Abstract

Care costs for the elderly within Japan’s long-term care insurance system (LTCI) have been and are still increasing (from ¥3.6 billion in 2000 to ¥9.4 billion in 2013) due to the rate of ageing (17.4% in 2000 and 25.1% in 2013) and increasing expectations. In order for LTCI to be sustainable, the Government is working towards establishing an integrated community care system, with formal care provision becoming more pluralistic and informal care, based within the community, being developed. The prospect is that the voluntary sector will play an increasing role as service provider. At the same time, the number of elderly living alone has been increasing and support is needed to address issues relating to social isolation. Monitoring services for the elderly living alone have been developed within communities and the government is seeking to strengthen communities and address issues relating to care and social isolation. The Government’s strategy is essentially twofold: LTCI needs to address care issues of those elderly with the greatest needs while also promoting informal care within the community for those with less severe problems. Community-based, informal care systems have therefore become a significant research agenda.

This research addresses how such systems can be promoted and two objectives are identified: (1) What actions are required to rebuild community care and support? (2) How LTCI contribute towards preventing social isolation? Two methods were employed. First a review of published reports was undertaken. Community statistics were then collected, followed by a social isolation survey, conducted in 2014 in Tokyo (‘A’ ward).

Provisional results reveal:
From statistics:
• Rapid ageing of population due to declining birth rate
• Increasing single-person households (30.8% in 2000, 40.9% in 2010)
• Decreasing participation rate of neighbourhood associations (71.1% to 57.6%)
• Isolation death quadruple (103 to 397), three quarters male (M:298,F:99), largest group males aged 60-62

From the survey:
• Half of residents almost never have contact with their neighbourhoods
• 9.1% who live alone have no contact with family or relatives
• 15.4% have no advisor if they face difficulties
• 9.7% do not have any support if they become ill

The main reasons cited are that ‘don’t want to rely on somebody’ or ‘they thought they can manage themselves’ The highest at-risk groups were those aged under 65 who haven’t as yet received LTCI services. They tend to be isolated from the community services and local residents because they prefer city 69 life and dislike having neighbourhood contacts. Thus, while LTCI expects communities to be selfsupporting, even in urban areas, this might prove difficult to achieve.

Policy implications: (1) In order to reinforce mutual support, including monitoring services, specialist community workers are needed (2) Integrated community care support centres should expand their functions to support key workers within the community (3) In order for community residents to function as supporters, clear reasons for participation are needed

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