Nursing for the older people
in Japan
2. Nursing for the Older People:
Current Situation and Challenges

Japanese Nursing Association

1. The Aging of the Japanese Population
2. Nursing for the Older People: Current
Situation and Challenges
3. The Japanese Nursing Association in
Action(to be issued soon)

2
Japanese Nursing Association

Glossary• Welfare facility for the elderly requiring longterm care: Living facility for older people who
require long-term care
• Healthcare facility for the elderly requiringlong-term care: Rehabilitation facility for theolder people requiring long-term care to go
back to home/community• Sanatorium-type medical care facility for theelderly requiring long-term care: Long-term
medical care facility for older people who
require high-level medical care and/or longterm care
• Long-term care level: Classified to five levels
in accordance with the conditions of the user(e.g. intensity of care). Care level 5 signifies
the highest level of requirement for longterm care, and care level 1 the lowest.
3
Japanese Nursing Association

Japanese government switching its focus in care forthe aged from facilities to local communities
When get sick

After discharged<Community based comprehensive caresystem >Acute care hospital
advanced medicine including
emergency and surgery
Early discharge

Sub-acute / subacuterehabilitation
hospital
Focused on
rehabilitation→
early recovery

Local partner
hospital
Everydayhealth care
Primary care
physicianHome
Required staff at acute care settings
will be increase to 1.6-2 fold ofcurrent staff in FY2025

Comprehensive
management- Hub for thecollaboration
among home
based medicine- Community
general support
center- care manager

Healthandmedicalcare

Longterm
care

Visit a Attend a
hospitalcare
Home visit
facility Home visit
medicine/
long-term
nursing
care/ nursing

Living place

Home/ Elderly housing with care

Facilitating thesmooth transition
from medical tonursing careconsultation andcoordination ofservices

Users of home based medicine
and nursing
FY2012 170,000 people/day
FY2025 290,000 people/day

Senior citizen’s club/ long-term careprevention/ livelihood support etc.
Livelihood support/
Preventive long-term care
support
Users of in-home /Home based
long-term care
FY2012 3,5million people/day
FY2025 5,2 million people/day

Note: It is assumed that the geological unit for community-based comprehensive care represents a “middle-school” area with a population of about
10,000.

Source: Public relations office, government of Japan; Comprehensive reform of social security and tax, accessed at http://www.govonline.go.jp/tokusyu/201208/naniga/img/jujitsusaku_01_l.gif in September 18,2003.

In the backdrop of aging society, increasing patients with chronic diseases, tightening
health economy, etc., the Japanese government has powerfully promoted homehealthcare. In December 1989, the Ten-Year Strategy for Promoting Health and Welfareof the Aged ("Gold Plan") was enacted, setting a flow for switching from care at facilities
to care at home. In 1992, the Medical Care Act was revised to position homes as places
for providing health care. In 2000, the long-term care insurance system was introduced,
based on the Long-Term Care Insurance Act.

As the aging of society proceeds, the government aims at establishing a community
based comprehensive care system by around 2025, when the baby boom generation
reaches the age of 75 or above, which could provide a package of housing, health care,long-term care, preventive care, and support for living, so that older people could
4
continue living in the places they are familiar with, as long as possible toward the end ofJapanese Nursing Association
their life.

Many older people hopeto live at home
One’s own homeChild’s home

Male

Relative’s home

Welfare facility for the elderly requiringlong-term care
Health care facility for the elderly
requiring long-term care
Medical institution

FemalePaid nursing home for the elderly
Others

0%

20%

40%

60%

80%

100%

Unknown

The desired place to receive long-term care
One’s own homeChild’s home

Male

Relative’s home

Residence with care for the elderly

Special nursing home for the elderly or otherwelfare facility

FemaleHospital or other medical facility

0%

20%

40%

60%

80%

The desired place to die

100%

OthersUnknown

Source: Attitude Survey on Health of the Aged, 2012, Cabinet Office

Many older people hope to live at home.

