My name is Bruce Marshall, and this blog was started after a study tour I made to Japan in September 2018 to get some insights into how the country was handling it’s transition into it’s current status as a “Super-Aged Society“. As well as the trend of an ageing population things are being further compounded by a shrinking population, making it an incredibly complex and interesting time in Japan’s history. (and that’s saying something for a country that has had an incredibly complex history to date!)
The study tour itself was made possible through a scholarship from Economic Development Australia,(EDA) with the idea being to gain learnings and insights that could be shared with fellow economic development practitioners in Australia. A key focus of the trip was a 2 day conference in Tokyo aptly titled “Ageing & Society”, which was an international multi-disciplinary conference (which basically meant both academics and non-academics were welcome). As a non-academic myself, it was great to be welcomed into the midst of academics from across the globe who had gathered in Tokyo to share their research into a topic which, before long, is going to be one of the biggest issues facing 1st world countries across the planet.
Either side of the conference I arranged to make a number of site-visits, join events and conduct interviews, and more or less see where my nose led me on my quest to learn more. It proved to be an amazing learning experience, that, from a personal perspective at least, gave me immense satisfaction to be able to use my mostly dormant Japanese language skills for something productive.
Post study tour a full report was completed and that’s available to download on the EDA website. However, over the 10 days of the tour I got no where near close to visiting all the places I really wanted to, and in my preparation for the tour I found so many interesting bits of info that it seems a waste not to share them somewhere. Hence the idea for this blog.
Going forward I’ll share a mixture of my actual case-studies and site visits from the study tour, as well as some interesting side-stories and news relevant to the theme of Japan’s Ageing Society & shrinking population. While there is some relation to my professional work, this blog is really linked to my ongoing passion for Japan and I’m genuinely curious about what is going to happen over the next 15-20 years. I hope you enjoy.
Being checked into the “Henn Na Hotel“ in Tokyo by a robotic Velociraptor. “You’d like to see my passport you say?….Who am I to argue with a talking dinosaur!”
While in Japan on my 2018 study tour I visited Mori tower for an interview to get an insight into modern urban development in Tokyo. As hinted at the time they have now announced their next audacious development project. There is no suggestion that the new development will cater for the ageing society…..but that has never been part of Mori’s strategy.
Mori Building Co, one of Japan’s major urban landscape developers, on Thursday announced it has begun construction on its Toranomon-Azabudai District Category 1 Urban Redevelopment Project, a project aimed at revitalizing a large area of central Tokyo. It will include residences, offices, a luxury hotel, retail shops, restaurants, cultural facilities,…
An interesting article about the increasing number of foreigners living and prospering in Japan.
When I used to live there in the early naughties, foreigners were still very much a novelty, and there was a definite difference in the way that Japanese treated Asian foreigners as opposed to Caucasians like myself. It’s intriguing to see how things are changing. – Bruce
Another article with an update on population figures declining in Japan. – Bruce
Japan’s population excluding resident foreigners declined to 124.8 million as of Jan. 1, falling by the biggest number since the current survey began in 1968, affected by record-low births, government data showed Wednesday. With fewer than 1 million births in Japan for the third straight year in 2018, the population…
It looks like the aging and shrinking population of Japan is getting more attention with the G20 signalling the trend as a global threat.
-Bruce
Ballooning healthcare costs, labor shortages and financial services for the elderly: for the first time Sunday, the world’s top policymakers are tackling economic issues relating to aging and shrinking birthrates. G20 finance ministers and central bank chiefs meeting in Japan — where a rapidly aging population is a major domestic…
The Chinese characters for ‘Reiwa’ chalked onto a wall at my wife’s parents home in Aomori.
Today, (1st March 2019) marks the first day of the new ‘Reiwa Jidai’ (令和) or ‘Reiwa Era’ in Japan’s history. With the succession to the throne of Emperor Naruhito, the 30 years of the Emperor Akihito’s Heisei Era have come to an end.
I’m actually in Japan on a family holiday as I type this and it has been interesting to see the mixed reactions from the community to the changing of the emperor. There are naturally a lot of zealous and passionate people who have really gotten into this rare occasion (including myself I must admit), though I get the sense that for most people it is just something happening in the background that has no real bearing on their day to day life.
With no direct political influence or power, the most significant thing about the reign of the Japanese emperors is that there is a calendar aligned to the period. People in Japan therefore need to know two separate calendars and in particular things such as official birth records must be recorded against the era name. Hence, any child born from 12:01am this morning will be born in the Reiwa period. The era names also serve as a useful way to describe a certain period of time which is usually longer than the 10 year blocks of time we use in western society. For the sake of this blog, I’ll give a brief description of the last couple of eras that are relevant to the Japanese people still alive today.
