UH CNAS，RINCPC Bulletin Vol．23，2016

A Survey on Care Managers

79

Perception and Support for

Foreign Residents Using Long‑term Care Insurance in JapanLEE Kumsun１），NASU Junko２），TAKAHASHI Fusako３），TAWARA Shinobu４）

Abstract
PurposeThe purpose of this study was to clarify the current situation and the usage of the long‑term careinsurance by foreign nationals residing in Japan．This study provides the details and baseline data on healthand welfare issues of the elderly in Japan，which leads to the further discussion of internationalization andmulticulturization of the society．
Methods
Paper based survey was conducted among Care Managers（CM）working inin‑home care centersinJapan．WAMNET database was used for probability proportionate sampling and simple random sampling，
extracting two thousands of centers．
Results
Responses from 709 CMs were analyzed．144 CMs had experience managing the case of foreign residents．
Korea / South Korea was the largest ethnic group of users by 204 cases（72.3%），followed by China（35，12.4%），Taiwan（13，4.6%），Brazil（9，3.2%），Others（19，6.7%）．Most frequently used service was home‑
visit care．20 CMs（23.3%）had difficulty in dealing with the cases of foreign residents such as
condition due to dementia ， personality problem of the user ，and

unstabledifferent lifestyle and culture ．CMs

were trying to manage those cases by consulting with colleagues or other staffs in the local care center．
Discussion
Over twenty percent of CMs had experienced the cases with foreign residents from various countriesof origin．One out of four CMs expressed that they have difficulty in dealing with the problematic casesof foreign residents most of which arise from personality traits and cultural backgrounds．With growing
population of the elderly of foreign nationals in Japan ，their use of in‑home care is increasing ．
Internationalization of the health care system in Japan，standardized organizational structures for foreign
residents and the support system for CMs are needed．
Key words：foreign residents in Japan；long‑term care insurance；in‑home service；
multicultural coexistence society

１）Home care Nursing，College of Nursing，Art and Science，University of Hyogo
２）Graduate school of Nursing，Toho University３）Graduate school of Nursing，Art and Science，University of Hyogo
４）Faculty of Nursing and Rehabilitation，Konan women s University

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在日外国人の居宅サービス利用における対応状況

utilize the system．

Introduction

Registration of foreign residents in Japan is based

At the end of June 2014，the total number ofon the residency management system．Due to theforeign residents residing in Japan was 2,086,603．

inaccessibility to the system and resident cards that

Among those 131,270 were aged over 65, which

all qualifying residents hold，it is difficult to conduct

１）

． The

a survey of the current condition of long‑term

nationalities（birthplaces）of foreign residents spannedcare for foreign elderly．As such，studies addressing

approximately 90 countries．As the number of elder

issues on care for foreign elderly are limited；data

foreign residents increases the number of the elderly

can only be obtained from the registries under

who requires long‑term care is predicted to increase．

the jurisdiction of different ethnic groups，such as

However，the governmental statistics on their usage

interviews，questionnaire survey，session reports ofof long‑term care（LTC）insurance remains unclear．

non‑profit organizations（NPOs）related to LTC

was the highest number ever reported

The elderly from North and South Korea make up

５）

and individual case reports

４）

，

．

the most of the total number of foreign elderly at 80

Among the group of foreign residents in Japan，%．Followed by Chinese elderly，which doubled

L T C issu es p ertainin g to K ore a n eld erly are

the number in the past 20 years．The history of

becoming prominent as emblematic issues．Issues

migrants from the Korean Peninsula and Taiwan

on long‑term care insurance service usage that haveduring the former colonization era spans over 100

been raised are as follows：1）Financial issues due

years．Along with the long‑term settlement，thoseto the lack of pension，2）Difficulties in accessing

migrants of the first‑generation and the second‑

information due to the low literacy rate，3）Difficulties

generation are subsequently entering old age，andin communication due to trouble with hearing，

issues of the elderly care arise．

dysarthria，and regression to one s native language，On the other hand，the revision of the Immigrationand 4） Differences in lifestyle and values as well

