: Basically we accept only foreign immigrants who
are specialists. Manual labor people can not get into
Japan. There are some disputes over the future labor
shortages, especially the future shortage of manpower in
caring for the elderly. Some young male economists
suggested to get workers from other Asian countries. One
guy tried to bring nurses from China because the nurse
shortage is very critical. It is not so difficult to find
home attendants, because everyone can be a home
attendant, a homemaker can be one. However, nurses must
be trained and need special education. We don't have
enough nurses, so one guy tried to import nurses from
China. There was a group discussing this program with the
Ministry of Health and Welfare. The Ministry of Health
and Welfare said, "Maybe it is a good idea. How
about 3,000 or 30,000?" The figure got bigger.
Finally, China mentioned, "How about 3 million? We
will send 3 million girls to Japan." Then, they
said, "No! No! We do not need them." Actually,
it is not legal, it is illegal, but some nursing homes or
hospitals introduced Chinese or Filipino nurses and
girls. We call them "trainees," and they stay
for six months to one year, and then they go back. They
cannot stay for a long term.
In addition to my teaching, I am a member of a
feminist group called the "Women's Group for Better
Aging Society," just like the "Older Women's
League" in the U.S. We organized this 15 years ago,
and I am a founding member. We say, "Why don't men
participate in caregiving to solve the problem? Now, many
Japanese retired men don't find anything to do. They
spent a lot of time just playing golf or fishing or doing
nothing. We suggested retired persons can be good home
attendants.
Q: Did you say the chances of women over 30 getting
married are very low? Are these women single women in
work force, like an unprivileged class? There should be a
lot of them.
A: Yes, but now it may be changing. A girl has a
chance until 35. One of my subjects is elder workers. One
time, an employment agency operated by the government
said they set up a special section for older workers
because they have a more difficult time finding a job. I
visited there and asked the guy at the office several
questions. I asked, "How old are the older
workers?" He was laughing, looking at me, and said,
"After 35 years is old for women. That's old for
women. For men it is after 55 years old. " They
consider women over 35 years old as old.
Q: What is the divorce rate?
A: It is not so high. Compared to the U.S., it is
about one-third, but it is increasing. Especially among
middle-aged women, the divorce rate is increasing. The
divorce rate is highest in women in their forties now.
Because it is not so difficult to be economically
independent, and also, I think, the long life expectancy
is related to their attitudes. Once I met a middle-aged
woman who decided to get a divorce. She was married to
her husband for nearly 30 years. I said, "You stayed
with him for 30 years. Why can't you stay more?" She
said, "It's enough." Because now the life
expectancy for women is 83, but those who live more than
50 years live until 85 or 86 years old; 40 or 50 is just
a middle of a whole life.
Q: Do they still get benefits and allowance?
A: Yes, and they get a child allowance from the
government, even though it is not a big amount of money.
Some local governments offer some money for divorced
women to start their own business.
Thank you very much.
(The above article is offered for reference purposes
and does not necessarily represent the policy or views of
the Japanese Government)
Takako Sodei
Born in 1938. Received her M.A. in sociology from
Tokyo Metropolitan University. Has been a
visiting scholar at the National Council on Aging
while a senior researcher of the Japan-U.S.
Educational Commission. Is now professor of
gerontology at Ochanomizu University. Author of
Two-Paycheck Families, Life Design after
Retirement, and other books in Japanese.
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