Heisei: This era ran from 8 January 1989 to 30 April 2019 (30 years). The name literally translates to ‘Peace Everywhere’ and Emperor Akihito was lauded for his humble and publicly visible approach to the role. Indeed, he is being referred to as the ‘People’s Emperor’ and he was often seen comforting victims of Japan’s various natural disasters (that unfortunately have been a fairly regular occurrence under his reign.) Heisei was a period of peace for Japan, though there were some real hardships such as the bursting of the Japanese economic bubble in the early 90s which is something the country has never really bounced back from.
People born in Heisei year 1 would be turning 30 in 2019.
Showa: This era ran from 25 December 1926 until 7 January 1989, a period of 63 years. Emperor Hirohito is infamously associated with the World War II atrocities that Japan was involved in, though the reality appears to be that it was the government of the day rather than the Emperor himself that used the name of the Emperor to drive national pride and convince citizens to go to war. The Emperor didn’t have much direct contact with the general public, and indeed when his voice came over the radio to announce Japan’s surrender in WWII, for most people it was the first time they had heard his voice.
Naturally, over the course of 63 years there was much change in Japan though most people associate the Showa era with the post war rebuilding of Japan. Indeed there is a strong nostalgic sense to the word Showa as it took in the 60s and 70s where Japan’s massive baby boomer generation were in the prime of their lives. Those same baby boomers are now all nearing retirement. Someone born in the first year of Showa would be turning 93 in 2019.
Taisho: A relatively short era from 1912 – 1926 (14 years). Emperor Yoshihito was apparently a rather sickly man and had limited influence himself. This period was significant for World War I where Japan fought on the side of the allies and become a much more powerful country in the Asia region after successful military campaigns in China. Somebody born in the first year of Taisha would be turning 107 this year.
Meiji: Probably the most famous imperial era in Japan which ran from 1867-1912 (46 years). While most people born in this period would now likely have passed away (anyone born in the last year of Meiji would be 107+ this year), the Meiji era is when modern day Japan was born. Without going into all the details, basically there was a civil war to overthrow the government which at the time was still based on the feudal Shogunate system of the samurai. The way the coup was able to work was that it was on the basis of restoring power to the emperor who had been relegated to a symbolic status in the background for centuries. Hence it is often referred to as the ‘Meiji Restoration’. With the new government formed, Japan quickly modernised and for the first time really opened its doors to western influences.
So as Japan becomes a ‘Super-Aged Society’ the Reiwa Era will no doubt be an interesting period in Japan’s history. The name itself roughly translates to ‘Beautiful Harmony’, and in his first public address this morning the new Emperor made a pledge to continue to a be an Emperor of the people like his father had been.
Emperor Naruhito is 59 years old himself, so all things being equal, we can expect at least another 30 year reign which will be ample time to see how Japan adjusts to its new demographic paradigm.
When preparing for this study tour,
it became blindingly clear that the demographics population pyramid was
pointing towards a fairly dire situation for Japan’s future work force. It is this future workforce that, in the
current economic model at least, will have to financially support the retired
population.
In 1965 the working age population
in Japan had a ratio of around 9 workers for every retired person. By 2012 the ratio had dwindled back to 2.4
workers per retiree. By 2050 that ratio
will be 1.2!
I was really curious to see what
younger Japanese people thought about the trends and to that end I made plans
to visit my former employer the ‘International Innovation Centre’, a Not for
Profit company set up to support young Japanese to travel abroad and to promote
international friendship and cooperation.
There were two planned activities
for the day. A seminar class in the
afternoon called ‘Let’s talk about Japan’s Seniors’, and a more relaxed party
in the evening where I could chat with students and also take a survey of their
thoughts.
The afternoon session was aimed at
people who had a professional or personal connection to the topic, and it also
attracted some participants who themselves were in their 80s which allowed for
an incredibly insightful discussion with opinions from multiple generations.
Participants in the “Let’s Talk About Japan’s Seniors” seminar session
Amongst the participants there was:
Sayaka, a 20 year old female
university student who’s grandmother (and 103 year old great grand mother)
still live at home, and who had seen her grandmother inadvertently hasten her
grandfather’s death by over feeding him after he had suffered a stroke and
developed dementia.
Setsu, a passionate and well
informed 35 year old guy who has a senior management role in a company that
owns and operates 640 senior care facilities across the country.
Yaichi, a 58 year old chap who had
experienced his mother going through dementia, before passing on, and who was
now living with and caring for his 93 year old father. He is a an insurance
broker specialising in insurance for senior care facilities.
