Yen for Living

Killing with kindness? Caregiver helps elderly woman into her apartment

Ever since the government launched the kaigo hoken system in 2000 to provide nursing care services for seniors, the health ministry reviews revenues and expenditures every year and adjusts them accordingly. What this means is that every year premiums go up, which makes sense since the number of seniors is increasing while the population in general remains static or shrinks. In 2000, 15.6 percent of the population was 65 or older. In 2011 the same demographic accounted for 21.4 percent of the population.

Starting at age 40, every resident of Japan pays kaigo hoken premiums, the amount determined by age and income. Even seniors who are eligible for and receive kaigo (nursing care) services pay premiums. They also bear 10 percent of the cost of their care. As each year passes, the burden gets heavier. In 2000, the average monthly premium for people 65 and older was ¥2,911. This past April, that amount breached ¥5,000, and it’s sure to go up. The baby boom generation will turn 75 in 2025, when it is estimated that the cost of kaigo hoken services, including the 10 percent that seniors bear, will total somewhere between ¥19 and ¥23 trillion. That’s twice the cost of such services in 2012. Consequently, average premiums for seniors will be more than ¥8,000.

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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.

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If you can read the fine print then you can’t move in

Advertorial supplements are pretty common these days in newspapers, and often they focus on one subject. A topic I see a lot lately is assisted living facilities for seniors, sometimes two or three times month. Despite Japan’s storied respect for the aged, old age homes, derisively referred to as rojin homu, were never very popular until the last decade when the kaigo hoken (nursing care insurance) system was enacted, thus directly and indirectly providing government assistance for start-up businesses. With the economy lagging and the population aging faster than you can say “hip replacement surgery,” assistant living facilities have become a growth business, though if you take a look at the ads in the supplements it’s easy to get the feeling that all old people in Japan are rich.

The main sticking point is the “moving in fee” (nyukyohiyo), which tends to run anwhere from ¥50 to 90 million; in other words, the price of an expensive house or condominium. These fees are “deposits” to a certain extent. Usually about 10 percent are automatically deducted when a contract is signed, and then over the next 10  years it is treated like depreciation. If you “leave” the facility before the 10 years elapses an appropriate portion of the deposit is returned to you or our heirs depending on how long you have stayed. Of course, “leaving” in most cases means “dying,” so you get the idea. On top of that, the “tenant” pays a substantial monthly rent for his or her unit, which can be a simple room or a full apartment with kitchen. Then there are lots of add-ons, the main one being meals, but, of course, with assisted living there tend to be different grades of “care.” That’s where the real money comes in. One’s monthly rent can double or triple depending on one’s physical condition.

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