In this article we explore the development of group homes for elders with dementia in Japan since the inception of the long-term care insurance program in 2000. We suggest that the combination of demographic and policy trends in recent years have created a context in which entrepreneurial activities related to elder care have increased significantly. By focusing on one of the new institutions that has emerged, we show one way in which social policy has had a significant influence on the lives of elders suffering from dementia and their families. Finally, we point out some of the problems that have arisen along with the growth of these new forms of care, such as a lack of involvement by family members in visiting and caring for elders.
Keywords: Japan; dementia care; elder group homes; long-term care insurance
In many respects, one can describe the past eight years in Japan as a period of elder care entrepreneurship characterized by the creation of an array of new services and facilities. These are needed to address the rapidly growing requirements of an elder population that currently represents about 20% of the Japanese population and is expected to grow to more than 35% by 2050 (Ministry of Internal Affairs and Communication, 2008a). A quick look at some basic figures associated with dependency and population aging gives a clear sense of the rapid change in Japan's elder population. In 1970, for example, the dependency ratio stood at 10.3; by 1990, this had increased to 17.3, and, by 2004, the estimated dependency ratio was 29.2. 1 During the same period, the aging index of Japanese society increased from 29.4 to 140.3. 2 These demographic trends in Japan are largely the result of a combination of decreased fertility and increased longevity. As of 2004, the total fertility rate for Japan was estimated by the government to be 1.29 children per woman, and life expectancy at birth was 78.64 years for men and 85.59 years for women (Ministry of Internal Affairs and Communications, 2008f).
As the population of people over the age of 65 has grown, so has the need for both public and private services aimed at providing care for elders encountering anything from limited problems with activities of daily living to advanced forms of dementia. The 1990s and early 2000s have seen a general growth in both the number and proportion of people over the age of 65 living in institutional settings, even while there has been a decline in the disability rate since the mid 1990s (Schoeni et al., 2006). The government has promoted the development of a broad network of services aimed at assisting family members in providing in-home care and developing systems for community-based, rather than institutional, care of frail elderly (Campbell & Ikegami 2003; Traphagan, 2003, 2004a). Nevertheless, providing care for individuals with dementia has been a problem. Some nursing homes have refused admission to dementia sufferers on the grounds that the homes are not equipped to provide appropriate forms of care (Traphagan, 2000; Traphagan & Knight, 2003), although some senile dementia therapy wards in hospitals have existed since 1988 (Nakagawa et al., 2003).
These demographic and policy trends have contributed to a context ripe for entrepreneurial activities focused on elder care. The catalyst that led to a rapid growth in the development of new and creative services for elder care in general, and dementia care in particular, was the promulgation of a long-term care insurance (LTCI) program in 2000. This article explores developments in institutions that are directed at providing care for dementia sufferers and supporting their families, as they have expanded within this context of elder care entrepreneurialism. We will discuss the basic structure and organization of one institution devoted to care for elders suffering from dementia. Our aim is primarily descriptive in terms of the facility, but it will also become clear that current social policy in Japan has a significant influence on the lives of elders suffering from dementia and their families. …