Kotaro, Yoshiaki and Kohei a few 20
something year old guys who had studied to be social workers and/or were
currently working in related industries such as physiotherapy.
Megumi, a 75 year old lady who lives
alone in Tokyo, and is worried about developing dementia herself, and as such
is actively learning new things and trying to complete her ‘bucket list’ while
she is relatively fit and able.
Noriko, an 84 year old who had
recently moved to Tokyo from Hokkaido to live close to her 80 year old sister.
Junko, Noriko’s 80 year old younger
sister who is keeping busy by being heavily involved in her local seniors club
which has activities and events every day.
Yoshida-san, Junko’s 80 year old
friend who has a daughter working in
senior care.
Taizo, a 58 year old man with over
10 years experience as a care worker in senior care facilities.
Some of the key points raised and
discussed during the session were:
It is a real struggle to find
workers to fill roles in the aged care sector.
Those that are working are being over worked, and consequently there are
mistakes and accidents emerging that are costing lives. This in turn is compounding people’s
resistance to entering the industry, and with a national unemployment rate of
around 2.5% there are no shortage of alternative job options.
There are a range of senior care
options available, and the government is trying to offload cost and
responsibility to families and the private sector. Some cheaper options are emerging in the
market which are servicing niches where partial family care can be paired with
private sector care.
The cost burden for the government
is immense at 109 trillion yen per year (approx $1.36 trillion AUS) and has an
annual growth rate of approx 2.3% ($31.3 billion AUS). Naturally the government are trying to cap
this spend and reduce it if possible.
If you have money, there is no
problem getting care, but otherwise there are long waiting lists for care
homes.
An example was given where an
elderly couple both developed dementia at the same time and their son
essentially had to stop working and provide full time care for 6 years before
they could get into a care facility.
It is getting harder for ‘3
generational households’ to continue.
Traditionally the eldest son of a family would inherit the family home,
in exchange for taking the lead responsibility for caring for the parents when
they aged. With many rural and regional
children leaving home to find work in the bigger cities, this traditional model
has been broken. In the bigger cities,
the cost of dwellings makes it very prohibitive to be able to find a place big
enough to support the model. Having said that, there were a few younger people
in the room who were planning to live with this traditional family structure.
There are many seniors who are now
living alone, including some of the participants in the session. They all said that it was imperative that
they keep their social connections by remaining active in the community, but at
the same time, they know people who have started to become reclusive. The idea of seniors living in share houses to
reduce loneliness was mentioned, but all seniors in the room said they didn’t
like the idea.
On the topic of living alone, there
is a very popular book called “Ohitori-sama no Rogo” (Aging by one’s self) that
was released about 10 years ago. It has
become a best seller, and is somewhat of a manual for seniors who are preparing
to live out their final chapter on their own
“O-Hitori-sama no Rogo” A guide for growing old alone gracefully.
There was some discussion around
urban design and the concept of ‘barrier free’ living to allow people of all
abilities to get around. Everyone
acknowledged that Tokyo had made great progress on this recently, particularly
with improvements around train stations.
However all said that regional and rural areas were still lacking with
this regard. Additionally there are
loans available from the government to help refurbish family homes to become
barrier free, and further encourage inter generational living in the same house. The loans can be up to one sixth of the
market value of the property.
There was also some discussion that
‘barrier free’ senior homes could actually be speeding up the process of
dementia. Consequently a new trend of
‘Barrier Ari’ (with barriers) style nursing home has started to emerge, which
helps ensure residents’ cognitive and physical ability is challenged on a daily
basis.
In regards to retirement, the
current nationally mandated retirement age is 65. Everyone in the room thought that working
beyond 65 made sense, and that a lot of talent and experience is being forced
out of the work force. There is however a disincentive in the current tax
structure to continue working or to re-enter the work force as it has a
negative impact on the pension you can receive.
There was consensus that the Japanese government needs to make some
reforms in this area.
There was discussion about the
‘Silver Jinzai’ (Silver human resource) centres which were proactively
connecting retired talent with meaningful opportunities to contribute to
society and the economy.
There was some discussion about the
idea of “Furusato Sai-Sei” (Reinvigoration of Country Towns”.) It is a concept of senior retired people
in small rural communities banding together
to hand over their skills and knowledge to a new generation of people. It also involves giving land to young
families who make the decision to relocate from metropolitan areas.
In regards to the use of robotic
technology for helping reduce the workload required for senior care, it is
starting to become more common place. In
addition to robots, Artificial IntelligenceI technology is being used to help
reduce the administration tasks required to manage people through the quite
complicated maze of paperwork and bureaucracy that usually accompanies senior
care.