Control and Refugee Recognition Act led to a rapid

as differe nces in cultu ral back gro u n d arisin gincrease in the number of South Americans of Japanesefrom regression to the culture of one s country ofdescent，Chinese returnees，Indo‑Chinese refugees，origin６）７）．

and foreign spouses of Japanese citizens．Those

Regression to one s native language is seen

migrants tend to settle longer due to their acquisition

parti‑cularly among foreign elderly with dementia．

of permanent residency，and approximately a half ofConversation is carried out more with Korean，rather

the foreign residents currently holds qualification tothan Japanese，resulting in having difficulties instay permanently in Japan．It is said thatinternal

communicating with their family members as wellglobalization will progress in the near future，which

as caregivers．Exhaustive research conducted withleads to the increased diversity of nationalities andCare Managers（CMs）in Osakamulticulturalization of the foreignelderly in Japan．

concentration of Korean residents in Japan is，showed８），where the largest

Japanese government launched the LTC insurance

that over 40% of CMs had experience being insystem as a new scheme that supports and resolves

charge of foreign residents．North and South Korean

issues for the elderly．The system was commenced

made up the largest group among the foreignin April 2000 as a new system of social security，

residents by 90%，followed by seven other nationalities．

and foreign elderly are required to have municipality

CMs perceived 30% of those foreign residents had

registration and to meet certain requirements todifficulty in communicating in Japanese，and 60%

UH CNAS，RINCPC Bulletin Vol．23，201681

was regarded as experiencing financial difficulties．

stay，or 4） a person who may continue to stayThis trend becomes more prominent among thetransitionally in Japan by birth or loss of Japaneseelderly．

nationality．

However，there has been no nationwide research
conducted on the actual circumstances of foreign

２．Korean in Japan

residents who utilize home‑care services，thus，North and South Korean who have those citizen‑

objective ascertainment of the actual conditions

ships and reside in Japan with resident qualifications．

has been difficult． This study aimed to reveal
the corresponding conditions of foreign residents

３．WAMNETrequiring home LTC，conducting research with CMs

Welfare And Medical Service Network System

across Japan．The findings obtained will present（WAMNET）is the internet website which provides

basic data to address the issues pertaining to healthcomprehensive information related to welfare，healthcare of the elderly in Japanese society，which isand medical services，operated by Independent

experiencing a shift toward internal globalization in

A d m inistrativ e A ge n c y W elfare a n d M e dical

the perspective of multiculturalism．This study aims

Organization WAM．

to attain specific and effective indicators that can beutilized in solving problems and making strategies on
emerging LTC issues for foreign residents in Japan．

Methods
１．Study design

Purpose of the study
The purpose of this study was to clarify theAnonymous self‑administered questionnaires by mail.

２．Participants / subjects

current situation and the usage of the LTC insurance

Two thousand care managers who are the directors

by foreign residents in Japan．This study providesof Two thousand In‑Home Long‑term Care Support

the details and baseline data on health and welfare

Providers nationwide．

issues of the elderly in Japan ， w hich leads tothe further discussion of internationalization and

３．Selection of participants

multiculturization of the society．

１）Based on the Ministry of Justice

Statistics on

foreign residents in japan （June，2013），calculated

Definition of terms
１．Foreign resident in Japan
In this study，foreign residents in Japan is definedas persons who have nationalities（birthplaces）otherand listed a number of foreign residents aged 65
and above in each prefectures．
２）Using the information from the WAMNET data‑base ， m a de a list ofIn‑ H o m e L T C S u p p ort
Providers in each prefecture．

than Japanese and maintain a residence in Japan，

３）Probability proportionate sampling based on

a n d als o s atisfyin g a n y o n e of t h e follo w in g

population distribution was employed and 2000 In‑

conditions on the Basic Resident Registration Act：1）

Home LTC Support Providers were selected．

medium to long‑term resident，2）special permanent４ ）Simple random sampling using the table ofresident，3）a person who has been granted landing

random numbers was employed to select In‑Home

permission for temporary refuge or provisional

LTC Support Providers in each prefecture．

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在日外国人の居宅サービス利用における対応状況

４．Data collection and analysis

foreign residents as users of the system was 282．

Anonymous self‑administered questionnaires and a

As shown in Table 1，North and South Korean

return envelope were sent to the care managers

made up the most by 204 cases（72.3%），followed

who are the director of the In‑Home LTC Support

by China（35 cases，12.4%），Taiwan（35，12.4%），

Providers．The participants were asked to answer

Brazil（7，3.2%），and other including 8 nationalities

the following questions：basic attribution of the care

（19，6.7％）．The results are also shown in Table

managers，general description of foreign residents

2．The most commonly used services were Home‑

who the CMs were responsible for，and the current

help service（52 cases），Rental of welfare equipment

issues of those clients and how CMs deal with it．

for long‑term care（48 cases），and Daycare services

The data obtained were quantified and analyzed（43 cases）．

quantitatively，focusing on descriptive epidemiology．

Eighty‑six C Ms were currently in charge ofCom mercially available statistical software IB M

foreign residents，and 23.3% expressed difficulty

SPSS Statistics 22 was used to conduct statisticalin interacting with them ． Table 3 shows theiranalysis．The data were collected from November todifficulties such as

