8USNCEE
Abstract /Paper ID 608

HOW EFFECTIVELY THE JAPANESE CARE MANAGEMENT SYSTEM WORKED
FOR DISASTER RESPONSE TO THE ELDERLY IN THE 2004 NIIGATA FLOOD AND
THE 2004 MID-NIIGATA PREFECTURE EARTHQUAKEK. Tamura1, H. Hayashi2, S. Tatsuki3 and R. Kimura 4

ABSTRACTTwo researches were conducted to clarify the disaster process of the elders in
the Niigata Flood and Mid-Niigata Prefecture Earthquake. The major findings
were as follows: 1) the care managers as the professionals licensed by thegovernment-sponsored Long-Term Care Insurance System worked effectively to
manage the needs of moving temporarily to care facilities, 2) 51 elders still stayedin the care facilities, while victims in the impacted area had begun to constructtheir lives in the region, 3) the numbers of people who took in-home services
decreased month after the impact, while the numbers of victims who took infacilities services increased. The disaster care management system needs to beestablished for responding to the elder’s special needs in disasters.

Introduction
Background and Aim of the Study
The Niigata Prefecture suffered two big disasters in 2004. The Niigata Flood occurred on
July 13 and caused 15 deaths, 13 of which were senior citizens. Of those 13 deaths, 8 were 75 orolder. The disaster reminded the public that disaster-prevention measures for the elderly arenecessary. The Mid-Niigata Prefecture Earthquake occurred on October 23 and had 1) longlasting aftershocks, 2) evacuations by the village units, 3) officials advised a wide area toevacuate, and 4) substantial damage to the life line, which resulted in a larger number of
evacuees and more senior citizens needed care. The aim of this study is to gather basic data on
the response to the elderly, to show the necessity for disciplined disaster management care, andto develop a systematic approach to the disaster process for seniors under dramatic changes insocial environment.

1

COE Researcher, Disaster Prevention Research Institute, Kyoto University, Uji City, JAPAN 6110011
Professor, Disaster Prevention Research Institute, Kyoto University, Uji City, JAPAN 6110011
3
Professor, Faculty of Social Studies, Doshisya University, Kyoto City, JAPAN 6028580
4
Assistant Professor, Graduate School of Environmental Studies, Nagoya University, Nagoya City, JAPAN
4648601
2

1

Method of Survey 1(1) Subject disaster and area
Sanjo City, Niigata Prefecture was the subject area in Survey (1) on “the Niigata Flood on
July 13”. According to the Kakenhi (Grants in Aid for Scientific Research) report, four patternsof death were observed in “the Niigata Flood on July 13”. Deaths were caused by 1) a landslide,2) house destruction by gushing water, 3) moving outdoors after the house was flooded well
above the floor level, 4) remaining in a house flooded well above the floor level. It wasdetermined that most of the deaths of the elderly who normally needed daily care were caused by4) remaining in a house flooded well above the floor level. Therefore, we collected data to assess
this issue. We mailed the questionnaires to the subjects and asked them to return the completed
survey via mail. We mailed the questionnaires on March 18, 2005 and collected them until
April 5, 2005. Toward the end of March, reminders were mailed to those who had yet to return
their questionnaires.
(2) Subjects of this survey
Participants in Survey (1) included 1) leaders and sub-leaders of community associations in
the area where the elderly victims lived, 2) nursing-care insurance service providers, whoprovided services in the subject area, and 3) care managers, who were caring for the elderly
victims. Care managers are nation-certified specialists, who have special knowledge andtechniques, which help senior citizens receiving care to lead an independent daily life.

Results of Survey 1(1) The conditions that surrounded the deaths of the elderly care receivers
On July 13, 2004 at 13:07, the left bank of the Igarashi River at Suwa (Magaribuchi) broke.
The surveyed area (Rannan, Sanjo City, which is on the west side of the Shinetsu Line, therailroad) was a little far from the broken bank. Flooding began at 15:00 or later and reached 1.5
m. In the interview, the leaders and sub-leaders of community associations uniformly told that 1)
they assumed it was “a typical flood” since the surrounding area had frequently flooded, 2)
although the official advice to evacuate was issued at 11:40, they were unaware that anevacuation had been issued, 3) when the floodwater rose swiftly, all they could do was to go
upstairs, 4) they felt that the residents of their community association would manage to survive
the flood by themselves since the seniors lived by themselves.
The four senior citizens, who died in this area, were 75 or older and they all died in theirhomes. The interview revealed that these four people “needed some assistance to walk”, or“could not walk by themselves”. It was confirmed that three of them were receiving in-homenursing care services, but at the time of flood, none were receiving care from a caregiver (Table
1).