The government has a target of
addressing many of the current issues in senior care by 2025. This year has
been identified as a critical crunch point for Japan’s aged care sector as it
is a perfect storm of when a huge wave of people are expected to be turning 70
and becoming eligible for government subsidised support.
Another interesting point raised by
the seniors in the room was that they quite often don’t know where to go to get
relevant information relating to their care and wellbeing. It was noted, with a bit of scepticism from
some of the younger people that perhaps the government is deliberately
withholding information from seniors as the more people that know what support
is available, the more cost and burden will be added to the health care system
that is already bursting at the seams.
Following the afternoon session, a
small party was held at night which gave some more people a chance to
attend. It was a very casual affair,
with some food and drink shared while having a yarn around the tables.
It gave me a great chance to have
some interesting conversations when people had their ‘guard down’ a bit. I took the opportunity to conduct a brief
survey of the 20 or so participants.
As well as getting their perspective
on the aging population I was really keen to understand what they themselves
were thinking about with regard to starting their own families and having
children.
There is a bit of myth out there
that Japanese youth don’t want to have children, but from this sample size of
20 the results overwhelmingly showed that having families is a priority. In fact, the general consensus from the event
was that the biggest priority the government should focus on is to do more to
make it easier for young people to start families.
Hamamatsu is a relatively large city
with a population of just under 800,000 located roughly half-way between Tokyo
and Osaka. It is an area that has
traditionally been a major manufacturing hub for Japan with companies like
Suzuki Automotive and Honda, and musical instrument manufacturers such as
Yamaha, Roland and the like having their key manufacturing hubs located
nearby.
Hamamatsu’s intercultural status has
come off the back of it having a relatively long standing portion of the
population that has migrated to Japan from Brazil to work in some of the large
factories.
I was curious to learn more about whether Hamamatsu’s model of attracting migrant workers could be the answer to Japan’s labour shortages and I made plans to meet with some Hamamatsu City Officers at the city’s Intercultural Support Centre who gave me a refreshingly honest ‘warts and all’ background to the intercultural story.
They explained that the
intercultural story all began around 30 years ago when Brazilian residents who
had Japanese heritage (ie, half Japanese Brazilians) were encouraged to come to
Japan to fill some labour shortages during Japan’s ‘Bubble Economy’ years.
There was a big influx that took the
opportunity at the time and most of them became settled in Japan. Before long there were children being born
and families being raised and a unique community of migrants had found a niche
in Japan.
I was half expecting to find a
‘little Brazil’ somewhere in Hamamatsu, but as the officials explained, the
pockets of Brazilian migrants have never organised themselves to that extent,
and any related businesses have generally popped up in isolation. The city was looking to help try and
encourage the consolidation of some of the businesses into a sort-of little
Brazil and then the Global Financial Crisis (or the Lehman Shock as it is
referred to in Japan) hit and that changed everything.
The economic downturn of that period
saw a lot of factory workers laid off.
For a country like Japan where unemployment rates are generally very
low, and prolonged unemployment support isn’t a social norm, the prospect of
having to potentially financially support a large cohort of foreign nationals
while the economic crisis played out wasn’t something some government officials
were keen on. Consequently a government
policy was devised that would pay a one-off lump sum payment to foreigners in
Japan on permanent residency visas to return to their country of origin. The scheme existed from 2009 through 2010 and
offered approximately $3000 (US) to workers, and $2000 for any dependents that
were willing to leave Japan. Initially,
the program mandated permanent departure, but this was subsequently reduced to
three years outside Japan.
It proved to be a particularly well subscribed policy, and in a short space of time the foreign population in Hamamatsu had decreased from a peak population of 33,326 in 2009 dropping back to just under 21,000 by 2015, a drop of 36% in 5 years.
The downward trend has stopped and
in recent years the foreign population is beginning to return, though the
officials noted that it was a more diverse mix of foreigners coming to
Hamamatsu now than the previous concentration of Brazilians and other South
Americans. Currently, foreigners make up
about 3% of the population.
So, was this ‘social experiment’
working or not? The answer, was an
appropriately vague, ‘Yes and No’. For the most part, the foreign residents
seemed to be contributing to society, and were able to find work in the big
factories. Children were being
integrated into the local schools, with some high schools having commenced
special Portuguese language classes to help with student development. They generally socialised amongst themselves,
and there wasn’t much cross-cultural marriage evidenced over the years with
most Brazilians preferring to partner with other Brazilians.
It was noted that whenever there are
any problems, the local Japanese residents have a strong tendency to blame the
foreigners. This might include things
like leaving rubbish out on the kerb on non-rubbish days, holding noisy parties
late into the night and parking in places that aren’t supposed to be parked in.