December 2014．

（9 cases）， Due to the user s personality （9 cases），
and

５．Ethical consideration

Unstable due to dementia，etc

Lifestyle and values （7 cases）．The mostcommon coping mechanisms wereThis study was conducted with the approval of
the respective institutions research ethics committees．

Consulting withcare center staff （17 responses）andConsultingwith the Com munity General Support Center（11 responses）．
A s part of a C are Plan tailored for foreig n

Results

beneficiaries， C Ms have massively favored andSeven hundred and nine CMs returned questionnaire．

gave positive answers to two items in the list：（1）

We excluded the ones that were undelivered or the

A better consideration ofcenters that were currently not in operation，andand cultural particularities （67.9%），and （2） A

the response rate was 35.8%．One hundred forty‑four

betterCMs（20.3%）had experience being in charge ofshown in Figure 1．At an operational level，CMs

cases of foreign residents，and the total number ofhave also favored as para mount three items ：Foreign language support （46.6% ）as

Table 1．Nationality（country of origin）of the users of in‑home LTC＊
services by foreign residents in Japan
Nationality

n＝282

Daily‑specific habits

％

Korea

204

72.3

China

35

12.4

Taiwan13

4.6

Brazil9

3.2

Others（eight countries）

19

6.7

Non‑respondent2

0.7＊LTC＝long‑term care

UH CNAS，RINCPC Bulletin Vol．23，2016

Table 2．Use of LTC services by foreign residents in Japan（multiple answers allowed）
In‑home services

n＝86

％

Home‑visit nursing

16

18.6

Home‑help service

52

60.5

Home‑visit bathing service

7

8.1

Home‑visit rehabilitation

8

9.3

Day care service

43

50.0

15

17.4

1

1.2

1

1.2

10

11.6

Rental of welfare equipment

48

55.8

Sale of specified equipment

14

16.3

Benefits for house alterations

17

19.8

Day rehabilitation service（day care）
Creation of 24‑hour regular home
visitation and as‑needed visitation
services
Combined services
Short‑stay daily‑lifeservice（welfare or medical care‑oriented
short stay）

Table 3．Characteristics of the difficult cases of LTC＊
service users by foreign residents in Japan
Item

n＝86

％

4

4.7

2

2.3

Due to the user s personality

9

10.5

Rejection of the service

3

3.5

Unstable due to dementia，etc

9

10.5

Declining the family care support

6

7.0

Economical reasons

5

5.8

Lifestyle and values

7

8.1

Japanese communication

3

3.5

5

5.8

Others6

7.0

Non‑respondent

4

4.7

Family cooperation is not provided
The user s intention and thefamily s have a gap

Not understanding LTC insurance
services＊LTC＝long‑term care

83

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在日外国人の居宅サービス利用における対応状況

Figure 1．Issues of the making of a Care Plan for foreign residents in Japan（1）The establishment of consultation service andprocesses，foreigner residents occupation zones are

improvement of one s adequate skills；（2）An increase

well disseminated all over Japan．As a result of this，in foreign language‑translated documentation ；according to regions，it has also been found that

and（3）an increase in medical‑，day care‑related

CMs dealing with foreign residents are far frominterpretation service．

being rare and are relatively poised to face thissituation ． A mong the C M‑handled nationalities

Discussion（birthplaces），the amount of long‑term stay Koreans
having taken up residence in Japan in the aftermath