2

Table 1. Situations when the People who Needed Assistance Died in the Niigata Flood
Community
association

Community Association A

Community Association B

Attributes

Female, 87, walking witha cane, living alone

Female, 76, needed
nursing care, living alone

Female, 84, needed
nursing care, living alone

Male, 77, confined to bed

Estimated time 13th in the afternoonof death

13th around 20:00

13th in the afternoon

13th around 17:00

Time the bodywas found

15th around 12:40

14th around 09:00

15th around 17:45

13th around 21:00

Place the bodywas foundIn between the flooded
kitchen and living room inher house

In the flooded water on thefirst floor of her house

In the flooded living roomin her house

In the flooded water on thefirst floor of his house

Cause of death

There are traces of theflood up to 130 cm above
the floor in her house. It
seems that she stayedhome without being able
to evacuate by herself anddrowned in the rush of theflood

It seems that a neighborinitially carried her to thesecond floor, but she laterwent downstairs by herself
for some reason anddrowned, probably as she
fell

There are traces offlooding to 110 cm above
the floor in her house. It
appears that she stayedhome without being able
to evacuate by herself anddrowned in the rush of theflood

He was confined to bed
and received nursing care
at home. He drowned in
his house that was flooded
120 cm above the floor
level, although his wife
tried to save him

Community Association C(2) Action taken for the elderly care receivers in the Niigata Flood
Care managers and nursing care workers have become social resources to assist the elderly
since many senior citizens that live in their own homes receive nursing care insurance. Those
professionals essentially worked well during the disaster. However, one reason for the elderly
deaths is that there was not a systematic emergency preparedness plan for community caremanagers. It was also concluded that there was a clear gap in understanding the senior citizens’
needs between the nursing care workers and the leaders and sub-leaders of community
associations or district welfare officers.

Method of Survey 2(1) Subject disaster and area
The subject area of Survey (2), which assessed “the Mid-Niigata Prefecture Earthquake on
October 23” was Ojiya City, Niigata Prefecture.
(2) Subjects of this survey
Survey (2) included 23 care managers that provided home-based nursing care support inOjiya City and 399 senior citizens, who were sent to welfare facilities for the elderly or hospitals
during the emergency evacuation. Since it is difficult for some seniors to answer thequestionnaire, we asked the care managers, which cared for the senior citizens that evacuated towelfare facilities or hospitals, to answer the questions on the seniors’ behalf.

3

Results of Survey 2(1) The general situation
The questionnaires were distributed on January 15, 2005 through the Geriatric Welfare
Division, Ojiya City Office, and collected on January 31, 2005. A 100% response rate wasachieved with the assistance of the Geriatric Welfare Division since all 23 care managers thatprovide home-based nursing care in Ojiya City responded to Questionnaire-A in Survey (2).
Questionnaire-B was distributed to 399 senior citizens, although 382 were returned, only 257
were assessed to be useful for the survey. Consequently, the effective response rate was 64.4%.
(2) Situation of the senior citizens received at welfare facilities and hospitals in Ojiya City
after the Mid-Niigata Prefecture Earthquake
The graph in Fig. 2, which is based on the data from the Geriatric Welfare Division, Ojiya
City, chronologically shows the extent that care managers coped with the emergency evacuationneeds. The division accumulated the data by calling the welfare facilities and hospitals to
confirm the senior citizens received during the emergency evacuation based on reports from thecare managers. The division continued calling the facilities and hospitals until December 12,
2004, and the total number of people received reached 399. On the day of the earthquake, theneed for emergency evacuations arose mainly for “the elderly, who are highly dependent on
medical care”. The needs then shifted to “senior citizens, who have difficulties staying at the
shelters for a long period.” The needs peaked on October 27, 4 days after the earthquake (Fig. 1).
Numbers of people
50

