Time to Share the Burden: Long Term Care Insurance and the Japanese Family

Abstract

Japan is faced with population dynamics unprecedented in its history. In the next 30 years Japan’s population will become the oldest in the world due to earlier rapid declines in fertility and mortality. As Japan’s population dramatically ages, one key challenge looms large: the need to provide care to a generation of elderly people. As many as 5.2 million of them will require long term care in the coming years. Further, profound demographic and social changes are laying siege to the tradition of relying on families, particularly women, to care for the elderly. This has changed what it means to be old in Japan; as Hashimoto notes, ‘old age is no longer a bonus or a stroke of good luck: it has now become a social problem’. In response to the growing ‘social problem’ of providing care to elderly people, in 1997 the Japanese government passed the Long Term Care Insurance Law (Kaigo Hoken Ho ̄) (LTCI Law). This law established the Long Term Care Insurance System (Kaigo Hoken Seido) (LTCIS), which came into effect in April 2000.

This article considers the question: is the LTCIS responding to the needs, values and expectations of the contemporary Japanese family, and more specifically, the female caregivers? This question is pertinent for two reasons. First, in Japan, as in most other countries, care of the frail elderly is the work of daughters-in-law, wives, and daughters; 85% of family caregivers are women. However, the position of women in Japanese society and the traditional framework of caregiving have been changing, and extra strain has been placed on the family unit. The Japanese government has had to ask itself: Where does the responsibility for caregiving lie: with the family, the state, the local community, employers, or all of the above? ...

Keywords: Japan, Japanese family, long-term care insurance, japan care insurance