A survey conducted in Japan has found that oneof WW2 is of course extremely high；however，thefift h of C M s h a v e e x p e rie n c e d d e alin g w it hdistribution of nationalities is consistent with theforeigners residents in Japan．At the end of Junesenior citizen nationality‑specific structure of the2014，the total figures of those aged and above

population．These nationalities（birthplaces）cover aamounted to 32.26 million people．Among them，

total of 12 different countries．

those who are certified as needing LTC have reached

Dementia，living alone，service refusal，differences

5.91 million．The total amount of foreign residentsof opinion within the family，and miscommunicationin Japan aged 65 and over currently represents

have been highlighted as hindrances in a qualitative

131,000 people，and it merely accounts for 0.4

survey designed on common characteristic items

percent of the total population of the same age

found in CM‑handled difficult cases, and targetingof Japanese citizens．However，due to historicalthe day care‑related NPO s CMs involved in life

m i g r a t o r y a n d n a tio n alit y ‑ s p e cific fo r m in g

support activities for Korean senior citizens currentlyUH CNAS，RINCPC Bulletin Vol．23，2016

living in Japan．This survey has revealed that one

85

choice for foreign elderly themselves．

fourth of the CM have experienced trouble while

In so m e localities ， a s yste m of dis p atc h e dproviding nursing care to foreigners．Beside thecommunication auxiliaries is being implemented forcase of mentally‑ill or dementia‑afflicted persons，it

LTC given that local foreigners‑oriented supporting

can be also noticed that matter of concerns widelygroups are called into action

originate in the lack of u n dersta n din g of theresidents currently living in Japan strug gling

values differences，daily life customs or individualwith Japanese reading or unable to receive any

singularities．In addition to the problems commonly

help from theirs relatives，a system of registeredarising with the Japanese elderlies in need of nursing

helpers fluent in foreign languages and aware of thecare，this survey has revealed that foreign people

cultural issues has been made available for nursing

day‑care entails its own multi‑faceted，specific issues．

insurances．However，this system is currently limited

As part of the set of measures that could be

９）．In the case of foreign

to some localities．

taken in order to address those difficult cases，twoJapan is in the w ake of beco min g an aged

items have been favored the most，namely，（1）population in which multicultural issues are likely

consultation with area‑located global support centerto arise．In order for foreign elderly in needs ofalong with same LTC business‑involved personnel，

LTC services to take benefit of it in the smoothest

which includes the In‑home LTC type of work suchpossible way，it is thus of the utmost importance toas CM，and（2）the necessity to compile issue‑based

set up the following host of measures，that is，analysis of each individual cases in terms of culturala system of counseling and support designed forspecificities of foreign elderly and their families．

the CM，enhancement of the multilingual interpreterA s p art of a care pla n tailore d for foreig n

dis p atc h syste m ， th e creatio n of infor m atio nbeneficiaries，CMs have massively favored and gave

tool such as multilingual documentation，and thepositive answers to two items in the list：（1） A

lasting establishment of consultation service design tobetter consideration of daily‑specific habits and cultural

facilitate a better mutual understanding．

particularities；and（2）A better foreign language
support．At an operational level，CMs have alsofavored as paramount three items：（1）The establish‑

Conclusion

ment of consultation service and improvement ofOver twenty percent of CMs had experienced theone s adequate skills；（2） An increase in foreigncases with foreign residents from various countries

language‑translated documentation；and（3）an increaseof origin．One out of four CMs expressed that they

in medical‑，day care‑related interpretation service．

have difficulty in dealing with the problematic

An overhaul of the counseling and foreign language

cases of foreign residents most of which arise fromsupport has been mainly highlighted．In the attempt

personality traits an d cultural backgrou n ds ．

to carry out their jobs smoothly，the incapacity toWith growing population of the foreign elderly income to a consent with the patients for the CM has

Japan，their use of in‑home care is increasing．

proven to be not only a cause of nuisance whenInternationalization of the health care system intrying to cope with addressing the persons

needs，

Japan，standardized organizational structures fordesigning care plans or even performing assessments，

foreign residents and the support system for CMs

but also an hindrance to exercising the right to takeare needed．

benefit of a LTC service and to make the appropriate

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在日外国人の居宅サービス利用における対応状況

was supported by JSPS KAKENHI（24593548），

Acknowledgements

Scientific Research（C）．The authors presented a

The authors are gratefully acknowledge the CareManagers who participated in this study．This workpart of this article at the 19th East Asian Forum of
Nursing Scholars．

