NEW WAYS TO HELP THE OLD:
Elderly-Care Service Industry Enjoys Boom

August 18, 1997

As Japan's population pyramid grows more top-heavy, a number of "silver businesses" are beginning to provide a range of elderly-care services. The services run the gamut from home care for those aged left alone after their families have moved out to overseas tours accompanied by nursing-care staff.

A Growing Menu of Services
One of the more unique services now available is the home care for the elderly who find themselves home alone, begun in May of this year by a group of personnel dispatch companies in Tokyo. The service keeps an eye on the situation at home and reports to the senior citizen's family, who can then feel at ease as they move elsewhere in Japan or even overseas for work. The program also includes assistance with the care recipient's housework. One goal of the plan, intended to combat the tendency toward senility that often accompanies the lack of stimulation after a person's family has moved out, is to support the independent living of the aged customer while helping with the shopping or chores around the house. The company charges about 2,200 yen (18 dollars at 120 yen to the dollar) per hour for these house calls. Most of its customers are currently individuals, but the group sees the corporate-level welfare-service niche as certain to grow along with the increased foreign presence of Japanese companies and the higher numbers of employees sent overseas.

A major welfare service company has also entered this burgeoning market with its overseas tours catering to the elderly needing nursing care. The firm's first tour, a four-night package to Hawaii accompanied by a nurse and a home-care specialist, took place this February. About 10 people, including some in wheelchairs, enjoyed the tour. The tour made use of a condominium, applying the staff's nursing home management expertise to make the trip as comfortable as home for the participants. The company is planning to offer other tours by the end of the year, including shorter trips as well as European vacations of several weeks in length; these tours will be a regular feature of the firm's offerings from now on.

Nearly 60 taxi companies have established a cooperative emergency alert support network; this service is now operating in around 40 areas throughout Japan. Customers of the service pay a 4,800 yen (40 dollar) monthly rental fee for an emergency alert device. They register their medical information, such as blood type, blood pressure, medical history, medicinal allergies, insurance information, and family doctor, with the service. In an emergency they have only to activate their alert device and this information will all be displayed on a monitor at the nearby taxi company, which will send a cab for them right away; depending on the situation, thecompany can also contact an ambulance or the police. A private security company is offering a similar service, but the taxi version is more diverse, as it can be used for normal cab service when there is no emergency. Local governments are examining this network closely, and a few municipalities are financing a portion of the program.

Not Just for Health Professionals
This burgeoning business field is attracting participants from a wide range of industries. This June, a major maker of medical instruments headquartered in Tokyo started a bathing assistance service for elderly shut-ins. The firm intends to expand its service into other home-care fields; while it cannot count on making a profit for the time being, it is seeking to gain valuable experience and knowhow from its actual operations.

Other entrants include a large Osaka housing company that established a fully funded subsidiary this July to run a private nursing home, and a beverage firm active in the Kansai region that is now making preparations for its new home nursing-care service. And a Tokyo life insurance company has established a "care corner" in each of its five main urban offices across the country. These corners, operated in concert with local social workers, offer health and other advice and referrals to care professionals; the company intends to build a storehouse of knowledge upon which it can draw as it makes its own entry into the industry.

Care service, as a labor-intensive industry that sees most expenses tied up in personnel fees, has until now been less able to attract large companies' capital investment and less amenable to economies of scale. For these reasons, major players in other industries have traditionally been chary of making inroads into the field. But this resistance is being broken down by the expected introduction from April 2000 of a system of public nursing-care services. Many firms are ready and willing to get into what they perceive as a growth industry.

Looking to the Private Sector
The public nursing services currently handled at the municipal level are broadly divided into those offered at live-in facilities and those available to recipients remaining at home. The latter encompass services including care workers' house calls to provide nursing care or help with chores, transport to and from facilities providing a range of day-care services, and short stays at elderly-care homes. These are all run on the principle of keeping the burden on the recipients within their financial reach. But public services are unable to meet the ever-growing demand.

The Ministry of Health and Welfare estimates the number of elderly currently needing nursing care at over 2 million. This number is on track to increase to 2.8 million in 2000, 4 million in 2010, and as high as 5.2 million in 2025. To better prepare for this, the Health Ministry plans to separate nursing services from existing medical care and institute a social insurance plan to cover the former. The bill to establish this program was tabled in the regular Diet session that ended in June, and discussion will carry over into the extraordinary session to begin this fall.

The new insurance scheme is expected to incur expenses of 4.2 trillion yen (35 billion dollars) in fiscal 2000 (April 2000 to March 2001), its first year of operation under the public nursing-care plan. This amount is, frankly speaking, out of reach of public organs alone. The Ministry, for instance, is calling for 10,000 nursing-care centers to be in place in fiscal 1999; there were only 2,600 as of March 1996. Private participation in this industry is seen as indispensable to cover the gap left by public services.

Furthermore, it is commonly accepted that private services will cost less than their public counterparts. According to a survey conducted this March by the Japan Association for Administration of Local Government, an hour of "home-helper" service, involving nursing care and help with household chores, costs over 5,000 yen (42 dollars) when provided by municip al employees, but less than half as much for the private equivalent. A privately run bathing service only costs about 14,000 yen (117 dollars), compared to the public charge of 32,400 yen (270 dollars). And a one-month stay in a municipally operated nursing home costs close to 366,000 yen (3,000 dollars), almost 50% more than the 267,000 yen (2,200 dollars) charged by a private home.

Despite the dramatic difference between private and public expenses, out-of-pocket costs for care recipients are set lower at the public facilities. This is, of course, because they are supported by taxes. With more nursing care being entrusted to the private sector, there may arise the need for controls such that competition does not lead companies to concentrate exclusively on the pursuit of profits. The number of local governments cooperating with private concerns as they seek to improve their own public services is on the rise, though, and the private sector seems certain to shoulder an ever bigger portion of the nursing-care load in the future.

Ministry of Foreign Affairs

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