JAPAN: Needy elderly leaving Tokyo

. OSAKA, Japan / Yomiuri Shimbun / March 11, 2009 Shortage of facilities forces aged on welfare to live outside capital By Takeharu Yasuda, Kazuo Otsu and Fumihiko Abe, Staff Writers As the economy continues to deteriorate at a frightening pace, the shortage of accommodation facilities providing people with nursing care and medical services has been quickly worsening, especially in big-city areas. In Tokyo, there has been a sharp rise in the number of cases in which elderly people on livelihood protection welfare find themselves moved from hospital to hospital or with no alternative but to move to nursing care homes outside Tokyo. Given the rapid graying of society, fears are growing of similar problems spreading to midsize and even smaller urban regions. Around-the-clock care system: The Sanya district of Tokyo's Taito Ward is known as a place densely packed with cheap lodging. One such establishment catering to those in needy circumstances is the Furusato Hotel Sanko (Homely Hotel Sanko). In principle, residents of Sanko have their own individual rooms and are able to receive nursing care and medical services 24 hours a day thanks to support from home-visit nursing and nursing care agencies as well as medical institutions in the neighborhood. One resident is Sumio Ninomiya, 77, who has been certified by the ward office as being in need of Category 4 nursing care, the second-heaviest assistance category on an official scale of five. Living in a room on the fifth floor, Ninomiya is on livelihood protection welfare and has home-visit nursing care every day and a weekly visit by a nurse. For about 10 years before he started living at Sanko, he struggled with the aftereffects of a stroke, and had been in and out of about 20 hospitals. Although Ninomiya has little need for medical treatment, he had little choice but to enter hospital simply because there were no other facilities available to him where he could receive nursing care. But with the support of staff at the low-price lodging facility, his living conditions have improved significantly. He has also been attending a local nursing care day center since October. Running Sanko is the Self-Reliance Support Center Furusato no Kai, a nonprofit organization based in Taito Ward. "I'm so happy to be able to receive nursing care services here without having to worry. Given the chance, I'd have liked to have moved in here much earlier," Ninomiya said with a smile. Sanko is supposed to serve as a facility offering transitional care to poor people before their eventual entry into homes for the aged requiring around-the-clock in-house nursing care. All 81 residents of Sanko are on the government welfare program and nearly 70 percent of them are aged 65 or older and need care in almost all aspects of their daily lives. Forty-six have been cleared to receive government-backed nursing care services, while about 20 percent of the residents are suffering from dementia. Over 100 on waiting list: Ninomiya is one of the lucky ones, though. More than 100 others are on a waiting list for admission to the eight facilities including Sanko run by nonprofit organization Furusato no Kai. The NPO runs the facilities, which house a total of about 200 needy people requiring nursing care in Taito Ward and adjacent Sumida Ward. Tokyo has about 170 government-authorized lodging facilities for needy elderly people, which house a total of about 4,400 residents. Few of these facilities, however, can provide residents with nursing care. Furusato no Kai, therefore, is bombarded with requests from the Tokyo metropolitan government's social welfare offices to accept new residents. The NPO wants to increase the number of facilities it runs that are capable of giving nursing care services, but it receives no financial support from the government for funding these facilities. Ken Takewaki, a director of the organization, said, "To take care of the aged who need nursing care in our facilities, we need to secure the cooperation of nursing care service agencies and medical institutions in the neighborhood." "Without securing funds to cover the personnel costs of providing dedicated staff for this system, this kind of service will not expand any further," Takewaki said, calling for public funds to be funneled into the organization's activities. Goodbye to familiar environment: The shortage of facilities is not only limited to this kind of transitional establishment. Facilities at which people, including those on welfare, can live while getting nursing care services are also badly lacking. Currently, about 38,000 people are on waiting lists for admission to homes in Tokyo for elderly people in low-income brackets who require around-the-clock nursing care. It is becoming increasingly difficult for these people to gain admission to one of the facilities. The result is that a growing number of people end up having to find care facilities farther afield, a trend that runs counter to the guiding principle of the government's nursing care policy, which stresses the importance of enabling the aged to live "in a familiar environment." Of those receiving welfare from one of Tokyo's wards or other municipal governments and recognized as eligible for free nursing care services, about 500 have been forced to live at fee-paying nursing homes for the aged in such areas as Ibaraki, Chiba and Shizuoka prefectures. This development has emerged amid a rise in the number of elderly persons who have no relatives to rely on and are unable to continue living alone with only part-time help from nursing care workers, or those who cannot find nursing care facilities in Tokyo after being released from hospital. Reportedly, a rising number of aged people on welfare in Tokyo are being obliged by local governments to move to places outside of Tokyo on the understanding that the ward or other municipal government will continue to pay their welfare benefits and cover their nursing care service costs. As a result, an increasing number of elderly people on welfare have been moving out of Tokyo to other areas, in particular, to Ibaraki Prefecture, which is not far from Tokyo and enjoys relatively low land prices and a favorable climate. A social welfare official of the prefecture's Mito municipal government said, "We can't put an exact figure on it, but the number of elderly people [living here] who receive welfare and payments for nursing care services from Tokyo has become very noticeable compared with a few years ago." Recently, a growing number of rented housing units that offer meals and nursing care and are specially designated for the aged are being built in Ibaraki Prefecture for use by elderly people receiving welfare from Tokyo, the official said. But when elderly people on welfare move outside Tokyo, it becomes difficult for Tokyo's social welfare offices to keep an eye on their living conditions, and fears are growing that their lives could actually worsen after moving out of the capital. In light of this, the metropolitan government in January instructed its ward and other municipal governments to check on the living and nursing care service standards in the areas where the aged on welfare move. The municipal governments of Tokyo have also been instructed to vigilantly keep track of how such elderly people are getting along after moving to areas outside the capital. The metropolitan government has also been making preparations to increase the number of residents at homes for the aged requiring 24-hour nursing care to about 40,000 from the present 34,600, in addition to improving nursing care facilities exclusively for poor elderly people living alone. Housing policy defective: Of households on welfare across the country, about 470,000, or 44.1 percent, comprised elderly members in 2006, almost double the figure of 240,000 households, or 31.2 percent, in 1985. There can be no telling whether all recipients of welfare, whose number has been swelling in city areas, can be taken care of at government-backed nursing care facilities in the future. Furthermore, there are no prospects yet of an extension of government subsidies to accommodations in the private sector that provide needy elderly people with nursing care services. Looking back, government social welfare policies have failed for decades to pay due attention to providing poor elderly people with sufficient housing assistance. Prof. Koji Takahashi of Rikkyo University, an expert in community nursing care policy, said, "Housing is of fundamental significance to the quality of life, and the central government needs to genuinely buckle down and come up with an effective housing policy." "Instead of placing priority on increasing the number of nursing care facilities, local governments should provide more backing to nonprofit organizations that are playing a key role in helping the needy who require nursing care to live in those areas," he said. © The Yomiuri Shimbun