East Asian Social Policy WorkshopEast Asian Social Policy Workshop (13(13thth – 15 – 15thth January 2005) January 2005)

Aging and Social Policy sessionAging and Social Policy session

The Impact of Long Term Care The Impact of Long Term Care Insurance Act on the Provision of Insurance Act on the Provision of Personal Social Services for Older Personal Social Services for Older

People – A People – A

Case Study in Japan –Case Study in Japan – Junko Yamashita Junko Yamashita Department of Social Policy and Social work Department of Social Policy and Social work

The University of York The University of York

AimAim To explore how recent policy reform, To explore how recent policy reform,

which intends to promote ‘socialization which intends to promote ‘socialization of care work & encourage care of care work & encourage care provision from the independent sector, provision from the independent sector, have impacted on the functions of have impacted on the functions of service delivery by Welfare Nonprofit service delivery by Welfare Nonprofit Organisations (WNPO) operating in the Organisations (WNPO) operating in the field of personal social services for field of personal social services for older people in Japan.older people in Japan.

To evaluate the LTCI Act’s scope of To evaluate the LTCI Act’s scope of service provision.service provision.

The Structure of the The Structure of the Presentation Presentation

The historical context The historical context The LTCI Act The LTCI Act The characteristics of WNPOs The characteristics of WNPOs Sampled WNPOs for the study Sampled WNPOs for the study

Is there any originality in the way Is there any originality in the way WNPOs deliver services? Why?WNPOs deliver services? Why?

What kinds of demands are WNPO’s What kinds of demands are WNPO’s responding to? Why? responding to? Why?

The increase in the numbers of The increase in the numbers of WNPOs after the mid 1980sWNPOs after the mid 1980s

1674

1912 1915

1409

11831002

861691

520452

3593322712071380200400600800

100012001400160018002000

Num

bers

of

NPO

s

The emergence of WNPOs from tThe emergence of WNPOs from the mid 1980she mid 1980s

‘‘Socialised hospitalisation’ Socialised hospitalisation’ Problematisation of the ‘burden’ upon the fProblematisation of the ‘burden’ upon the f

emale family membersemale family members

Groups from grass-root level began to be Groups from grass-root level began to be organised by women with the idea of mutual organised by women with the idea of mutual help.help.Government also encouraged these activitieGovernment also encouraged these activities. s.

The Historical ContextThe Historical ContextDemographicDemographic

The fastest ageing population and the The fastest ageing population and the longest life expectancy longest life expectancy

Changes in household structureChanges in household structurePoliticalPolitical

‘‘Japanese-style of welfare society’ in the Japanese-style of welfare society’ in the end of 70send of 70s

Delaying proper preparation for the aging Delaying proper preparation for the aging

society.society.

Japanese style of welfare Japanese style of welfare societysociety

Stop following Western models Stop following Western models Inventing a tradition Inventing a tradition Opposing to the demographic trendsOpposing to the demographic trends

The society has welfare programmes for the elderly The society has welfare programmes for the elderly with the burden of the tax prayer and it does not have with the burden of the tax prayer and it does not have the purpose that individuals do not need to take the the purpose that individuals do not need to take the responsibility. Its purpose is to be a ‘last rescue boat’ responsibility. Its purpose is to be a ‘last rescue boat’ in such an exceptional case, that is, for those who do in such an exceptional case, that is, for those who do not have any relatives or their family do not have any not have any relatives or their family do not have any ability to take the responsibility. If one might think ability to take the responsibility. If one might think they do not need to take care of their parents because they do not need to take care of their parents because the government or local authorities provide social the government or local authorities provide social welfare for them, this is completely mistaken. (Jiyu welfare for them, this is completely mistaken. (Jiyu Minsyu To [Liberal Democrats Party] 1979 Study Minsyu To [Liberal Democrats Party] 1979 Study paper ‘Japanese-style welfare society)paper ‘Japanese-style welfare society)

The policies concerning WNPOsThe policies concerning WNPOs The Specified Nonprofit Activities Law 1998The Specified Nonprofit Activities Law 1998 access to a legal status became much easieraccess to a legal status became much easier The Long Term Care Insurance Act 2000The Long Term Care Insurance Act 2000 - ‘Socialisation of care work’- ‘Socialisation of care work’ - The emphasis on ‘user’s choice’- The emphasis on ‘user’s choice’ - Creation of a quasi-market of care provision- Creation of a quasi-market of care provision - The Introduction of a social insurance system - The Introduction of a social insurance system - The promotion of local autonomy- The promotion of local autonomy

Socialisation of care workSocialisation of care work

‘‘enabling the frail older people to keep their enabling the frail older people to keep their autonomous life at home even without care provision autonomous life at home even without care provision from the family’(The Ministry of Health and Welfare from the family’(The Ministry of Health and Welfare 1998)1998)

Japan becameJapan became the first country in Asia whose the first country in Asia whose government bears an essential part of the government bears an essential part of the responsibility for the care provision of its older responsibility for the care provision of its older citizens.citizens.