The officials mentioned that one
issue is that the city government has very few fines or penalties that they can
actually issue to help try and shape the behaviour of residents. Consequently, the behaviour that is
inappropriate by Japanese standards often continues and the feelings of angst
and ill-will grow and fester.
In the Abe Government’s ‘Japan
Revitalisation Strategy 2014’, one of the key strategies identified is to
attract skilled foreigners to migrate to Japan for employment. It envisages a Japan where highly skilled
workers are encouraged to relocate to to help cover skills shortages. One practical example of this is the
‘Technical Intern Training System’ that has been developed to help attract
foreigners into the aged care sector in Japan.
This program, which has largely been targeted to the Phillipines, sees
prospective interns having to pass quite difficult Japanese language tests and
prove their skills before they can come to Japan for placement.
While good in theory, some of the
feedback I had on this study trip is that if they are smart enough to pass the
tests, then they are unlikely to want to continue long in a relatively
un-skilled, but high pressure work environment of the aged care sector.
With that perspective, and judging
by Hamamatsu’s experience, it may not be as simple as calling in a few
foreigners to fill the gaps. It sounds
like a more ‘nuanced’ skilled migration policy may be needed, and more
integration support to help not just the new residents, but also the existing
Japanese residents, to adjust to the mixed population.
“Servitsu”, a brazilian grocer and restaurant servicing the ex-pat community of Hamamatsu
The Hamamatsu City Government’s officials who welcomed me for a meeting at their Intercultural Centre
A can of Guarana fuelled energy drink with origins in Brazil, but now popular in Hamamatsu.
Another reason for visiting Kobe was because of a recently opened ‘retirement home’ I’d discovered as part of my research. Sun City Tower Kobe is the latest luxury retirement home/community built by Sun City Corporation which has 18 similar facilities in operation across Japan.
The most immediately striking thing
about Sun City Tower Kobe is the fact that it is a 35 storey apartment tower
right next to Kobe harbour with uninterrupted 360degree views across the
picturesque Kobe sky-line.
As I approached the complex I was
amazed at how big it actually was.
Directly opposite it was what looked like a very new hospital, and there
were a range of nearby conveniences such as shopping centres that were within
easy walking distance.
Although I hadn’t been able to make
a pre-booking for a visit, I thought I’d put on my friendliest face to see if
the duty manager would be kind-enough to let me in for a sticky beak. My charms worked, and though I was only able
to get a tour of the ground floor it was more than enough to get a sense for
the 5 star quality of the place.
On our walk around the ground floor
I saw a beautiful cafe area, a library, various break/out relaxation lounges,
an arts and crafts area, a billiard room, a Karaoke room, a small movie
theatre, a board game room and more, all built around a stylish central
garden. The 35th floor (which I
unfortunately couldn’t get access to) is the main dining area, so each night
residents gather to enjoy their million dollar views across Kobe, while
no-doubt dining on fine (but age appropriate and healthy) cuisine.
What wasn’t apparent in my pre-visit
research was that next to the 35 storey tower of luxury apartments was a 5
storey care facility. Should residents fall ill or require nursing care, they
can be admitted into the care facility.
This provides the benefit of friends from the tower being able to easily
make visits, and indeed, for couples to remain close should one of them require
care.
So I was impressed, and the only
question was how much would I need to save in order to be able to retire
here. A quick look at the website
revealed the following prices:
So, it doesn’t come cheap, but there
is clearly a niche that the company has identified and is servicing very well
as it continues to plan and build new facilities across Japan.
Kobe is a relatively famous Japanese
city. It is a nestled in a beautiful
port-side location on the foothills of some lush mountains not far from Osaka,
and is famous for a range of delicious food but none more so than the world
renowned ‘Kobe-Beef’. For those old
enough to remember, it is also very famous for a huge earthquake that hit in
the mid 1990’s that essentially knocked the city to the ground.
What it isn’t famous for is the fact that it is actually home to a research centre for the World Health Organisation (WHO), which was set up as a show of support in the aftermath of the big earthquake.
In my research for the study tour I
had stumbled onto this little known fact, and I then discovered that they were
currently halfway through a major piece of research into ways to detect early
signs of dementia that will help inform preventative health practices across
the world.
I made an appointment to meet with
Dr Ryoma Koyama, a medical doctor who had been
given the job to lead the research project.
Dr Ryoma was a warm, bubbly
character who was more than happy to share his insights into not only this
particular research project, but more generally on social issues emerging with
Japan’s ageing society.