10/27

47
45

Total number confirmed before
December 12th, 399 people

40 39
35
29

30

25

25

25

26

28

27

22
19

20
17
15

16
13
10 10

10
7
5

7
5

4
2

3
0

1

2 2
0

0 0 0

1

2
0

0 0 0 012

3
1

04/10/23
04/10/24
04/10/25
04/10/26
04/10/27
04/10/28
04/10/29
04/10/30
04/10/31
04/11/1
04/11/2
04/11/3
04/11/4
04/11/5
04/11/6
04/11/7
04/11/8
04/11/9
04/11/10
04/11/11
04/11/12
04/11/13
04/11/14
04/11/15
04/11/16
04/11/17
04/11/18
04/11/19
04/11/20
04/11/21
04/11/22
04/11/23
04/11/24
04/11/25
04/11/26
04/11/27
04/11/28
04/11/29
04/11/30
04/12/1
04/12/2

0

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Fig. 1. Elderly People Evacuated to Hospitals/Welfare Facilities in Ojiya City
after the Mid-Niigata Prefecture Earthquake4(3) Actual situation of the elderly received at welfare facilities or hospitals during the
emergency evacuation
The average age of the 257 “senior citizens received during the emergency evacuation” was
84. 89.9% were 75 or older, 6.2% were 65 to 74, and 3.9% were under 65. The reasons for the
emergency hospitalization or reception at welfare facilities were: 1) their houses were damaged
and it became impossible to receive home-based nursing care (58.2%), 2) it became impossible
for the family member(s) to care for them at home (19.5%), 3) their facilities suffered physicaldamage (8.6%), 4) their needs changed (2.3%), 5) their conditions changed (1.8%), 6) theyevacuated outside the city (1.8%), and 7) other (7.8%). The resources that supported the homebased care decreased by 77.7%.
Before the earthquake, 65.9% of the received seniors dwelled at home and 27.1% resided in
welfare facilities (Others were 7%). On the day of the earthquake, 37.1% stayed in a tent or acar, 16.3% evacuated to shelters, 17.6% stayed in welfare facilities, 6.9% stayed in hospitals, and10.6% remained at home. Two to four days after the earthquake, 20% were still living in tents,
cars, or shelters. One week after the earthquake, the number of senior citizens received at
welfare facilities and hospitals increased and peaked one month after the earthquake. By thattime, 61.7% had moved to welfare facilities and 23.0% to hospitals (Others were 15.3%). Twomonths after the earthquake, the number of seniors at welfare facilities and hospitals decreased,
implying that they started to return home. However, three months after the earthquake only
42.0% of the received seniors had returned home (Fig. 2).
100％
N=245-256

90
Private home 80(before the Earthquake)

65.9%

70
Nursing care insurance service facilities

60
50
Private home

40
27.1%

30
Hospital

Welfarefacilities(before theEarthquake)

20

7%

10

Others(before theEarthquake)

Tent/car/garage/parking lot

Shelter

The person diedTemporary housing

With relatives
At friends/neighbors

0

Rented house

The day of earthquake

2-4 days 2 weeks

10

10

1 month 2 months 3 months

2

10

3

2 years 3-6 years7-8 years

1 year10

4

X=log ‘Time elapsed since the earthquake’

Fig. 2. Changes in Dwelling Places of Victims Received during the Emergency Evacuation5(4) Senior citizens returning home from hospitals/welfare facilities
Figure 3 chronologically compares “the number of senior citizens received at
hospitals/welfare facilities during the emergency evacuation” and “the number of evacuees
staying at shelters”. The number of evacuees peaked five days after the earthquake. 29,000 of
the 44,000 residents in Ojiya City evacuated. The number of evacuees started to decline two
weeks after the earthquake and all of them returned home by December 20, 2004. On the other
hand, the number of elderly people received at welfare facilities and hospitals during the
emergency evacuation increased in accordance with the increase of evacuees at the shelters andpeaked 12 days after the earthquake. Although the number of evacuees sharply declined two
weeks after the earthquake, the number of the seniors at the welfare facilities and hospitals did
not decline as rapidly. The number of senior citizens staying at welfare facilities and hospital
gradually declined to 177 as of December 12. These finding suggest that the senior citizens, who
needed care, were unable to reconstruct their lives compared to the other evacuees. Via a verbal
confirmation on February 17, 2005, 67 seniors were still at hospitals and welfare facilities. As of
May 27, 2005, that number decreased to 50. Thus, our current task is to help these 50 seniors
return to their own homes.
35000