5Japanese Nursing Association

More number of older people haveincreasingly high needs for health care
• Evolving health care technologies• Reduced days of hospitalization

Due to evolving health care technologies and reduced days of hospitalization,
the number of older people who requires medical procedures after discharged
from hospital are increasing.

6
Japanese Nursing Association

More number of patients with dementia
are linked to expanding population aged
65 and over
• One out of approx. seven people aged
65 and over suffer dementia.
• The prevalence rate of dementia
among people aged 65 and over inJapan is estimated at 15%.
Source: Comprehensive Research Project on Measures against Dementia, Health Labour Sciences
Research Grant"Incidence Rate of Dementia in the Urban Area, and Response to Living Functional Disability Caused by
Dementia", Comprehensive Research Report 2011 to 2012, Published by Takashi Asada, Principal
Investigator, March 2013

The Ministry of Health, Labour and Welfare estimated the population of older
people with dementia who require any kind of support at 2,800,000, based on
2012 data. This makes up 9.5% of the overall population aged 65 and over. This
percentage is expected to further increase.
The research on the prevalence rate of dementia uncovered that one out ofapprox. seven people aged 65 and over, which means approx. 4,390,000 people
overall, suffer dementia, with or without need for support, as of 2012.
In order to support these people on a community basis, it is required that mostresidents properly understand and take appropriate actions to older people withdementia.

7
Japanese Nursing Association

Municipal governments are providing
service for prevention of dependence on
long-term care to support independent
living of older people in local communities• Primary care prevention
Target: People aged 65 and over
Activities: Dissemination of long-term care prevention,
development of volunteers and other human resources,development of and support to local activity organizations,etc.

• Secondary care prevention
Target: Older people with lowered physical functionality
who may use long-term care service in the near future
Activities: Identification of target older people, provision of
long-term care prevention program through daycare service,
comprehensive clarification of issues through visits, andprovision of necessary consultation and guidance service

Prevention of dependence on long-term care is an initiative to prevent andrestore deterioration of mental and physical activities, so that older people
could continue independent living without necessity for care covered by thelong-term care insurance system. This initiative is undertaken by individualmunicipal governments. For older people with remarkable deterioration ofmental and physical activities, who may use long-term care service in the near
future, support toward independent life is provided by specialists, such as publichealth nurses, certified social workers, care managers, etc. The services
provided may include, in accordance with conditions of the older people,
1) improvement of motor function, 2) improvement of oral function, and
3) improvement of nutritional conditions.
8
Japanese Nursing Association

Long-term care services• Facility Service• Home-based Service
Home visit nursing, home visit long-term care, home visit
bathing, day care rehabilitation, day care service, shortterm stay, rental service/ purchase of equipment for longterm care, etc.

• Community-based Services
Combined services, periodical round, multifunctional longterm care in a small group home, home-visit at night for
long-term care, etc.

Services under the long-term care insurance system are largely divided into facility
services, home-based services, and community-based services. Facility and homebased services are designated and supervised by the competent prefectural
government, while community-based services are designated and supervised by thecompetent municipal government.

Facility services are provided to those staying at nursing homes for the elderly andsimilar facilities. Home-based services provides the essential support to continue thelife at home. Typical home-based services include home visit nursing and day careservice. Community-based services are long-term care provided in the places that arefamiliar to older people, taking into account the expected further increase in older
people who suffer dementia and/or who live by themselves. Service types other than
the above include group shared residence for older people with dementia, etc.
9Japanese Nursing Association

Many Users of the Long-Term Care
Insurance System Use Home-based
Services(1,000 people)
3,000

2,500

2,000

1,500

1,000

500

0

Home-based service

Community-based services
Facility services

Home-based services f or prevention of dependence on long -term careCommunity-based prevention of dependence on long -term care services* The Long-Term Care Insurance Law was revised in 2005, introducing preventive services.
Source: Based on Annual Data on May, "Survey of Long-term Care Benefit Expenditures",
Monthly Reports, Ministry of Health, Labour and Welfare

Increased number of population are using the long-term care insurance system.
Users are particularly on the rise of home based services, which are indispensable
to continue living in the familiar community.
More than half of people who require high-level care use facility services.