References

１）Japan Immigration Association，Statistics on the foreigners registered in Japan，2014．
（In Japanese）．
（online），
available from＜http://www.moj.go.jp/housei/toukei/toukei̲ichiran̲touroku.html，（2015‑8‑10）２）Ministry of Health，Labour and Welfare s Annual Report on the Status of LTC Insurance Services，2014．
（In Japanese）．
（online），available from＜http://www.mhlw.go.jp/toukei/list/84‑1.html＞
３）Kakita，Y．Elderly Korean residents in Japan in the long‑term care insurance system．Shakai mondai
kenkyu．54 盪，2005，77‑90．（In Japanese）．
４）Lee，K．et al．An analysis of long‑term care for elderly Korean immigrants in Japan：A case study at along‑term care insurance facility．The 1st International Nursing Research Conference of World Academy of
Nursing Science，Program & Abstracts，2009，211．
５）Shoya，R．& Nakayama，T．Kourei zainichi Kankoku Chousen jin［Elderly Korean residents in Japan］．
Ochanomizu Shobou，1997，p496（In Japanese）．
（ISBN 978‑4275016584）
６）Lee，K．Health care support for elderly foreign residents in Japanese society：Focusing on the problems inlong‑term care for elderly Koreans in Japan．Journal of International Health．vol．26 蘯，2011，149‑150．
７）Lee，K．et al．Seeking A Place Where One Belongs ：Elderly Korean Immigrant Women using Day Care
Services in Japan．Journal of Transcultural Nursing．vol．
23 盻 October，2012，351‑358．
８）Lee，K．Public long‑term care insurance service use among foreign residents in Japan：Survey by Osaka
city．JSPS KAKENHI，Grant‑in‑Aid for Research Activity Start‑up Report，2012．
９）Lee，S．et al．Medical Interpreter in Healthcare．Kyorin Syoin，2015，30‑36．（In Japanese）．（ISBN 978‑4‑7644‑0535‑6）

UH CNAS，RINCPC Bulletin Vol．23，2016

在日外国人の介護保険サービス利用における介護支援専門員の対応状況に関する調査研究李 錦純１）

那須 潤子２）

要

高橋 芙沙子３）

俵 志江４）

旨【目的】
全国の介護支援専門員（CM）を通して、在日外国人の介護保険の居宅サービス利用における対応状況を明らかにすることで、多文化共生社会の観点から、日本社会における高齢者保健福祉問題を講じる上での基礎資料を提示することを目的とした。

【方法】
都道府県別の65歳以上の在日外国人の人口分布に基づき、WAMNETのデータベースを用いて、確率比例抽出法および単純無作為抽出により選定した居宅介護支援事業所2,000か所のCM宛に質問紙調査票を送付した。調査項目
は、担当している外国人利用者の居宅サービス利用状況、対応や課題に関する項目であった。得られた回答は、数値化し量的分析を行った。

【結果】709名のCMより回答を得た（回収率35.8％）。CM144名（20.3％）が外国人の担当経験をもち、担当した外国人利
用者総数282名の国籍（出身地）別内訳は、「韓国・朝鮮」204件（72.3％）、「中国」35件（12.4％）、「台湾」13件（4.6％）、「ブラジル」９件（3.2％）の順に多く、「その他」19件（6.7％）には８か国が含まれていた。最も利用されているサービスは訪問介護であった。CMの23.3％が対応困難を感じており、その内容は「認知症等で不安定」、「利用者の性格によるもの」、「生活習慣や価値観」の順に多かった。対応は同事業所職員への相談が最多であった。ケアプラン作成上の課題として肯定的な回答が多かったのは、「生活習慣・文化への対応」、「言語への対応」で
あった。

【考察】
在日外国人の担当経験があるCMは全国的にも20％を超え、その国籍は多岐にわたっていた。CMの４人に１人が対応に困難を感じ、その内容は認知症等疾患によるものの他に、個人特性や文化的背景の理解に起因するものが多かった。介護保険サービスを利用する在日外国人の多国籍化・多文化化が進展しつつあり、外国人利用者の文化的特性をふまえた個別事例の課題分析を蓄積していくとともに、CMの相談支援体制の充実が求められる。

キーワード：在日外国人、介護保険、居宅サービス、多文化共生

１）兵庫県立大学看護学部

在宅看護学２）東邦大学大学院看護学研究科

博士後期課程３）兵庫県立大学大学院看護学研究科

博士前期課程４）甲南女子大学看護リハビリテーション学部

87