Services and Housing for the Elderly in Japan ➂I have talked about Japan’s long-term care insurance system and how the elderlychoose their housing in my previous article.
First, you need to consider whether or not you require nursing care, and then you needto further consider whether or not you require any medical support.
Your dementia symptoms will also affect your housing selection.
In this article, I will go over more details, and introduce key points for the elderly’s
housing or facility selection.
The first step, before listing up your preferences, is to check which facilities areavailable for you with your current physical condition.
1. Need for nursing care/ With or without dementia/ Necessity of medical supporti.
Available facilities depend on the level of nursing care you require.
For example, Special Nursing Homes for Old People, which is public nursing homes,
only accept the elderly with the level 3 and above of long-term care certification inprinciple.
Public operated group homes specify their admission requirements and the elderly who
have dementia symptoms with the level 2 and above of long-term support certification
can be admitted. There are other requirements to enter these facilities, such as age orwhether or not your registered address is in the same city where the group home is located.
In most cases, the level of requiring nursing care is expected to rise as time passes by,
so it is also important to make sure that the facility can provide appropriate nursing-careservices to the level of care you need, even your condition becomes severe.
In addition, you can neither ignore nor forget about the full-time staff who providecare-services and their qualifications.
If you require sputum suction or tubal feeding through gastric, intestinal or nasogastrictubes, you must make sure if the facility has the staff who can perform such medical
treatment and then the number of the staff if the treatment is available.
Just for your reference, as the aging of the population advances in Japan, problems ofaging and more severe health condition of the residents have also arisen within nursingcare facilities. Sputum suction and tubal feeding used to be considered as the medical
practices that could be performed by only doctors, or nurses instructed by a doctor, butsince April 2012, a partial amendment to the Social Welfare Act and the Long-Term Care

Welfare Act has allowed care providers who receive a certain level of training to performsputum suction and tubal feeding.
ii.
The facilities you can enter depends on if you have dementia or not.
You also might need to pay attention to whether or not a facility lets residents do what
they can do by themselves to continue to live their life as who they are, whether or notsafety management is thorough, and whether or not staff have sufficient level ofunderstanding for dementia, in other words, whether or not a facility provides its staff
with workshops or training sessions about dementia. Some facilities set conditions fortermination of residency with certain dementia symptoms, so you might need to check itout.
In addition, some facilities separate floors or areas by dementia symptoms so you alsoneed to check if such living environment or arrangement is acceptable for you.
iii.
The facilities you can enter depends on medical supports you require.
You need to carefully examine a residential agreement, particularly conditions set forth
for the admission and termination, such as what kind of medical treatments are available,
and a facility can accommodate you if your physical condition changes. In some cases
when your physical condition changes, you will be asked to leave or asked to pay more
fees for additional medical services.
Another point you shouldn’t forget is the arrangement of nurses. If you require medical
practice that cannot be done by care providers all the time, it is very important to havenurses placed within the facility.
It is also necessary to check if there is an adequate system put in place for residents
including checking vital signs, frequency of communication, providing first-aid, andmanaging medicine.
And what is important is a cooperation system between a facility and medicalinstitutions. Public operated health services facilities for the aged are set the staffing
standard for doctors; however, other facilities are not necessarily required to place doctors
or nurses around the clock since these facilities are just a place of living for the elderly
and are not required to place doctors stationed all the time or nurses at night.
So, it is important to check the number of medical institutions that a nursing facility
has a cooperative relationship with and how those medical institutions work for or work
together with the facility.
For your reference, Table 1 shows the requirements for cooperating medical
institutions selected by nursing care facilities as Japan’s Ministry of Health, Labour andWelfare has announced in the revision of nursing care service fees for FY2024 to mandatethat nursing facilities such as special nursing homes and elderly health facilities will berequired to select cooperating medical institutions as their supportive function. Potential
medical institutions could be home care support hospitals and clinics, medical facilities
which operate community-based care ward with less than 200 beds, or hospitals wheredoctors can look after the elderly who have been home cared. It is more desirable if these
hospitals are located close to the nursing facility.
Table 1Requirements for cooperating medical institutions selected by nursing care facilities
1.

A system in which doctors and nurses are available to respond to a nursing
facility in the event of a medical emergency must be maintained at all times.

2.

A system to provide medical treatments upon a nursing facility’s request must
be maintained at all times.

3.

In principle, a system to admit a nursing care facility resident who requires
hospitalization in the event of an emergency must be maintained.

* Fulfilling the above requirements by designating multiple medical institutions is alsoacceptable.
◼

At least once a year, the emergency response system must be reviewed
between a cooperating medical institution and a nursing facility, and nursing
facilities must notify the designated authority of the names of cooperating
medical institutions.

A rehabilitation system is also something you have to check out.
Facility residents can benefit from working with physical therapists (PT), occupational
therapists (OT), and speech-language-hearing therapists (ST), and there is also daily life
rehabilitation, which utilizes daily activities as part of rehabilitations.
Physical therapists provide rehabilitation working toward restoring motor functions,occupational therapists provide rehabilitation working toward restoring activities of dailyliving, and speech-language-hearing therapists improve language communication andeating/swallowing functions, etc. Daily life rehabilitation involves performing tasks thatare part of everyday life activities, such as folding laundries, wiping tables, and servingfood.
In addition, functional training instructors are assigned to not only day care facilities,
but also residential facilities, supporting residents' activities of daily living.

Lastly, you have to make sure that a facility will provide end-of-life care.
Recent years, more facilities have come to take care of their residents till their death;however, some facilities do not do that.
It is important to give careful consideration to how you or your family would like to
be treated at the end of your life, and how you would like to spend your final moments,
and then choose a facility that accommodates your expectations.

References (Available only in Japanese)
Ministry of Health, Labour and Welfare “Regarding the sputum suction system.”https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/seikatsuhogo/tannokyuuin/index.ht
mlMinistry of Health, Labour and Welfare “Current situation regarding sputum suction innursing care facilities.”
https://www.mhlw.go.jp/stf/shingi/2r9852000000bhqz-att/2r9852000000bjio.pdf

Joint, https://www.joint-kaigo.com/

About the writer:

Yuko Horiuchi, Gerontologist and Senior Life Designer
President, Senior Life Design
Collaborative Researcher, Institute for Gerontology, J.F. Oberlin University
Executive Director, Society for Applied Gerontology-Japan
Yuko Horiuchi started her career working for an architectural firm, involving a homerenovation for a client requiring care services. Before reaching her current position, she
has worked as a marketing consultant at a consulting company specialized in the seniormarket. She holds Master of Arts in Gelotology from J.F. Oberlin University.