The Care for the Elderly in Sweden and in Japan No.1

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The Care for the Elderly in Sweden and in Japan


1.   Japanese "Cheaper and Worse" Elderly Care Produced 700,000 Bedridden Elderly  

In the past in Japan it was quite natural that the families took care of the elderly.  Recently the elderly became to live much longer, but the responsibility of elderly care is still on the family and the pubic elderly care has not developed in Japan.  Most of the family care givers take care of the elderly without getting money and without getting help by the homehelpers.

And the number of stuffs at the Japanese facilities is about half compared with those in Sweden.  This is another reason why there are so many bedridden elderly in Japan.

On the contrary, the cost for the health care for the elderly in Japan is about half than that of Sweden and the social service cost for the elderly in Japan is about one tenth than that of Sweden.  So from the standpoint of the cost, Japanese elderly care is much more "effective". 

2.   Low Standard of the Profit -Making Geriatric Hospital

  The privatization of elderly care is much more popular in Japan.  Because Japanese people believed that "If we privatize the elderly care, the profit-making organization would compete each other and the quality of the care would improved and the cost will be reduced". But this is not true in Japan. 

The quality of care at the private geriatric hospital is too bad. Because there is no competition at all.  The number of facilities for the elderly in Japan is too few, so even if the quality is very low, many people apply for the beds. 


3. The More and More Social Service Is Needed in Japan 

In Japan social service was believed only for the poor people.  So people prefer health care to social service. But it is expensive and not always correct to take care of elderly by health care. In Japan the ratio between health care and social service is very imbalance. To improve the care for the elderly effectively, Japanese elderly care must be changed to the 
"social service oriented model" from the current "health care oriented model". 


The Elderly Care System Depends on the Aging Rate 
- The Current Elderly Care in Japan is similar to 1960's in Sweden-

 Sweden and Japan is a different society. But even if the society is different, it mainly depends on the aging rate that what kind of resources are needed at the society. 

For the next ten years, the aging rate (>65) in Japan is supposed to rise up to 18% from 13%. So the development process of the elderly care in Sweden for the last 30 years is very interesting for Japan. 

l . Introduction
The reason why I came to Sweden? 
- The Swedish Elderly Care is the best in the World. -

In 1989 1 have visited U.S.A., U.K., Denmark, Sweden and Singapore in eight months and practiced at the old age homes, nursing homes and home help care in each country. This research was a very shocking experience for me, because I found that the care for the elderly in Japan, which mainly depends on the care by the families, were very low quality. I wrote the series of articles every week about my research and experience in different countries in the Kyoto Newspaper for one and a half year. And in 1991 I published the book "Elderly Care in the World" (IWANAMI SHOTEN Publishing Company) .This book has published 80,000 exemplar until today. 

Through my research in 1989 1 found that the care for the elderly in Sweden and in Denmark (Nordic Model) are the best in the world. Particularly I was very impressed that there is very few "bedridden" elderly in Sweden. That is why I came back to Sweden once again to research the care for the elderly. 

In this report I write the situation and the problem of the care for the elderly in Japan by comparing with the Swedish elderly care. 


1.2 What is the problem? The Reason why I write this report 

The aging rate has increased in Japan very quickly. In 1992, the percentage of the elderly over 65 is 13%. But the rate will increase very rapidly and in 2000 the Japanese aging rate will catch up Sweden (16.9%) and in the 2lst century Japan is supposed to be one of the most aged countries in the world.

Swedish society has been facing aging problem for the last 40 years, but in Japan it is a very new problem. So we have some serious problems now as follows.


1.2.1 700,000 "Bedridden" Elderly  

In Japan there are about 700,000 bedridden ( or bed-bound ) elderly in 1991. It is estimated about 5% of the elderly over 65 are bedridden elderly.

The rapid increase of the bedridden elderly is an unique phenomenon in Japan. The definition of the "bedridden elderly" in Japan is that "the elderly who spend most of the time on the bed every day".

