Thursday, March 04, 2010

Elderly care

My friends and I are arriving at the age where our parents and in-laws need a lot of care. When I visit with my friends, the conversation which once revolved around kindergarten activities and then cram school and entrance exams, now focuses mostly on parental care. And all my friends speak of exhaustion, irritability and broken family relationships.

In some ways, Japan has an excellent system for caring for the elderly. Each person over 70 is categorized as needing a certainly level of care. Those who are still independent, are in fairly good health and have no dementia are eligible for limited care or help. Others who suffer from poor health, who are bed ridden or have Alzheimer's are awarded more hours and levels of care.

For example, my mother-in-law lives alone in an apartment but she no longer walks without a walker and holds onto arm rails. She also doesn't see very well but she survives with certified "helpers" provided by the city to come in to clean and occasionally cook a meal. The helper will also do some light grocery shopping but that had to be negotiated between our family, the care manager and the city. My mother-in-law also gets daily meals brought in and has access to "health care taxis" which will take her to the doctors. All this is at a VERY minimal fee but my mother-in-law balks at paying anything and she isn't very happy about the way the helpers clean or cook etc. If she had been "categorized" as being less independent or slightly senile or in poorer health, the care would have been more complete and cost even less so right now my mother-in-law is not happy that she is considered healthy.

The levels of care include in home medical care; short stay programs where a convalescent facility will accept an elderly person for a few days (in order to let the family have a break); and day care services. Day care programs will pick up the person by a facility van, will provide meals and activities and in some cases the person will be bathed. At the end of the day the person will be brought home. Some of my friend's parents use this service three or four times a week. My mother-in-law won't have anything to do with short stay care nor day service care and so she is getting along on the helper system.

Convalescent homes in general are dreary places (sorry Tetsu). They are warped linoleum, thumb tacked announcements, plastic aprons, crowded feeding centers. It is no surprise that so many elderly people do not want to go there. There are private convalescent homes that may be comparable to nice American facilities that one must pay a lot for but Japanese are not used to paying for health care so only the extremely wealthy are able to live in these private facilities. I'm afraid I wouldn't want to live in a subsidized convalescent home and I guess Tetsu isn't thinking of putting his mother in one yet...

For so many families, the burden of caring for their elderly falls on the daughter or the daughter-in-law. Japanese men work long hours. They aren't particularly good at expressing their emotions and the pain of watching elderly parents decline is pushed onto the women. In many cases the husband has been transferred to another city (or country!) and the wife remains in the in-laws home to take care of them. Resentment sets in between siblings and spouses. By the time the parents are gone, no one is speaking to each other any more!

I once got into an argument with a neighbor for saying something simple like,

"I don't see my children ever coming back to living with Tetsu and me. They have their own lives and we raised them to go out into the world and touch others."

"What on earth is the point of having children if they are not going to take care of their parents! After all I've sacrificed for my children, their first duty is to care for the parents who brought them into the world and gave them everything so far!" (And in my neighbor's thinking, her son needed to find a good wife who would cheerfully take care of his parents. Good luck!)

It is an impossibility to explain one side to the other and by far, the children's duty to the parents plays a very important role in Japan. By those standards Tetsu and I aren't doing well by his mother nor my own.

Japan has the highest population of elderly in the world. Actually the government is having trouble keeping up with social security, health care and services. The ideal is to keep the elderly person as independent as possible and many programs are being developed and businesses abound. Still, it looks like it will be a long haul before everyone is satisfied... In twenty years or so I'm going to be needing some of these services myself. I hope they get it worked out.

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