10
Japanese Nursing Association

The number of beds at long-term carefacilities for the elderly in Japan are lessthan its older people
Comparative Beds at Facilities for Care of the older people(per 1,000 people aged 65 and over)

(%)
100

Japan

90

Australia
Belgium80

Denmark

70

FinlandFrance60

Iceland50

Ireland
Italy

40

Korea

30

Netherlands
Spain

20

Sweden10

Switzerland
United Kingdom

02000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

United States

Source: OECD Health Data, accessed on October 3, 2013

The number of beds at facilities for care of the older people in Japan are far lessthan its population aged 65 and over.
On the other hand, the government is proceeding toward establishing a regional
comprehensive care system for providing a basis of community-based living to older
people who suffer dementia and/or who live by themselves, taking into account the
expected further increases in their population. Residence with services for the older
people is also put in place to support community-based living of older people wholive by themselves or of aged couples.
11
Japanese Nursing Association

Nursing human resources who work forcare of older people
The percentage of nurses who work for long-term care to
the population aged 65 and over (2009)
(%)
7
6
5
4
3
At f acilities

2
At home10* Estimates are used for Czech and the Netherlands. The figure for Japan is an adjusted value (break in series).

Source: OECD Health Data, accessed on October 3, 2013

The OECD data suggests that the number of nursing personnel who work for long-term care in
Japan is small relative to the share of aged population.

12
Japanese Nursing Association

Nursing at Facilities

13
Japanese Nursing Association

Long-term care facilities:
Types, human resource allocation criteria
and the number of facilities in Japan
Welfarefacilities forthe elderly
requiring longterm care
(Special
nursing home
for the elderly)

Healthcare
facility for theelderlyrequiring longterm care

Sanatoriumtype medicalcare facility forthe elderly
requiring longterm careGroup sharedresidence forolder people
with dementia

Long-term carefor residents ofspecifiedinstitutions(e.g. paid
nursing home
for the elderly,
residence withservices for theelderly)

Characteristicsof the facility

Living facility
for olderpeople who
require longterm care

Rehabilitation
facility for theolder people
who requirelong-term careto go back tohome/community

Long-term
medical carefacility for
older people
who require
high-level
medical careand/or longterm careGroup homesetting for
older people
with dementia

Living facility
for olderpeopleincluding those
who requirelong-term care

Allocation ofnursesUsers:Staff
3:1

3:1(Nursing staff
make upapprox. 2/7 ofthe full timeequivalent(FTE)
workforce.)

At least 6:1

Allocation of
long-term care
staff

At least 6:1

At least 3:1

At least 1 longterm care or
nursing staff
for every threeolder people
who requirelong-term care

Facilities

5,953

3,533

1,711

9,484

3,165

Quota

427,634

318,091

75,991

141,941

183,980

Source for facilities and quota:"Survey of Institutions and Establishments for Long-term Care", 2011,
Ministry of Health, Labour and Welfare

The number of nursing staff to be allocated varies by the characteristics of long-termcare facilities. The allocation criteria have been set by law.
14
Japanese Nursing Association

Many users of facilities require high-levelcare
Welfare facility for the elderly requiringlong-term care
Healthcare facility for the elderly
requiring long-term care
Sanatorium-type medical care facility
for the elderly requiring long-term care
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Care level 1

Care level 2

Care level 3

Care level 4

Care level 5

Others

Source: "Survey of Institutions and Establishments for Long-term Care", 2011,
Ministry of Health, Labour and Welfare, as of September 30, 2011

Many users of facilities require high-level care.

15
Japanese Nursing Association

Present status of Nurses at long-termcare facilities
FTE staff per facility
Welfarefacilities forthe elderly
requiring
long-term care
(Special
nursing home
for theelderly)

Healthcare
facility for theelderlyrequiring
long-term care

Sanatoriumtype medicalcare facility
for the elderly
requiring
long-term careGroup sharedresidence forolder people
with dementia

Long-termcare forresidents ofspecifiedinstitutions(e.g. paid
nursing home
for the elderly,
residence withservices forthe elderly)

Nurses

2.0

4.6

5.6

0.2*

1.6

Assistant
Nurses

2.0

5.6

6.5

0.2*

1.1

Long-termcare staff

31.5

29.5

14.1

11.4

17.4

* Included in long-term care staff
Source: "Survey of Institutions and Establishments for Long-termCare", 2011, Ministry of Health, Labour and Welfare

The number of nurses who work at long-term care facilities is small. Each nursing
staff member take care of 17.7 residents at a welfare facilities for the elderly
requiring long-term care, and 8.2 residents at a healthcare facility for the elderly
requiring long-term care.