The biggest reasons why so many bedridden elderly exist in Japan is that the lack of caregivers and social service.  The sick elderly usually lie one the bed every day without any rehabilitation, so the number of bedridden elderly has been increasing so rapidly.  I will explain this problem more in detail later.

About one third of then stay at home and on third of them stay at the nursing homes and the rest stay at the geriatric hospitals and the hospitals.

In the past in Japan the majority of the elderly lived with their children and the children took care of their parents at home.  But recently the percentage of the nuclear family and the working women have increased rapidly in Japan.  But the social service for the elderly has not enough developed.  The number of the homehelpers and the nursing home are very few in Japan.

l 2 2  One Million Senile Dementia Patients in Japan  

There are about one million Senile dementia elderly in Japan.  But the majority of them are cared at home by the their families and their situations are very serious.  It is almost impossible for the families to take care of the senile elderly at home without the help of the social service.

In the past the Japanese people believed that the care by the family was the best. But the Japanese society has developed and changed so quickly after the second world war.  Recently most of all Japanese people realize that the limitation of the care by the family and the need to develop the social service for the elderly.  The situation in Japan today is similar to the situation in 1960's in Sweden.


1.2.3 The Reason why the comparison between two countries is interesting

I have been researching the care for the elderly for the last six years.  I visited in U.K., Denmark, U.S.A., Singapore and Sweden in 1989 under one year and researched the care for the elderly in each country.  And especially I was very surprised at the gap between Japan and Sweden.  It is true that Swedish care for the elderly also has some problems, but it is much, much better than that of Japan.  

Through the comparison between two countries I believe that I can find the problem of the Japanese care for the elderly and the ways how to improve it.

And recently the Swedish care for the elderly has been changing rapidly. More informal care (by the families) , privatization and voluntary activity are emphasized. And it seems to me that the Swedish care for the elderly is a little coming near to "Japanese Model".  So I think that it is useful for the Swedish people to know the "reality" of the Japanese situation.


l .3  Purpose and Question
l.3.1 The Introduction of the Japanese Care for the Elderly for the Swedish Researchers  

How to cope with the aging issues and the care for the elderly are the serious problems all over the world.  We Japanese researchers have so much information about the care for the elderly all over the world.  But on the contrary, the number of reports about the Japanese care for the elderly written in English is very few. I think that it is one of our responsibility to inform the care for the elderly in Japan for the foreign researchers..

But to introduce the Japanese system for the foreign researchers -especially for the western researchers- is a little difficult.  Because the background of the society, history, culture and the definition the words are very different in different countries.  Fortunately I have stayed in Sweden and researched the Swedish system also, so it could be possible for me to compare the system in both countries.

By this report I hope that foreign researchers especially Swedish researchers can understand more about the reality of the Japanese care for the elderly and they can learn something from the Japanese current situation.

1.3.2 The Reason Why the Japanese Care for the Elderly Is so Bad 

Because of the lack of the social service, some of Japanese sick or handicapped elderly are in very terrible situation now.

Through my research I would like to make it clear the reasons why the Japanese care for the elderly is so bad.  

l.3.3  The Ways How to Improve the Japanese Care for the Elderly

 Through the comparison I want to know that what kind of resources are most needed for the future of the Japanese care for the elderly.

2. Method
2.1  Comparative Method ~the Quantity and the Expenditure~

I would like to compare both countries by the measurement the quantity of the resources and the expenditure.

The research is through the  

1. Newspaper and report 
2 Practice at the old age home and the servicehus and the group living in both countries
3 Interview  


2.2 Limit

Sweden is a country of western culture and Japan is a country of oriental culture.  And the history, society and the lifestyle are so different in two countries.  So it is rather difficult to import Swedish model to Japan directly.  But through this research I think that I can guess how much resource will be needed for the future of Japan.

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