In addition, the long-term care system pays equally to all individuals over 40 and allows them to choose an independent, assisted living, or home care service. When it first passed in 2000, the system supported the first retirement communities by providing funds for construction costs, nursing, and other services.
Now, Watanabe says, 770,000 people live in longterm care facilities, including 50,000 in assisted living last year. Some of these communities are owned by foreigners, an unusual development in Japan.
A new kind of reform
Mori says nothing short of reform will maintain the system. Some of these are the typical cost reduction (pharmaceutical and hospital) approaches used in the U.S. Hospital costs are very high in Japan because people stay very long (and receive aftercare)— 60 days, for example, for heart surgery.
But other reforms are uniquely Japanese.
Healthy lifestyles are promoted to save money. “The government encourages diet and exercise and even requires people signing up for long-term care to agree to gymnasium courses to strengthen muscle fiber,” Mori says. The Japanese are so healthy, Watanabe says, that “when they talk about elder care, they are talking about people over 85 years old.”
The government also tries to keep costs down by encouraging work—they specifically ask and financially encourage businesses not to retire people at the required retirement age of 60. “The Japanese (particularly the men) work all of their lives; work is where they create their own identities and social bend,” Ozawa says. “Thus, working is keeping in the mainstream.”
Since the retiring boomer generation is known as the wealthiest and the biggest spenders, Japan is encouraging them to enrich the economy through their purchases.
A new “Excitement Plan” touts special tours for older travelers to places like the Middle East, Africa, and Latin America. New special products are advertised widely, such as green vegetable juice, royal jelly, Re-Sara sausages that neutralize fats, and other health food products.
How big is the Japanese retirement problem? And can it be fixed?
Mori thinks the Japanese are off to a good start. “We have good access and quality in our health care programs,” he says.
Can this system be saved?
But Ozawa says quality is a relative term. “In Japan, families come to hospitals to care for the sick, and if they want to stay, they sleep on the concrete floor on blankets.
If you need personal care, a family member stays and sleeps on blankets on the floor,” she claims. (Mori insists this is no longer the case.)
Other observers, like Dave Potter of the Hartford Life, have found negative attitudes when the company surveys the Japanese about how comfortable they were with the new demographic patterns. A study by Hartford Life found that three out of four people lacked confidence in financial planning for their retirements in Japan.
Still, Mori believes in the ability of the current “massive generation” to survive and thrive. And he finds comfort in knowing that “when we have reform, we can control costs by increasing consumer copayments.” He thinks the solution rests in a combination of returning to work and cobbling together income from long-term care programs and government and private pensions.
Sound familiar?
Robots to the rescue?
Robots offer a fantasy alternative health care force and cater to Japan’s fascination with technology.
They’re quick-moving, and can carry glasses of water, or roll over like a pet.
The paddle-tipped hand of a robot named Ri-man picks up bedridden humans and—says his website—“exhibits the skill and ability to realize human care and welfare tasks.”
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