16
Japanese Nursing Association

Current situation of night shift at longterm care facilities
Work shifts of nurses
Day shift only

Special nursing home for the elderly
Two shifts

Healthcare facility for the elderly
requiring long-term careThree shifts
Night shift onlyGroup shared residence

Other
No answer
0%

20%

40%

60%

80%

100%

Allocated number of nursing staff
5.00 am

11.00 am

9.00 pm

AverageStandard
deviation

AverageStandard
deviation

AverageStandard
deviation

Special nursing
home for theelderly

0.1

0.6

4.1

2.0

0.1

0.5

Healthcare
facility for theelderly requiringlong-term care

1.2

0.6

5.6

2.5

1.2

0.9

Group sharedresidence

0.1

0.2

1.2

0.7

0.1

0.3

Source: "Status Survey of Nursing Staff who Work at Facilities for Care of
the Elderly", 2012, Japanese Nursing Association

According to the survey conducted by Japanese Nursing Association, targeted at
nursing staff who worked at facilities for care of the elderly registered as JNA's
members as of 2012, 60.8% of all respondents worked at night shift. At two-shiftfacilities, respondents worked for 16.1 hours per night shift on the average.
Among respondents, 38.7% said that they worked for facilities with anon-call system.
17
Japanese Nursing Association

Nurses at long-term care facilities play awide range of roles• Supporting the living of residents in healthcare and nursing aspects• Exercising nursing expertise as a member ofhealth care team
• Protecting health of the entire facility• Taking into account the management of theentire facility while fulfilling one's own roles• Identifying information on necessary social
resources in alignment with the local
community

Because long-term care facilities are places for living, nurses are required toprovide high-quality care in collaboration with long-term care staff and otherprofessionals, while trying to understand the life of each resident and responding
to their preference. For this purpose, nurses are required to have not only
nursing expertise and skills necessary for providing nursing care to residents, butalso management perspectives and competency, in order to guarantee safe andhealthy conditions of the entire facility, to prepare resources required forproviding necessary care, to establish an information sharing system, etc.
18
Japanese Nursing Association

Nurses at long-term care facilities
provide care for better everyday life
• Nursing care at the time of admission• Basic care to establish the rhythm of
everyday life
• Management of medications• Emergency response, including accidents• Support for end-of-life care
• Nursing care at the time of discharge

Nurses who work at facilities for the elderly provide care for better everyday life
through health management of older people who require support in their life, incollaboration with long-term care staff and other professionals.
Their main tasks include the assessment of body temperature, blood pressure, etc.,
observing health conditions and maintaining physical cleanliness, nutrition
management, excretion management, prevention and treatment of bedsores,
management of medications, respiratory care, palliative care, and instructions tolong-term care staff. Nurses also observe day-to-day conditions of each resident,
and, in the event of acute change or abnormality in conditions, make decision on
moving the resident to a local hospital in collaboration with the physician.

19Japanese Nursing Association

Challenges• Unclear scope of work
• Training opportunities for nurses• Collaboration with other professions
inside and outside the facility, andlocal networks

As increasing number of people live in long-term care facilities, needs are rising forindividual long-term care and health care. Needs for end-of-life care are also on
the rise. Unfortunately, nurses are not able to provide sufficient care in responseto these needs. As factors for these insufficient care , it has been pointed out thatthe number of nurses allocated to long-term care facilities is small, and theposition of nursing in the organization is not clear. It has also been uncovered thatfew new graduates are employed as nursing staff, and nurses do not have many
training opportunities, resulting in difficulty of acquiring nursing knowledge andskills required at long-term care facilities. At the same time, collaboration withother professionals is indispensable to fully exercise the functions of nursing.
In order to improve the quality of nursing, it is required to strengthen thefunctions of nursing, to provide training opportunities for acquiring knowledge
and skills, and to bolster local networks.

