East Asian Social Policy Workshop (13 th – 15 th January 2005) Aging and Social Policy session The 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

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 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 Act ’ s scope of service provision. To evaluate the LTCI Act ’ s scope of service provision.

The Structure of the Presentation The historical context The historical context The LTCI Act The LTCI Act The characteristics of WNPOs The characteristics of WNPOs Sampled WNPOs for the study Sampled WNPOs for the study Is there any originality in the way WNPOs deliver services? Why? Is there any originality in the way WNPOs deliver services? Why? What kinds of demands are WNPO ’ s responding to? Why? What kinds of demands are WNPO ’ s responding to? Why?

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

The emergence of WNPOs from the mid 1980s ‘ Socialised hospitalisation ’ ‘ Socialised hospitalisation ’ Problematisation of the ‘ burden ’ upon the female family members 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. Groups from grass-root level began to be organised by women with the idea of mutual help. Government also encouraged these activities. Government also encouraged these activities.

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

Japanese style of welfare society Stop following Western models Stop following Western models Inventing a tradition Inventing a tradition Opposing to the demographic trends 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) 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)

The policies concerning WNPOs The Specified Nonprofit Activities Law 1998 The Specified Nonprofit Activities Law 1998  access to a legal status became much easier  access to a legal status became much easier The Long Term Care Insurance Act 2000 The Long Term Care Insurance Act 2000  - ‘ Socialisation of care work ’  - ‘ Socialisation of care work ’ - The emphasis on ‘ user ’ s choice ’ - The emphasis on ‘ user ’ s choice ’ - Creation of a quasi-market of care provision - Creation of a quasi-market of care provision - The Introduction of a social insurance system - The Introduction of a social insurance system - The promotion of local autonomy - The promotion of local autonomy

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) ‘ 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. Japan became the first country in Asia whose government bears an essential part of the responsibility for the care provision of its older citizens.

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

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

Sampled WNPOs WNPOEst. Hours of Service Provided per month Numbers of participants A B C D E F G H I J

The role of WNPOs regarding service delivery What is original about WNPO ’ s services? What is original about WNPO ’ s services? What kinds of demands are WNPOs responding to? What kinds of demands are WNPOs responding to?

The originality of WNPO ’ s services Cordiality Cordiality From user ’ s point of view From user ’ s point of view Responding to older people ’ s needs Responding to older people ’ s needs ? ? ? ? ? ? Under the LTCI Act it is difficult to differentiate between WNPO ’ s services and those of other organisation ’ s Under the LTCI Act it is difficult to differentiate between WNPO ’ s services and those of other organisation ’ s

The originality of WNPO ’ s services Standardisation of Service Responding to User’s Needs Providing original services ‘ Centre of WNPO ’ s activities ’ Same services, but with low fees and Services are not authorised by the LTCI Act

The originality of WNPO ’ s services Overwhelming administrative work for service provision under the LTCI Act Overwhelming administrative work for service provision under the LTCI Act Financial rationality Financial rationality Time consuming work  respect for individual needs Time consuming work  respect for individual needs Struggling to continue original services

High demand for services assisting with domestic tasks The LTCI Act regards care assistant services much higher than domestic tasks The LTCI Act regards care assistant services much higher than domestic tasks  Qualification and price  Qualification and price private companies prefer to take care assistant services

High demand for services assisting with domestic tasks The re-evaluation of domestic tasks by WNPOs The re-evaluation of domestic tasks by WNPOs Domestic tasks demand more hard work than care services Domestic tasks demand more hard work than care services Standardised salary Standardised salary

(A member of management body of WNPO F) 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) (An active participant of WNPO A) 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)

Exclusion of men The way of re-evaluating domestic tasks leads to discrimination barring man from participating in WNPOs The way of re-evaluating domestic tasks leads to discrimination barring man from participating in WNPOs Services are counting on the experience women Services are counting on the experience women have of being a housewife have of being a housewife Men are not wanted Men are not wanted

Being a housewife for years makes a difference, doesn ’ t it? The experience of being a housewife for a couple of decades makes you ca[able 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 didn ’ t 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.

Director of WNPO A : Director of WNPO A : There are difficulties using a male carer. R: 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.

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. 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.

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

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 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 ……. WNPOs are struggling to keep their original services, but if they do not run these services …….