Long‐term care of older personsThe case of Japan
Reiko Hayashi, Ph.D.hayashi‐[email protected]
Director of International Research and CooperationNational Institute of Population and Social Security Research (IPSS)
Tokyo, Japan
Regional Expert Consultation on Long‐term Care of Older Persons9‐10 December 2014
Bangkok
Population trend by age group in Japan(1920‐2060)
37,375(40%)
22,867(18%) 11,045
(13%)
50,694(54%) 74,968
(59%)
41,050(47%)
15,173(12%)
11,279(13%)
14,072(11%)
23,362(27%)
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
1920 1930 1940 1947 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
Popu
latio
n in
1,0
00
Year
0-19 years old
20-64 years old
93,419
128,057
86,737
Projection
55,963
Where are the elderly in
Japan(Aged 65+,2010)
At home alone
4,790,768 16.4%
At home with spouse 9,864,505 33.7%
At home with
children /family/oth
er 12,922,551
44.2%
Facility 1,201,136
4.1%
Hospital 448,748, 1.5%
Other 17,9770.1%
3
Source : Census 2010 www.e‐stat.go.jpCalculated from Table 6. Household Members, by Type of Household (2 Groups), Family Type of Household (16 Groups), Type of Institutional Household (6 Groups), Marital Status (4 Groups), Age (Five‐Year Groups), Sex and Average Age ‐ Japan* and Prefectures*
0
5
10
15
20
25
30
35
40
40
50
60
70
80
90
100
110
120
1870 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Popu
latio
n Ag
ed 65 an
d over (%
)
Life Expectancy (years)
YearLife Expectancy Population Aged 65 and over (%)
Health Insurance
Pension
Long‐Term Care Insurance
Universal Coverage
4
Long‐term care insurance system in Japan
Insurer and OperatorMunicipalities (Shi‐Ku‐Cho‐Son 市区町村)
Source of financing
Ope
ratio
n
Care‐needs assessment and Care‐Plan elaboration by Care‐manager
In‐home services
Facilityservices
Community‐based care services
Nursing care
prevention services
Community‐based nursing care
prevention services
Premium
Secondary insured
Aged 40‐64
Primary insuredAged 65+
Subsidy
National Prefectural Municipal
Co‐payment
Source : “The current situation and the future direction of the Long‐term Care Insurance System in Japan～With a Focus on the Housing for the Elderly～”, March 7, 2013, Website of Ministry of Health, Labour and Welfare
291 320 398 505601 674
59527 551 575 604 662 69245
521 629 662654 669 712
655
40 1
551 709 891
1,070 1,252 1,332
1,387 876 769 788 852
910 970
394490
571
641595
614651
756 806 823854
901952
317358
394
431492
527560 652 711
738 713700
724
339
365
394
424
479497
525 547579 590
630641
670
290
341
381
414
455465
465 489500
515564
593609
2000 2001 2002 2003 2004 2005 2006 2007 2009 2010 2011 2012 2013
Support Level Support Level 1 Support Level 2Transitional Care Level Care Level 1 Care Level 2Care Level 3 Care Level 4 Care Level 5
Source : Report on the Status of Long‐term Care Insurance, etc. Notes : Data are of April each year. Due to the Great East Japan Earthquake, 11 and 3 municipalities data are not included in the data of 2011 and 2012, respectively.
The number of persons certified for the long‐term careby care/support level (in 1,000)
2180
2580
3030
3490
38704110
4350 44104550
48704690
50805330
7
Source : “The current situation and the future direction of the Long‐term Care Insurance System in Japan～With a Focus on the Housing for the Elderly～”, March 7, 2013, Website of Ministry of Health, Labour and Welfare
Facility covered by public aid providing long‐term care to the
elderly
Long‐term care health facility
Fee‐based home for elderly
Group home for the elderly with dementia
Moderate‐fee home for the elderly
Sanatorium medical facility for the elderly requiring long‐term
care
Care facility for the elderly
Elderly housing with care service
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Admission
capa
city in
1,000
persons
The admission capacities of elderly housings/nursing homes
Source : Material 2 submitted at the Council on social security, 48th subcommittee of long term care insurance, 18 Sep.2013社会保障審議会介護保険部会（第48回）平成25年9月18日 資料2 『施設サービス等について』
expenditure of long term care insurance
Source : Website of Ministry of Health, Labour and Welfare, http://www.mhlw.go.jp/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/chiiki‐houkatsu/dl/link1‐2.pdf
trillion yen
Total expenditure Premium
Year
National government budget2013
Decentralization,
16.1, 17%Infrastructure, 6.0,
6%
Education and
research, 5.4, 6%
Defence, 4.9, 5%
Other, 9.7, 10%
Servicing government bonds, 23.3, 24%
Social security30.5 trillion yen
32%
Pension10.735%
Health11.237%
Employment, 0.2, 1%
Welfare5.518%
Care for Elderly2.6, 9%
Total General Budget = 95.9 trillion yen
Healthcare Long‐term care
Living support
Housing
Commuting to medical facilities/care facilities
Old people’s club, residents’ association, long‐term care prevention, living support, etc.