20
Japanese Nursing Association

Home-based Nursing

21
Japanese Nursing Association

History of home-based nursing
1982

The Law of Health and Medical Services for the
Elderly was enacted, providing the legal groundfor home-based nursing for the first time. The
law was revised in September 1991,establishinga home-visit nursing system for the elderly.

1994

The Health Insurance Act was partially revised.
In response to nursing needs of from children toolder people, nursing activities were promoted
in collaboration with medical care and welfare at
home.

1997

Home-based nursing was incorporated into thebasic nursing education curriculum.

2000

Gold Plan 21 was set, in prospect of
establishment of 9,900 visiting nursing stationsin 2006.

2006

Medical fees and long-term care fees wererevised. The scope of home-visit nursing was
expanded to special nursing home for the elderly,group shared residence, etc.

22Japanese Nursing Association

Nurses are involved in a variety ofservices covered by the long-term careinsurance system• Facility Service• Home-based Service
Home visit nursing, home visit long-term care, home visit
bathing, day rehabilitation, day care service, short term
stay, rental service/ purchase of equipment for long-termcare, etc.

• Community-based Services
Combined services, periodical round, multifunctional
long-term care in a small group home, home-visit at nightfor long-term care, etc.

Nurses are involved in providing home-visit nursing and other variety of services
covered by the long-term care insurance system, aimed at supporting living ofolder people at home.

23
Japanese Nursing Association

Nurses work on various settings to
support living of older people at home
FTE staff per facility or establishment
Home-visits

DaycareHomevisit longterm care

Homevisitbathing

Homevisit
nursing

Daycareservice

Nurses

-

0.9

4.2

Assistant
Nurses

-

0.8

0.4

OthersDaycare rehabilitation
Welfarefacilities
for theelderlyrequiring
long-termcare

Medicalinstitutions

Shortterm stayfor longterm care

0.5

0.5

0.8

0.9

0.6

0.5

0.6

0.9

Source: "Survey of Institutions and Establishments for Long-termCare", 2011, Ministry of Health, Labour and Welfare

Nurses are involved in a variety of home-based services. Their main tasks arehome-visit nursing services.

24
Japanese Nursing Association

Home-visit nursing supporting
continued medical care at home
Users

Care managers
Healthinsurance

Requests

Long-term careinsurance

Physicians

Homevisits

Homevisits

Written
instructions

Visiting nursing stations, hospitals and clinics

Professions that support medical care at home
Physicians

OTs

Dentists

STs

Public healthnursesNutritionists

NursesPharmacists

Certified social
workers

In-home helpers

PTs

Certified care
workers

Long-term caremanagerHome-visit nursing is provided by visiting nursing stations, hospitals and clinics,
based on the long-term care insurance system and the health insurance system. A
written instruction issued by the physician is required to start home-visits.
Manager of a visiting nursing station should be a dedicated public health nurse,
midwife, or nurse. At least 2.5 FTE nurses should be allocated to a visiting nursing
station.

In home-visit nursing, nursing personnel should support the maintenance,
promotion and restoration of the client's health, while minimizing impact of
diseases and/or disorders if any, thereby facilitating the client's long-term care athome. In doing so, nurses must align with many other professions engaging in the
medical care at home.

25

Japanese Nursing Association

Users of visiting nursing stations are
increasing(number of facility)(user)

350

10000
9000

300

8000
250

7000
6000

200

5000
150

4000
3000

100

2000
50

1000

0

0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

visiting nursing stations

Hospitals and clinics

Users of visiting nursing stations

Source: Based on data of May every year, "Survey of Long-term Care Benefit
Expenditures", Reports, Ministry of Health, Labour and Welfare

Users of home-visit nursing are on the rise under the long-term careinsurance system. The focus of institutions providing home-visit nursing
seems to be shifting from hospitals and clinics to visiting nursing stations.
The number of visiting nursing stations has been slightly increasing.

