East Asian Social Policy Workshop (13th

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East Asian Social Policy Workshop (13th 15th
January 2005) Aging and Social Policy
sessionThe Impact of Long Term Care Insurance
Act on the Provision of Personal Social Services
for Older People
A Case Study in Japan

• Junko Yamashita
  Department of
  Social Policy and Social work
  The University of York

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Aim

• To explore how recent policy reform, which
  intends to promote socialization of care work
  encourage care provision from the independent
  sector, have impacted on the functions of service
  delivery by Welfare Nonprofit Organisations
  (WNPO) operating in the field of personal social
  services for older people in Japan.
• To evaluate the LTCI Acts scope of service
  provision.

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The Structure of the Presentation

• The historical context
• The LTCI Act
• The characteristics of WNPOs
• Sampled WNPOs for the study

• Is there any originality in the way WNPOs
  deliver services? Why?
• What kinds of demands are WNPOs responding to?
  Why?

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The increase in the numbers of WNPOs after the
mid 1980s
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The emergence of WNPOs from the mid 1980s

• Socialised hospitalisation
• Problematisation of the burden upon the female
  family members

• Groups from grass-root level began to be
  organised by women with the idea of mutual help.
• Government also encouraged these activities.

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The Historical Context

• Demographic
• The fastest ageing population and the longest
  life expectancy
• Changes in household structure
• Political
• Japanese-style of welfare society in the end of
  70s
• Delaying proper preparation for the aging
  society.

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Japanese style of welfare society

• Stop following Western models
• Inventing a tradition
• Opposing to the demographic trends
• The society has welfare programmes for the
  elderly with the burden of the tax prayer and it
  does not have the purpose that individuals do not
  need to take the responsibility. Its purpose is
  to be a last rescue boat in such an exceptional
  case, that is, for those who do not have any
  relatives or their family do not have any ability
  to take the responsibility. If one might think
  they do not need to take care of their parents
  because the government or local authorities
  provide social welfare for them, this is
  completely mistaken. (Jiyu Minsyu To Liberal
  Democrats Party 1979 Study paper Japanese-style
  welfare society)

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The policies concerning WNPOs

• The Specified Nonprofit Activities Law 1998
• ? access to a legal status became much
  easier
• The Long Term Care Insurance Act 2000
• ? - Socialisation of care work
• - The emphasis on users choice
• - Creation of a quasi-market of care
  provision
• - The Introduction of a social insurance
  system
• - The promotion of local autonomy

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Socialisation of care work

• enabling the frail older people to keep their
  autonomous life at home even without care
  provision from the family(The Ministry of Health
  and Welfare 1998)
• Japan became the first country in Asia whose
  government bears an essential part of the
  responsibility for the care provision of its
  older citizens.

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The Characteristics of WNPOs

• Membership system
• Involving service providers and service users,
  89 had membership system
• Female participants
• 95 of participants were middle-aged
  housewives ? After 2000, more young women and men
  began to participate

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• Monetary exchange
• Accepted fees for services
• A means to keep reciprocity between service
  providers and service users
• Concentration in metropolitan areas

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Sampled WNPOs
WNPO Est. Hours of Service Provided per month Numbers of participants
A 1996 2700 60
B 2002 700 30
C 1989 440 20
D 2000 650 30
E 1999 4300 74
F 1990 1000 45
G 2001 450 21
H 1986 1800 60
I 1995 2150 50
J 1998 9986 200
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The role of WNPOs regarding service delivery

• What is original about WNPOs services?
• What kinds of demands are WNPOs responding to?

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The originality of WNPOs services

• Cordiality
• From users point of view
• Responding to older peoples needs
• ? ? ?
• Under the LTCI Act it is difficult to
  differentiate between WNPOs services and those
  of other organisations

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The originality of WNPOs services

• Standardisation
• of Service

Responding to Users Needs
Providing original services Centre of WNPOs
activities
Same services, but with low fees and Services
are not authorised by the LTCI Act
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The originality of WNPOs services
Struggling to continue original services

• Overwhelming administrative work for service
  provision under the LTCI Act
• Financial rationality
• Time consuming work ? respect for individual
  needs

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High demand for services assisting with domestic
tasks

• The LTCI Act regards care assistant services
  much higher than domestic tasks
• ?Qualification and price

private companies prefer to take care assistant
services
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High demand for services assisting with domestic
tasks

• The re-evaluation of domestic tasks by WNPOs
• Domestic tasks demand more hard work than care
  services
• Standardised salary

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• I thinks care assistant services are less
  demanding. You just need to follow patterns. But
  for domestic tasks, every user has their own way
  of doing it. (A member of management body of WNPO
  F)
• Well, each house has its own way to do things,
  you know. Some people give us such detailed
  orders, such as preference of taste, or the way
  to wipe a table. (An active participant of WNPO A)

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Exclusion of men

• The way of re-evaluating domestic tasks leads to
  discrimination barring man from participating in
  WNPOs

• Services are counting on the experience women
• have of being a housewife
• Men are not wanted

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• Being a housewife for years makes a difference,
  doesnt it? The experience of being a housewife
  for a couple of decades makes you caable of
  deciding what you will cook quickly, with looking
  at what is left in the fridge ( An active
  participants of WNPO A)
• R Are there any male participants in your group?
• Director of WNPO H Not at all, not even one.
• R Have you had any men who wanted to join
  your group as carer?
• Director of WNPO H Yes, year there was. We
  didnt reject him, but well, difficult, assisting
  domestic tasks is very difficult He said he
  would do cooking form now on and master cooking.
  But you know, it does not take so much time and
  trouble for us to do cooking, I mean, making
  normal dishes Actually there was no demand for
  him.

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• Director of WNPO A There are difficulties using
  a male carer.
• R Why are there difficulties?
• Director of WNPO A For example, for taking
  a walk for rehabilitation, men can do it, but you
  cannot take a walk together in silence
  Particularly Young men do no have enough skill to
  be a good company for older people.

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Concluding Comments

• WNPOs create a system of service provision and
  provide original services outside of the LTCI
  that respond to individual needs of older people
  which are not covered by the LTCI.

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Concluding Comments

• WNPOs are meeting demands for services to assist
  domestic tasks
• WNPOs re-evaluate the domestic tasks based on
  their practical experience of service provision

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Concluding Comments

• The inextricable link between the way domestic
  tasks are re-evaluated and dis-qualification of
  domestic tasks by the LTCI exclude participation
  by men and young women
• WNPOs are struggling to keep their original
  services, but if they do not run these services.