Integrated Community Care system
Home‐visit care• Nursing careOwn home/elderly housing with long‐term care
Provides consultation and coordinating
services
12
Prevention
Integrated community care support center/
care manager
Example : Kashiwa city, Chiba PrefectureKashiwa cityPopulation : 404,949 (2013)Aged 65+ : 19.9% (2010)
26.7% (2030)Distance from Tokyo : 30km40 min. by train from Tokyo stn.
Toyoshikidai ComplexPublic housing development since 19644,850 housholds Aged 65+ : 40%
Old buildings Renewed buildingCentral shopping mall
Kashiwa city University of Tokyo
Urban Renaissance Agency
Collaboration with• Community doctor / Nurse
• Hospitals• Nursing homes• Municipality• University
(research)
Community health care
Job creation for the elderly
Housing / neighborhood renovation
Human Resources for Health demand projection (Japan, 2011, 2015, 2025)
290 305 330
1,410 1,590 2,000
1,400 1,690
2,380 850 930
1,230
660
810
1,280
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
2011 2015 2025
in 1,000
personn
el
Year
Other(Care)
Other(Medical)
Careworker
Nurse
Doctor
Source : http://www.cas.go.jp/jp/seisaku/syakaihosyou/syutyukento/dai10/gijisidai.htmlreference material 1‐2 supplied at 10th Meeting on the Intensive Consultation on the Social Security
(第10回社会保障改革に関する集中検討会議), 2 June 2011, Cabinet Secretariat
Average of reformed scenario
pattern 1
Shortage of labour?
• Robots• The old care the older (老老介護)• Better working condition with appropriate career path
• From family to community• Foreign care workers
Number of entries under EPAfrom Indonesia, Philippines, Vietnam
Year Nurse candidateCare‐workercandidate Total
2008 104 104 2082009 266 406 6722010 85 159 2442011 117 119 2362012 57 145 2022013 112 195 3072014 98 410 508Total 839 933 2,377
Compiled from http://www.mhlw.go.jp/bunya/koyou/other22
30
40
50
60
70
80
90
100
110
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100Year 年
China
SouthKoreaThailand
PhilippinesJapan
Indonesia
Transition of dependency ratioAsian countries
Data source : United Nations, DESA, Population Division (2013). World Population Prospects: The 2012 Revision, CD‐ROM Edition
Depe
nden
cy ra
tio (<
15 & 65+)/(15‐64)
Foreign careworkers
• Ageing population in Asia> shortage of labour everywhere
• EPA(Economic Partnership Agreement)• Under discussion‐ Technical Intern Trainees‐ Status of residence : Medical
• Development of Human Resources for Health for ASIA
Proportion of the aged75 years and over in 2040municipality level (2010=100)
0
10
20
30
40
50
60
1920 1930 1950 1955 1960 1965 1970 1975 1980 1980 1985 1985 1990 1995 2000 2005 2010
in m
illio
n 4+
3
2
1
22.2%
18.2%
27.2%
32.4%
Household number by size (household members) Japan (1920 – 2010)
Data source : Census data, Statistics Bureau of Ministry of Internal Affairs (www.stat.go.jp)
28.1
32.3
36.9
42.0
47.2 47.6
49.3
48.0
50.7 51.6
52.2
52.4
52.0 52.9
54.1
54.0
20
25
30
35
40
45
50
55
60
1975 1980 1985 1990 1995 2000 2005 2010 2015
（%）
年
Source : 7th Migration Survey of Japan, IPSS
Single or only couple (without children) household in Japan
（65+）
3.1 9.5
30.8 25.4
27.1 26.9
39.0 38.2
0%
20%
40%
60%
80%
100%
20112001
Differentprefecture
Same prefecture
Samemunicipality
Same house
n=4,694 n=4,793
from living together to living close
1. At homewith family
care4%
2.Live at home
with family and external
care49%
3.Live at home
independentlywith
external care27%
4. Fee charging nursing home5%
5.Special nursing home6%
6.Hospital2%
7.Others3%
8.N.A.4%
1. At homewith
family care4%
2.Live at homewith
family and external care24%3.Live at
home independe
ntlywith
external care46%
4. Fee charging nursing home12%
5.Special nursing home7%
6.Hospital2%
7.Others3%
8.N.A.2%
Intention of long‐term care[If you need long‐term care] [If your parents need long‐term care]
1. Live at home receiving cares by mainly my family
2. Live at home receiving combination of external long‐term care services and care by my family
3. Receive long‐term care at home if there are services that enable me to live at home independently of my familymembers4. Move into fee charging home for the aged or house for the elderly with care to receive long‐term care.Source: “Opinion collection from the citizens concerning long‐term care insurance
system (result outline)” by Health and Welfare Bureau for the Elderly of MHLW 22
Healthy Life Expectancy Japan ‐Male
66
68
70
72
74
76
78
80
82
1970 1975 1980 1985 1990 1995 2000 2005 2010 2015
Years
Year
Male
Life Expectancy HLE not in bed not bed‐ridden no need for care independent
70
72
74
76
78
80
82
84
86
88
1970 1975 1980 1985 1990 1995 2000 2005 2010 2015
Years
Year
Female
Life Expectancy HLE not in bed not bed‐ridden no need for care independent
Healthy Life Expectancy Japan ‐ Female