26
Japanese Nursing Association

Some aged users of home-visit nursing
have unstable health conditions
Health aspects of users of home visit nursingn = 5,028
Up to 64 years old

Low
Moderate

65 to 74 years old

High

Serious

75 years and overN/A
No answer0%
Level
Conditions

Low
Conditions arestable, thoughrequiringoccasional vital
signs checks.

20%

40%

60%

80%

100%

Moderate

High

Serious

Conditions are stable,
though relapse ispossible. Vital signs
checks should bedone whennecessary.

Conditions are
relatively unstable.
Periodic vital signs
checks are
required.

Conditions are
unstable. Constantvital signs checks
are required.

Source: "Report of the Basic Survey on Home Visits and Home-Visit Nursing", FY2006, JapaneseNursing Association and Japan Visiting Nursing Foundation

Among people aged 65 and over who live at home, more than 60% have moderate tohigher needs for medical care. Many people with unstable conditions and high needs
for medical care also continue to live at home.

27
Japanese Nursing Association

Providing a broad range of care toenable continued life of aged people athome, from medical services to support
and consultation for caregivers•

Medical interventions under the direction of physician
Management of oxygen therapy, prevention and treatment of bedsores,
provision and management of injection and IV, provision and management ofcentral venous hyperalimentation at home, provision and management of
nasal tube feeding, enema and stool extraction, etc.

••

Observation of and advice on health conditions
Support to daily life
Bed bath, shampooing, oral care, meal care, etc.

•

•
•
•
•
•
•

Advice for improvement of in-home recuperation
environment
Rehabilitation at home
Support and consultation for informal caregivers such as
families
Mental and psychological support
End-of-life care
Coordination of different services (social resources)
Consultation on hospitalization and discharge

In order to enable continued living of older people at home, nurses provide a broad
range of services in a limited time frame, including advanced medical interventions
that are required due to reduced days of hospitalization, terminal care required
through promotion of end-of-life care at home, care for people with dementia, etc.
In providing these types of care, collaboration with other professions related to lifeof older people at home is indispensable.
28
Japanese Nursing Association

Current situation of nursing staff at
visiting nursing stations
Nurses’ workplace
1.1%

0.8%
2.3%
1.5%
2.9%
0.1%

3.0%

0.7%
0.6%
2.4%

Health centers
Municipal governments
Hospitals

2.1%

Clinics
Maternity homes
Healthcare facility for the elderly requiringlong-term care
Visiting nursing stations

20.7%

Social welfare facilities

62.0%

Welfare facility for the elderly requiringlong-term care
In-home services, etc.
Industries
Nursing schools, Institutes

Source: Statistical data on Nursing service in Japan 2012, JapaneseNursing Association Publishing Company
Researched by the Nursing Division, Health Policy Bureau, Ministryof Health, Labour and Welfare

While the number of visiting nursing stations has been slightly increasing, theshare of nurses who work at visiting nursing stations has remained at the samelevel over the past ten years.

29
Japanese Nursing Association

The majority of visiting nursing stations
are small-sized
Size of visiting nursing stations
2009, n = 2112

18.7

0%

47.3

20%

40%

20.7

60%

7.9 2.780%

2.5 to fewer than 3

3 to fewer than 5

5 to fewer than 7

7 to fewer than 9

9 to fewer than 11

11 to fewer than 15

15 to fewer than 20

20 or more

100%

Source: Japanese Nursing Association
Grant for Promoting Elderly Health care Services, Ministry of Health, Labour and Welfare,
FY2009, "Survey and Research Project to Analyze the Causes for the Declining Trend of Homevisit Nursing Establishments and Measures to Cope with the Trend"

It has been specified that at least 2.5 FTE nurses should be allocated to a visiting
nursing station.
According to the survey by JNA, the majority of visiting nursing stations are
small sized, with only fewer than five FTE employees.
* FTE = Total work hours of employees per week / Weekly work hours specified by theestablishment

30Japanese Nursing Association

Challenges•

Users of home-visit nursing have increasingly diverseand complicated needs.
Increasing patients with cancer, intractable neurological diseases, psychiatricdiseases, etc.
Increasing users who require medical interventions••

Because of the visiting nursing stations are small sized,
operations tend to be inefficient, resulting inincreased burden on staff.
Smaller sized visiting nursing stations are in poorer
business conditions compared to larger stations, andare unable to provide services around the clock.