350

Number of people staying at shelters (line graph)

Number of senior citizens evacuated to hospitals/welfare
facilities during the emergency evacuation) (bar graph)

04/12/20

04/12/18

04/12/16

04/12/14

04/12/12

04/12/10

04/12/08

04/12/06

04/12/04

04/12/02

04/11/30

04/11/28

04/11/26

04/11/24

04/11/22

04/11/20

04/11/18

0
04/11/16

0
04/11/1450

04/11/12

5000

04/11/10

100

04/11/08

10000

04/11/06

150

04/11/04

15000

04/11/02200

04/10/31

20000

04/10/29

250

04/10/27

25000

04/10/25

300

04/10/23

30000

Fig. 3. Comparison of the Number of People Staying at Shelters and the Number of Senior
Citizens Evacuated to Hospitals/Welfare Facilities during the Emergency Evacuation

6

Conclusion and Observations
An essential issue in disaster planning is how to help people that have difficulties
evacuating by themselves. Typically, the welfare services that support the life of these people
are only provided during fixed hours and are unable to handle abrupt catastrophic disasters.
Nevertheless, care managers play a pivotal role in the current welfare service and areknowledgeable about senior citizens and their need for assistance when a disaster occurs. Caremanagers also have a strong sense of responsibility for the safety of people in need. Thus, thesecare managers must be involved in developing individual evacuation plans for future seniorcitizens that need support. Since care managers determine the evacuation plan for senior citizens,
who require care, individuals and organizations, which will become the life-saving resources inan emergency, must be secured. Once these resources are ascertained, the administration, thewelfare-related employees, and the community need to simulate evacuations and provide training
in order to improve the disaster prevention abilities of the community.
After the emergency period of the Mid-Niigata Prefecture Earthquake was over, the caremanagers mainly provided support to the elderly requiring care by facilitating their reception at
welfare facilities and hospitals. However, there are fundamental issues. 1) The facilities wereselected from the limited options within the care managers’ network. It was difficult to selectthe facilities that might help these seniors reconstruct their lives. 2) These seniors tended to haveprolonged stays at these facilities. In Ojiya City, which was hit by the Mid-Niigata Prefecture
Earthquake, more than 50 senior citizens (as of May 27, 2005 when this paper is written) had yet
to return to their previous lives within the community.
The resources available to care receivers living at home decreased due to the disaster, which
prevented these seniors from leaving the hospitals and welfare facilities, and returning home.
Hence, a new special area called “disaster care management” must be established. This area
allows care managers to play a leading role in systematizing knowledge, techniques, andnetworking for total care management during a disaster and remain within the framework of
nursing care insurance system.

Acknowledgments
This research was partially supported by the Ministry of Education, Science, Sports andCulture, Grant-in-Aid for Special Purposes, Research of the Niigata, Fukushima and Fukui
Flooding Disaster in July 2004, and for COE Research, Center of Excellence for Natural Disaster
Science and Disaster Reduction (Disaster Prevention Research Institute, Kyoto University,
Japan).

7

References
Hayashi, H. and Tamura, K., 2005. Profiling Causes of Deaths at the Niigata Flooding Disaster on July 13,
2004, Journal of Social Safety Science, No, 7 (Printing). (Japanese)
Kimura, R., Hayashi, H., Tatsuki S. and Tamura, K., 2001. Determinants and Timing of Housing
Reconstruction in the 1995 Hanshin-Awaji Earthquake Disaster -A 2001 Replication-, Journal ofSocial Safety Science, No, 3, 23-32. (Japanese)8