The Characteristics of WNPOsThe Characteristics of WNPOs

Membership systemMembership system

Involving service providers and service Involving service providers and service users, 89% had membership system users, 89% had membership system

Female participantsFemale participants

95 % of participants were middle-aged 95 % of participants were middle-aged housewives housewives After 2000, more young After 2000, more young women and men began to participatewomen and men began to participate

Monetary exchangeMonetary exchange

Accepted fees for services Accepted fees for services

A means to keep reciprocity A means to keep reciprocity between service providers and between service providers and service usersservice users

Concentration in metropolitan areasConcentration in metropolitan areas

Sampled WNPOsSampled WNPOs

WNPOWNPO Est.Est.Hours of Hours of Service Service

Provided per Provided per monthmonth

Numbers of Numbers of participantsparticipants

AA 19961996 27002700 6060

BB 20022002 700700 3030

CC 19891989 440440 2020

DD 20002000 650650 3030

EE 19991999 43004300 7474

FF 19901990 10001000 4545

GG 20012001 450450 2121

HH 19861986 18001800 6060

II 19951995 21502150 5050

JJ 19981998 99869986 200200

The role of WNPOs The role of WNPOs regarding service regarding service

deliverydelivery

What is original about WNPO’s What is original about WNPO’s services?services?

What kinds of demands are WNPOs What kinds of demands are WNPOs responding to?responding to?

The originality of WNPO’s The originality of WNPO’s servicesservices

CordialityCordiality From user’s point of viewFrom user’s point of view Responding to older people’s needsResponding to older people’s needs

? ? ? ? ? ?

Under the LTCI Act it is difficult to Under the LTCI Act it is difficult to differentiate between WNPO’s services differentiate between WNPO’s services and those of other organisation’sand those of other organisation’s

The originality of WNPO’s The originality of WNPO’s servicesservices

StandardisationStandardisation

of Service of Service Responding to User’sResponding to User’s

NeedsNeeds

Providing original services ‘Centre of WNPO’s activities’

Same services, but with low fees and Services are not authorised by the LTCI Act

The originality of WNPO’s The originality of WNPO’s servicesservices

Overwhelming administrative work for Overwhelming administrative work for service provision under the LTCI Actservice provision under the LTCI Act

Financial rationalityFinancial rationality Time consuming work Time consuming work respect for respect for

individual needsindividual needs

Struggling to continue original Struggling to continue original servicesservices

High demand for services High demand for services assisting with domestic assisting with domestic

taskstasks

The LTCI Act regards care assistant The LTCI Act regards care assistant services much higher than domestic services much higher than domestic

tasks tasks

Qualification and priceQualification and price

private companies prefer to take private companies prefer to take care assistant servicescare assistant services

High demand for services High demand for services assisting with domestic assisting with domestic

taskstasks The re-evaluation of domestic tasks The re-evaluation of domestic tasks

by WNPOsby WNPOs

Domestic tasks demand more hard Domestic tasks demand more hard work than care serviceswork than care services

Standardised salary Standardised salary

I thinks care assistant services are less demanding. You just need to follow patterns. But for domestic tasks, every user has their own way of doing it. (A (A member of management body of WNPO F)member of management body of WNPO F)

Well, each house has its own way to do things, you know. Some people give us such detailed orders, such as preference of taste, or the way to wipe a table. (An (An active participant of WNPO A)active participant of WNPO A)

Exclusion of menExclusion of men

The way of re-evaluating domestic The way of re-evaluating domestic tasks leads to discrimination barring tasks leads to discrimination barring man from participating in WNPOsman from participating in WNPOs

Services are counting on the Services are counting on the experience womenexperience women have of being a housewifehave of being a housewife Men are not wantedMen are not wanted

Being a housewife for years makes a difference, doesn’t it? The experience of being a housewife for a couple of decades makes you ca[able of deciding what you will cook quickly, with looking at what is left in the fridge ( An active participants of WNPO A)

R: Are there any male participants in your group? Director of WNPO H: Not at all, not even one. R: Have you had any men who wanted to join your

group as carer? Director of WNPO H: Yes, year there was. We

didn’t reject him, but well, difficult, assisting domestic tasks is very difficult … He said he would do cooking form now on and master cooking. But you know, it does not take so much time and trouble for us to do cooking, I mean, making normal dishes … Actually there was no demand for him.

Director of WNPO A : Director of WNPO A : There are difficulties using a male carer.

R: R: Why are there difficulties? Director of WNPO A : For example, for

taking a walk for rehabilitation, men can do it, but you cannot take a walk together in silence… Particularly Young men do no have enough skill to be a good company for older people.

Concluding CommentsConcluding Comments

WNPOs create a system of service WNPOs create a system of service provision and provide original provision and provide original services outside of the LTCI that services outside of the LTCI that respond to individual needs of older respond to individual needs of older people which are not covered by the people which are not covered by the LTCI. LTCI.

Concluding CommentsConcluding Comments

WNPOs are meeting demands for WNPOs are meeting demands for services to assist domestic tasksservices to assist domestic tasks

WNPOs re-evaluate the domestic WNPOs re-evaluate the domestic tasks based on their practical tasks based on their practical experience of service provisionexperience of service provision

Concluding CommentsConcluding Comments

The inextricable link between the way The inextricable link between the way domestic tasks are re-evaluated and domestic tasks are re-evaluated and dis-qualification of domestic tasks by dis-qualification of domestic tasks by the LTCI exclude participation by the LTCI exclude participation by men and young womenmen and young women

WNPOs are struggling to keep their WNPOs are struggling to keep their original services, but if they do not original services, but if they do not run these services…….run these services…….