Because home-visit nursing is provided under the two separate systems of long-termcare insurance and health insurance, it takes a long time for complicated clerical work,
causing difficulty in increasing the case of home-visit nursing. This has a negative
impact on business efficiency and management.
Because opening of a visiting nursing station is approved with the allocation of atleast 2.5 FTE nurses, most establishments are small sized. Because of their small scale,efficiency is poor at these facilities, causing great burden on staff. Neither can they
increase users because of inability to fulfill their needs, nor can stabilize or reinforce
their management. It is also difficult for these facilities to provide services around theclock.
In order for users and their families to continue life at home, stable and seamlessservice provision is essential.
31
Japanese Nursing Association

Informal Caregivers

32
Japanese Nursing Association

Families as principal care givers at home
Relationship of principal caregivers with older people who
require long-term care

SpouseChildChild’s spouse
ParentOther relative
Service provider
Other
Unknown

Source : National Livelihood Survey, 2010, Ministryof Health, Labour and Welfare

As indicated on Slide 10, many older people use long-term care service at
home. However, their families serve as principal caregivers at home, because
there is a ceiling on the use of services under the long-term care insurance
system.

33
Japanese Nursing Association

Current conditions of care time ofprincipal caregivers
Care time of principal caregivers who live with older people

Support level 1
Support level 2
Care level 1
Care level 2
Care level 3
Care level 4
Care level 50%
Almost all day

10%

20%

About half day

30%

40%

2 to 3 hours

50%

60%

70%

When necessary

80%
Other

90%

100%

Unknown

Half of principal caregivers who live with older people requiring high-level carespend almost all day on providing care.

34
Japanese Nursing Association

Increasing people leave or change theirjobs to provide care to their families(Persons)

People leaving or changing their jobs for caregiving

120,000

100,000

80,000
Leaving jobs, Female

60,000Changing jobs, Female
Leaving jobs, Male

40,000Changing jobs, Male

20,000015 –85
19 20 - 25 - 30 - 35 - 40 - 45 - 50 - 55 - 60 - 65 - 70 - 75 - 80 - years
years 24 29 34 39 44 49 54 59 64 69 74 79 84 andoverSource: Employment Status Survey, 2012, Ministry of Internal Affairs and Communications

According to OECD, one out of every ten people are involved in caregiving fortheir families, etc. in OECD member states,* to a varying extent.
In Japan, increasing people leave or change their jobs to provide care to theirfamilies. Most of them are female.
* OECD (2011), Help Wanted? Providing and Paying for Long-Term Care, Paris.

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Japanese Nursing Association

A wide variety of concerns and stress ofprincipal caregivers
Concerns and stress of principal caregivers
HouseholdincomeandlivelihoodMale
男

Own illness
or long-tem
care

Familiy's disease or
long-term-careWork

Human relationship No free timewith families

女FemaleFamiliy's disease or
long-term-care

0%

20%

40%

60%

80%

100%

Source : National livelihood survey, 2010, Ministry of Health, Labour and Welfare

Principal caregivers have a wide variety of concerns and stress.
Many of them directly affect the life of principal caregivers and/or older people
requires long-term care, such as caregiver's own diseases and long-term care,household income and livelihood, and work.
In Japan, systems have been introduced to support working people who alsoneed to provide care, such as paid holidays for caregiving and flextime system.
On the other hand, no monetary benefits are available, such as carers allowance.

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Japanese Nursing Association• In order for older people to continue
living in their local communities,
seamless service provision is essential.
• Many professions are involved in the
support for continued living of older
people in their local communities.
Nurses are expected to play importantroles in the coordination amongprofessions which are indispensablefor high-quality service provision.

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Japanese Nursing Association