Caregiving not the unemployment panacea the government hoped for

December 9th, 2010 by Philip Brasor & Masako Tsubuku

The Kaigo Hoken Seido (Long-term Care Insurance System) that the government launched in 2000 had two purposes. The first was to collect monthly premiums from everyone over the age of 40 to pay for caregiving services for the ever-burgeoning ranks of the elderly; and the second was to provide employment for that other burgeoning demographic of people who needed full-time work in an economy that was increasingly shipping jobs overseas and which at home was resorting more to non-regular employees.

A nursing home in Arakawa Ward, Tokyo

According to the law the system has to be reviewed every three years, and the government is now thinking of revisions for 2012. In all likelihood, premiums will be raised again, since they’ve been raised every time the system has come up for review in the past. The average premium for salaried employees under 65 has risen from ¥2,075 a month in 2000 to ¥4,342 in 2009; while for people 65 and older it’s risen from ¥2,900 to ¥4,160.

These increases are supposed to help cover the cost of the system, which was ¥3.2 trillion in 2000, ¥6 trillion in 2005 and ¥7.9 trillion this year. Premiums provide half the money needed, with tax revenues covering the other half. People who require care pay about 10 percent of the bill out of their own pocket with the rest being paid for by the kaigo hoken system. These moneys are paid to care providers, often NPOs and even corporations that hire and dispatch licensed caregivers or run care facilities. So the money not only goes to pay workers, but also to purchase equipment and pay administrative costs. These various costs have skyrocketed in the past decade, and one of the changes that the government is contemplating for 2012 is a raise in the deductible to 20 percent. According to an article in the Yomiuri Shimbun, however, there are many elderly who are too poor right now to even cover the current 10 percent.

Moreover, the system doesn’t seem to be strong enough to support the kind of workforce the government originally envisioned. A survey conducted by the Wakate Fukushi Jushisha Network (Young Welfare Employees Network) found that 83 percent of younger professional caregivers thought their jobs were both “difficult” and “low paying.” Turnover in the industry is big. In 2008, the quitting rate among “home helpers” — workers who visit the homes of the elderly to clean house, as well as cook for and bathe their clients — was 13.9 percent. For nursing home employees it was 22 percent. Throughout the entire industry, whether the worker is part-time or full-time, 39 percent quit before they’ve worked a year and 36 percent quit before they’ve worked three years.

The Wakate survey also found that 86 percent of the 892 respondents said that they wanted to “make caregiving a career.” So the problem is not the work, which these people knew was going to be hard before they received their licenses, but the pay. Sixty-seven percent of the respondents said they made less than ¥3 million, and another 33 percent said they earned less than ¥2 million. Bennesse, the cram school company that has branched out into caregiving service, is currently looking for caregivers with class 2 certification for its facilities. Starting salary is ¥229,500 for full-time help; ¥1,080 an hour for part-time.

Prior to the start of the kaigo hoken system in 2000, many young people, as well as people who were not so young and had been laid off from other full-time jobs, studied to receive certification so that they could enter this brave new field of service. But some mindsets are hard to change. Caregiving is traditionally a woman’s job, and is performed at home by family members. The majority of paid caregivers today are also women, though more men are entering the field all the time. But it is still considered women’s work, which may explain why pay remains low. In any case, there is a severe shortage of caregivers and the number of clients grows steadily every day.

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One Response

  1. I think the real reason that 86% of respondents “want to make caregiving a career” is that it’s a boom trade … let’s face it, you are never going to be out of work if you are willing to do the sort of job that nobody else wants to, and traditionally elder care is one of those jobs. One of the hugest changes I’ve noticed about Japanese society is the recent willingness of middle-class people – particularly daughters-in-law – to shove their parents into rest homes. This is something that would’ve been unthinkable even 10 years ago. I’ve also noticed that some people, especially married housewives, are willing to accept sub-standard care for their elders in return for some freedom and autonomy (I’m NOT judging them, I’m just commenting. For example, one of my closest friends visits her bedridden parents-in-law nearly every day in their government-run rest home. Sometimes she notices that their water bottles haven’t been refilled, or are even covered with mould, or that they aren’t receiving as much attention as they could from the harried, overworked staff. She really does feel sorry for her parents-in-law … but not sorry enough to actually take on the task of caring for them in her own home. The notion of “dutiful daughter” has really changed a lot recently.)


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