Our conversation began with an
overview of the work that WHO has been focussing on. He explained that in the 20th century the
focus was on stopping the spread of communicable diseases and to enable
distribution systems to provide medicine, vaccines and health care support to
developing nations.
WHO’s work has proven successful,
and in the 21st century the new health issues are centred around
non-communicable diseases (diabetes, cancer, heart disease etc..). More recently, WHO has acknowledged that with
the rise in life expectancy across the world, the next major health challenge
will be global ageing.
WHO has adopted an ambitious plan
between 2015-2030 to tackle 17 new sustainable goals which it hopes will help
prepare nations across the world to transition into ageing societies.
One of the identified health
challenges associated with ageing is Dementia (or Alzheimer’s Disease). The Kobe branch of WHO was given the task of
producing some scientific evidence that will inform WHO’s evidence based policy
on how to handle dementia that will be rolled out across the world.
Dr Ryoma explained that when
tackling medical issues, the first focus is to develop a drug to cure it. When there is no medical cure for a disease,
the second focus is then to identify and intervene to prevent or slow down the
effects of the disease.
With regard to dementia, in 2015 it
was estimated that 47million people in the world had the disease. On current trends, by 2030 it is forecast to
be 75million and by 2050 it will be 132million.
In Japan alone in 2015 there were
4million people diagnosed with dementia, and another 4million were diagnosed
with Mild Cognitive Impairment (MCI), which can often develop into full
dementia.
From a cost perspective in Japan in
2015 it was estimated as:
Medical Costs: $20billion (USD)
Social Sector Cost: $65 billion (USD)
Informal Care Cost: $60billion (USD)
TOTAL: $145 billion (USD) annually
Source: MHLW report on dementia SBD
2015
If the current trend continues it is
projected that the cost to Japan will blow out to $250 billion (USD) by 2025.
Needless to say, from a purely
economic perspective there is a bit of an issue here. If you add to that the emotional strain and
burden that the disease places on carers, and the limited capacity for
sufferers to meaningfully contribute to society and it only gets worse.
So with the rather bleak background
in mind, Dr Ryoma began explaining what they are working on.
There has been an important piece of
study into dementia by “The Lancet” (a highly respected medical resource
journal) which revealed that 35% of the cause of the disease can be attributed
to modifiable risk factors from various stages in life, while the remaining 65%
is attributed to a person’s DNA.
With that in mind, we know that 35%
of possible causes for dementia can be influenced by adjustments in
lifestyle. The problem is we don’t know
who is at risk and who could benefit from early intervention and support. That is where the “Kobe Project” comes into
it, and it is what the 3 year study is trying to uncover.
The basis for the study is a yearly
‘residents survey’ that the City of Kobe carries out with all residents. It is a basic checklist type survey that
covers a range of topics. From the total
population the survey went to 80,000 people in the over 65 age group. Of them
there was a 70% response rate, which has provided an incredible sample to work
with. Dr Ryoma explained that there
appears to be 3 questions in that survey that are proving to be a reliable predictor
of whether someone might regress into dementia.
From that overall survey sample,
there were 5000 people who were considered at risk of developing dementia and a
range of ‘brain health’ classes has started to help them. The progress of these people will be
monitored over the next 12months and then there will be a year of analysis
before the research results are published by WHO and made available as a
resource to use across the world.
So while it may not be a cure, it
has the potential to reduce the speed at which people regress into dementia,
which when multiplied out across the world, will make a huge impact both
economically and socially.
Dr Ryoma also provided some insights
into aspects outside his research. One
item of note was a recent law passed by Japanese government for drivers over
the age of 70. The law says that if any
driver over the age of 70 has any form of driving indiscretion (speeding,
breaking a road rule, accident etc…) the police officer is now required to
administer a cognitive test via a smart tablet device. If the result of the test indicates that
there ‘might’ be an issue, the driver is required to visit a doctor to have a
test for dementia and provide the test result back to police within one
month. Fail to do so, and the license is
automatically cancelled…similarly, a diagnosis of dementia means automatic
cancellation of the license.
I could tell Dr Ryoma was quite
disgusted by this system which in his opinion was a government sanctioned form
of ‘agism’. He also noted, that the
isolation caused by not having a license will in fact accelerate the onset of
dementia for many people.
Another interesting discussion topic
with Dr Ryoma revolved around the current system of aged care in Japan. He commented that there are now many senior
care facilities that are owned by major hospitals (or more accurately, major
corporations that own and run hospitals).
While on the surface this would seem
like a good thing, he said that there are now many people who are have lost
most of their cognitive and physical functionality, however they are able to be
kept alive with intravenous feeding and medical treatment. While they are alive and in health care, the
company will be paid by the government and/or the family of the resident. For aged residents 80% of the cost of care
comes from government.
