July 21, 2010

JAPAN: Elderly living alone increasingly dying the same way

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TOKYO, Japan / The Japan Times / Life in Japan / July 21, 2010

GROWING OLD ALONE

Sign of an aging, isolated society:
lack of family, government support


By NATSUKO FUKUE,  Staff writer

Die unnoticed and in two months all that is left is the stench, a rotting corpse and maggots.

And this is not a war zone or even an episode of "CSI." As Japan's population rapidly ages and more seniors find themselves living on their own, many are also dying alone, victims of "kodokushi" (lonely death) who only get noticed well after the fact.


Kodokushi has neither an official definition nor data, but just in Tokyo, people over 65 who died alone in their residence, including by suicide, stood at 2,211 in 2008, compared with 1,364 in 2002, according to the Tokyo Medical Examiner's Office.

"Those who live alone and have no friends tend to be isolated from society," said Katsuhiko Fujimori, manager and chief research associate of social policy at Mizuho Information and Research Institute.


"A lot of young people, especially men, came to big cities to work during the period of postwar economic growth, and now they are old and alone" because they are unmarried or their partner died, he said. "They might have wanted a free lifestyle, escaping from a close-knit community. But now that they're old, they can't live alone, especially if they need nursing care."

Dying alone has become a growing issue as the society rapidly ages. The government has long assumed families would care for the elderly and thus was able to minimize funding for social welfare, compared with nations in Northern Europe that have extensive welfare systems.

Fujimori said the government must confront the problems of social isolation, poverty and nursing care, because not only are more older people living alone but singles in general are increasing.

The 2005 national census determined that one in 10 elderly men and one in four elderly women were living alone. The total in 2005 was 3.86 million, compared with 2.2 million a decade earlier.

Although more women live alone because they tend to live longer than men, Fujimori said men are more likely to experience social exclusion and end up dying lonely deaths because many don't participate in community activities.

Long hours on the job prevented men from attaining a work-life balance, and this has led to isolation after they retire, he said.

Singles are increasingly spending less time with people other than family, according to Fujimori. Among the member states of the Organization for Economic Cooperation and Development, Japan has the highest percentage of people who rarely or never spend time with people other than family members, followed by Mexico and the Czech Republic.

"The Japanese way of interacting with people is based on family," he said.

Experts note elderly people must depend heavily on family help in terms of nursing care even though there are public nursing care services.

A nursing care insurance system was introduced in 2000 under which 90 percent of costs are covered. But 70 percent of households with elderly people eligible to receive such services still rely on their families, Fujimori said, noting at most they can only receive five hours of nursing-care service a day.

These circumstances cause family members great mental and physical stress, and thus it is no surprise when a middle-aged, or older, family member, no longer able to function as a caregiver, murders a parent needing nursing care.

Social security expenses, including medical, pension and other welfare fees, amounted to ¥91.4 trillion in 2009. At quick glance, it would appear the government has allocated huge amounts to cover welfare costs, but the amount is only 22.1 percent of GDP, despite the growing elderly population.

In Europe, social expenditure ratios to GDP in 2005 came to 30.1 percent in Sweden, 29.4 percent in France, 27.1 percent in Germany and 19.1 percent in Britain.

"It is common for countries where families no longer play a key role in elderly care to try to expand the social security net," said Toru Suzuki, senior researcher at the National Institute of Population and Social Security Research, adding Japan needs to strengthen social welfare support for the elderly.

Fujimori said public support for the elderly living alone is well established in Northern Europe, particularly in terms of housing. "It's a big difference (compared with Japan)," he said.

Britain, Denmark and Sweden provide financial support for barrier-free housing with caretakers or nurses who can watch seniors around the clock.

"What's more, (Europeans) get 'informal care' from friends," said Fujimori, indicating voluntary nursing care by family, friends and neighbors. In Japan, such informal care provided by nonfamily members amounted to just 3 percent, according to a 2005 OECD report, compared with 53 percent in Sweden, 45 percent in Canada, and 35 percent in the U.S. and the U.K.

Researchers also point out that Japan lags greatly in taking measures to help impoverished seniors living alone.

Although the average income and financial assets of singles exceed those of couples when they are working, the situation is reversed at age 65, when singles are more likely to have an annual income of less than ¥1.5 million, Fujimori said.

In addition, he said, most married couples in their 60s own their homes, compared with half the single people in the same age group.

In the next 20 years, poverty is expected to spread to single men in their 50s, as one in four in their 50s and 60s will probably remain single.

The number of single men aged 65 and older is expected to increase sharply to 1.68 million in 2030 from 260,000 in 2005. Meanwhile, single elderly women will reach 1.2 million in 20 years, from 520,000 in 2005, according to Fujimori.

Unemployment, especially among single men in their 50s, is also becoming an acute problem. Men in this age group will probably be denied welfare because they are regarded as still young enough to work but not old enough to draw a pension, Fujimori said. "Single men in their 50s tend to fall into the gap of public financial support."

Suzuki also noted poverty is not just a problem for men.  He said data indicate women with stable incomes have higher chances of getting married. "The less fortunate they are, the greater likelihood that they will remain single," he said.

Fujimori said the government should improve social welfare by increasing taxes and restoring the nation's finances from their current heavily indebted state.

"We should discuss a redistribution of income, and allocate more to welfare and medical costs," Suzuki said.

Fujimori noted, however, that Japanese may be unwilling to share the burden because their trust in the government has flagged. He said the government must make every effort to convince the public of the need to remedy the nation's financial situation as soon as possible.
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GROWING OLD ALONE
Neighbors, more than kin, face onus of keeping tabs on seniors
By NATSUKO FUKUE

Cleanup after unnoticed death now a growing industry
By MIZUHO AOKI
(C) The Japan Times