Friday, May 23, 2008

Elder care

Michele suggested that I share on my blog this letter that I wrote to her. Michele and I both have aging parents that live a distance away and we take an interest in how our respective senior family members are doing. We were commenting about health care and the services available and I got on my platform and babbled a lot. Michele thought others might be interested in what I observe of elderly care in Japan.

The custom of caring for the aged in the home has changed quite a lot in the past 10-20 years. It used to be that extended families lived together and while the older generation helped take care of the home and grandchildren the younger couple worked in the fields or held jobs etc. That is changing somewhat but still you find extended familes living together. I notice amongst my friends that the wife's parents live with the younger couple more readily (and more peacefully!) than the husband's parents coming to live in the home. It seems in all cultures that generations living together has its difficult side. Mother-in-laws and daughter-in-laws often don't get along and the Japanese mother-in-law traditionally lords it over the daughter-in-law making life hell in the early years. Husbands/sons will usually try to make themselves scarce (easy to do in Japan) and leave the cat fights to the women folks. For this and other reasons, when the mother-in-law needs care, the daughter-in-law often isn't too generous with love and consideration. (picture from the Internet)

Japan is in the upheaval of revamping their health care system for the aged but it isn't going well. Part of the problem is that the elderly population continues to increase meaning that the burden of health care for them falls on taxes paid by the younger generation. I've read statistics that state that 21% of the Japanese population is now 65 years of age or older. The social security system is collapsing and the generation in their 20's, some of them referred to as the "Neeto" or "parasite-children", out and out refuse to put aside social security saying that when they'll need it someday the system won't be viable anyway so why add to the pot now. The pot now is what pays for the health care today so the country is going into debt.

As for daily health care, my mother-in-law lives alone in a small apartment but she is registered in a care system where someone will bring her a lunch box daily. (Sort of like Meals on Wheels). She also has "helpers" that come weekly to clean house for her or go grocery shopping and she can also use a service that will help her take a bath. All this service is given for a minimal fee and the rest paid by health care. Health care will also take care of taxiing to doctor's appointments. In the case of Alzheimer's and other dementia problems Day Care Centers are available and buses will pick up older people from their homes and take care of them (feed, bathe, do activities) at the center and deliver them back home. There are also "group homes" where a small group of 5 - 8 older people and a staff of 4 or 5 will live together. Less like a convalescent home, more like a big family and the older people will be guided in helping cook or garden or whatever. A long waiting list for any of these places.

All this sounds wonderful right? But each person over 70 is interviewed and then classified in levels according to care need. This means doctors, health workers, health care managers (they have 30 to 50 people under their care so they are swamped) go to visit the older person and then decide what level they are. My mother-in-law is handicapped and can barely see but she is mentally with it and can carry on an extremely shrewed conversation about what is wrong with the world, the system and the people she comes into contact with. The interviewers consider her to have a very low level need. And she is angry about it!

"I'm dying and they won't give me more care!"

What she means is that she resents the amount of money she still has to pay. She wants it free. My husband has tried to make her see how illogical she is. She is not bedridden as are many people. She is not kept alive by tubes and being force fed. The higher level rating actually means that the person is that much closer to the inevitable and therefore she should be thrilled that she is far better off than many people her age. She doesn't see it that way.

A booming business nowadays for people my age and a little younger with no other skills is to become certified (not that difficult) and then become elder care workers either in the convalescent homes, in the group homes or routinely going into the homes of people under their charge to do housework or cooking. A bit more certification and they will do physical care like bathing and cutting toenails etc. Elderly health care is not an easy job though and the system is having problems keeping up with the demands of the elderly so in recent years Filipino care workers have been introduced to Japan. Often the foreign health care workers have been far better trained (as nurses and such) in their own countries and they are willing to work for minimum wage. There are loads of problems associated with this system such as discrimination issues and the real problem of foreigners trying to master the Japanese written language.

Tetsu has worked in various convalescent homes for the past 20 years so I have seen a lot of homes and heard a lot of tales from him. Because elder care really only began in the past 30 years or so the "homes" are all serviceably nice and fairly new. But I have yet to see an American style "retirement home" where residents live in cottages or apartments and are able to drive or go into the city on the bus or whatever. Japanese convalescent homes are very institutional (sorry Tetsu) and the residents are horded together for meals and activities. The walls are all very washable, and grey, the floors linoleum and mop-able. I don't know what I expect... I have visited some of my mother's friends in America in their retirement centers and the dining tables have tablecloths and roses, the air smells sweet and the walls are decorated with floral wallpaper and knick-knicks. And most older people do not even want to end up there! Japanese institutions may be inexpensive (I actually have no idea of costs. I think it depends on a person's former income) but I know in America it is exorbitant.

Who knew that I could write so much about a subject I really know very little about!


artfilstitch said...

You have done a great job of describing a real growing problem which is , especially for the aging. There isn't as much compassion shown to the elderly as in past times. I had an aunt who lived to be 90+ and I'll never forget her famous saying, " If I had known I was going to live this long, I would have taken better care of myself". Let's all follow this motto and start today! :>)


Amanda said...

There's so much to say on this topic, and much of it conradictory (like your mother-in-law). Whilst the idea of the extended family, and older people being cared for by the family, sounds ideal, in practice I bet it could be a very unhappy situation, with no-one really happy with each other. I really don't want to live with my children when I get older, I think they should have the freedom to get on with their own lives. Life is difficult enough to cope with these days, without the added burden of looking after elderly people. My husband and I will do everything we can to save enough to pay for a good home for ourselves when the time comes.

Mrs. Goodneedle said...

Such a conundrum. My MIL is failing physically, but is mentally sharp. She is fiercely independent-minded but increasingly needy on a daily basis for transportation and household matters. She refuses to leave her home. I pray that as I age I will be a blessing to children and grandchildren and not difficult or a burden. We never know, though. Thanks, Tanya for giving us a glimpse into the life of the aging population in Japan.

The Calico Cat said...

It is an interesting situation that we (Globally) have to deal with.

I know those homes that you refer to in the states with roses & table cloths. I visited a lady (The mon of a guy that I was dating) in one in California. It was IMMACULATE - 100% modern. Still she had us shuttling her around to look at other places. (Some people are never satisfied. I would have moved in in a second!)

That Filipino scenario is growing globally too. In Israel, they hire Filipino help - for the same reasons as they do in Japan...

dee said...

My friend Pam visited a care facility yesterday that may be where her Dad is going. The cost is nearly $4000. a month. That was the average price of the places she looked at. It's scary to think what people do without means. Our local extended care facility is over $5000 Astronomical. Just a little over 5 years ago my late FIL stayed in a similar place but it was around $2500 and we struggled with that.

Quilting Journey said...

Tanya, I was so delighted that you took the time to write me such a comprehensive letter on this topic that I just KNEW it was one that needed to be shared. I am so glad you did!!! Look at the've truly hit a common nerve in all of us!