As happens, occasionally these
people will become sick, with pneumonia being the most common ailment with a
threat to life. Being attached to a
hospital they are quickly rushed in for medical treatment and in most cases
they will make a full recovery. While
they are in hospital 100% of the costs will be covered by the government until
such time as they are discharged. Then
they will go back to the care facility to continue the cycle….and to continue
the income stream for the company.
Dr Ryoma raised the philosophical
question of whether this was the ‘right’ thing to do? The families of the
residents aren’t out of pocket a lot, so they are unlikely to complain. They government is unlikely to come out and
say that it will cut of care payments for elderly patients, so he predicts the
cycle to continue for some time.
He then gave a counter example of
Norway where the government policy is that if aged people in care over the age
of 80 get pneumonia they aren’t given any medical treatment. If they can shake it off, then all is good,
but if not they will almost certainly pass away. He didn’t say that he thought this was the
‘right’ thing to do, however it is a different policy to Japan and provides a
way of breaking the ongoing care cycle.
It was a some-what heavy way to
finish our meeting, but coming from Dr Ryoma with his hearty laugh and smiling
face, it certainly didn’t feel heavy. I was thankful for the opportunity to get
an insight into the research project and will be keeping an eye for the the
results which are expected in 2020.
The Ageing & Society: Eighth Interdisciplinary Conference was hosted in Japan for the first time in September 2018. The theme for this particular conference was “Ageing, Health, Well-being, and Care in a time of Extreme Demographic Change.” This suited my study trip theme perfectly and I was looking forward to what I could learn over the two days of the conference with the best academic minds from across the world gathering at Toyo University in Tokyo. Fortunately the conference wasn’t only for academics, and there were a number of case studies from Japan which provided some great insights into what could potentially be emulated in Australia.
The imposing entrance to Toyo University
Note: It is not my intention to transcribe everything learnt from the conference. Some of the key statistics and trends have been included in the ‘background’ section of this report and the highlight presentations have been showcased over the next few pages.
Goyokiki – the 100 yen housework service
Goyo-Kiki founder Morohisa Furuichi with the trade mark apron used by his staff.
Goyokiki (literally translated to: “Respectfully listening to your Requests”), is a not-for-profit organisation that was set up in Tokyo to help service a gap in the market.
CEO and Founder Morohisa Furuichi,
had made the decision to leave the corporate world and search for a more
meaningful existence. He had identified
that while there were are range of service offerings to support the elderly at
home, these services are quite costly and often mean people would have to wait
weeks, if not months, to have a home visit where they can get help to do even a
simple task such as changing a light bulb, or opening a jar. These types of tasks were often essential for
elderly to feel safe and comfortable at home, yet for a trained care worker to
perform them was a waste of their time and skill.
Using a simple price/skill table
Morohisa was able to identify that there were a lot of essential jobs required
to support the elderly at home that required no skill. He also knew that for many elderly living
alone, it was often quite embarrassing for them to ask friends, family or
neighbours to come and do a simple task.
They might be able to ask somebody once, but to keep asking for favours
is something most Japanese would prefer to avoid.
On that premise he devised Goyokiki
where customers can request un-skilled jobs which are performed at 100 yen
(approx. $1.20 AUS) per 5 minutes. He
was able to quickly recruit a team of dedicated staff who are all paid above
minimum rate, and the service is now available in all 23 local government areas
that make up Tokyo.
Morohisa was quick to point out that
at just 100yen for 5minutes, there would be little chance of the organisation
remaining viable. That’s where the
brilliance of his business model lies.
The organisation also provides another level of service which requires
slightly more skill and effort which gets charged at 300yen per 5 minutes. Morohisa explained that the 100yen service is
a way of customers getting to know the organisation and to build trust. He equated it to the concept of downloading a
free app where there are ‘in-app’ downloads if you want to use the additional
features. (An interesting analogy
considering the organisation does zero digital marketing and relies solely on
word of mouth!).
The organisation actually survives
on the profits it can make from the
300yen per 5minute service with 69% of all revenue coming from this service
type.
The organisation currently has 120
staff on its books and with Tokyo now fully serviced they are preparing to
expand into new markets in other major cities.
The key to the success has been the
emphasis put on ensuring the first interaction with a customer is first
class. With the organisation relying on
word-of-mouth, it is essential that the first time a customer meets a staff
member they feel they can trust that person.
The fact that in most cases the customer will be letting a complete
stranger into their home emphasises the importance of this first meeting.
I was really happy to hear the
Goyokiki story as it confirmed a hunch I had that there would be new types of
business/service models emerging to cater for the shift in demographics in
Japan. After a lengthy chat with Morohisa,
I was warmed by his commitment to Goyokiki, and that it is not about making
profits, it is simply about making people feel safe and empowered to keep
living independent lives at their own homes.
I’m sure this is also exactly what
the Japanese government is hoping to see more of. A non-government organisation helping people
feel confident to keep living at their own homes, which also takes a huge
burden off the senior health care system.
Very much a win-win situation.
Fukushi Gakudan is a not-for-profit
that has developed and commercialised a range of successful social enterprises
in the greater Tokyo area. While Social
Enterprises that support people with disabilities and social disadvantages are
nothing new in Australia, I was particularly impressed by this case study
because of the emphasis it places on high quality design and quality in its
products and services.
The ‘Koisuru-Buta Laboratory Co.
Ltd’ (Literally, “The Laboratory for Pigs we Love”) is a vertically integrated
pig farm and meat producing operation near Narita Airport that raises around
7000 pigs, and then processes them to produce gourmet hams, bacons and related
products. The organisation provides
employment mostly for people with mental and physical disabilities. It includes a ‘Shabu Shabu’ restaurant
on-site which has become quite a destination in it’s own right, and it is able
to pay its employees a salary that brings their modest disability pensions up
to at least the average Japanese minimum wage.
Not to mention the mental and social benefits the meaningful work
provides to them and their families
The ‘Kurimoto Daiichi Firewood
Supply Station’ is another social enterprise that has integrated a range of
services onto a farm site. The business
harvests and sells firewood from sustainably managed forests. This approach only requires small machinery
and provides physical exercise for participating staff.
In addition to the firewood
operation, the farm also produces sweet potatoes, which are then processed and
sold as sweet cake treats. A high
emphasis is placed on design and the snacks are sold in attractive packaging,
making them a great take-away gift for visitors to give to family and friends.
The same facility also has an
elderly day-care centre where elderly can spend the day with supervised
care. It also allows them an opportunity
to help out with some of the farm tasks and remain active and engaged.
The diverse range of integrated
activities is an interesting variation to traditional business models, and is a
great way of thinking creatively to adjust to the challenges created by the
changing demographics.
The other social-enterprise
described was a Community hub called ‘Yoshikawa’. The background to this was that there were
some large government owned social housing apartment buildings that were
becoming a bit decrepit and starting to have vacancies.
An opportunity arose to take over a
vacant ground floor space and the plan was to repurpose it as a drop-in centre
for health professionals. Through a
range of place-making activities, it became apparent that there was a huge
amount of cooking talent living in the apartment building that wanted a space
where they could make meals to share with those that were no longer able to
cook for themselves. As a result a
common kitchen and dining space was installed instead.
This concept has since grown so that
community cooking classes are run to teach others how to cook traditional
recipes. As with the other social enterprises,
a high emphasis was placed on making the space attractive, and ensuring design
was used to differentiate the social enterprise from a typical social
service. From the case studies presented
it appears this approach is working well.
Professor Yoshinori Fujiwara from
the Tokyo Metropolitan Institute of Gerontology presented a case-study about a
project he had developed called “Reprints”.
The basis of this project was to find a meaningful and productive
pastime that elderly people could engage in that would also help them remain
healthy and mentally cognitive as well as helping to re-establish the
‘intergenerational links’ in Japan that have faded out since the 1960’s with
the decrease in ‘3 generational’ households.
The project involved recruiting
retirees to join a program where they would be trained to read stories to
children in a range of age groups between kindergarten and junior high
school. The training was tailored to
help participants prevent the onset of dementia and also provided a social
outlet for participants to meet new friends and build a peer support network.
Participants were required to choose
an appropriate book to read each week, practice reading, deliver the reading
session over 15-30minutes in front of the class and then do a group reflection
with other participants before beginning preparation for the following week’s
reading.
The identified benefits of the
program to date have been greater than expected. For the participants themselves, there have
been very positive health benefits, with less tendency to develop symptoms of
dementia, as well as better physical balance and agility due to the practiced
skill of standing and reading books to students.
For the students themselves, they
are having a change in their perceptions of the elderly. This is manifesting in a positive image, and
the children have demonstrated that they are better able to interact with elderly
people outside of the classroom setting.
For parents it is actually helping
appease them of their ‘sense of obligation’ that they need to volunteer at
their children’s school. This equates to
less ‘psychological burdens’ about having to support their school, and more
time and energy they can devote to their work and/or recreation.
The program was successful to the
extent that it was referenced in the World Health Organisation’s “Wold Report
on Ageing and Health”.
Super-Aged-Society 