Japan offers lessons in embracing longevity

The late Japanese supercentenarian Yasutaro Koide (centre), who was claimed by the Guinness World Records as the oldest living man.
The late Japanese supercentenarian Yasutaro Koide (centre), who was claimed by the Guinness World Records as the oldest living man.PHOTO: EPA

Japan is famous for the longevity of its citizens. A quarter of its population is older than 65. Japan's experience makes it an interesting example to learn from in the area of aged care.

In 2000, following a decade of stagnant growth, mounting public debt and skyrocketing hospitalisation, Japan introduced the Long-Term Care Insurance Scheme (LTCIS).

This universal and compulsory scheme provides support to assess and deliver care through institutional or community-based services for all people over 65. It provides sufficient funds to allow everyone to age in place - even those in public housing and with late-onset dementia.

The scheme represents one of the boldest social democratic experiments in aged care policy in the last 30 years.

Yet with bold experiments come surprises.

The Japanese experience of ageing is unique and varied, but presents a foretaste of the future for many post-industrial societies.

To the chagrin of the scheme's designers, the LTCIS has been too successful. Cheaper to implement than the policy it replaced, it is still oversubscribed and contributing to Japan's public debt.

The universal acceptance of the scheme contributes to a paradox: While Japan has the largest ageing population in the world, it is difficult to make a business of providing aged care, as the collapse of Watami, the food chain-cum-nursing home provider, demonstrates.

So what can this experience teach other ageing societies?

LESSON 1: CARE HAPPENS WITHIN THE COMMUNITY

The first set of lessons concerns community-based integrated care. Here, the LTCIS, following 2012 reforms, mobilises support through community general support centres.

The support centre in "Happy Active Town", Kobe, provides an example. This public housing estate houses many refugees from the 1995 Great Hanshin Awaji earthquake. Its proportion of residents over 65 is more than 50 per cent.

The LTCIS, with the local government, provides a care hub for volunteers, social workers and health professionals to provide services and respite care free to all residents on and off the estate. Community hubs such as these are designed to support a range of needs from intense support to community and family engagement in care across the life course.

LESSON 2: HARNESS TECHNOLOGICAL INNOVATION

The second lesson comes from watching and observing the Japanese experience of integrating technology in care provision. Dense, multi-storey buildings of small units are typical in Japan. New, so-called "Platinum" housing integrates universal design and new technologies to ensure safe independent living for the elderly.

Retrofitting large areas of public housing to this standard is complex and expensive. A limited number of exemplary regeneration projects where the local municipality, private providers and the LTCIS work together guide the way. One example is Toyoshikidai, a public estate built for young families in the 1950s in Kashiwa to the north of Tokyo.

Alongside these urban changes, a generational change is afoot.

LESSON 3: SMART HOMES FOR TECH-SAVVY OLD FOLKS

As the digitally literate generation reaches old age, smart home devices and new security and communication technology assume increasing importance. The business opportunities alone could amount to US$1 trillion (S$1.4 trillion) by 2035.

The Japanese government supports this shift with its "Silver ICT" agenda. This includes a raft of e-strategies to bridge the digital divide between "active and inactive" elderly populations.

Yet in the nation where the development of robotic assistive technologies enjoys vast sums of research and development support, there is little sign of this in daily life. In Japan, applying technology in aged care is fraught with ethical, personal and logistical challenges. The solution, for now, centres on the involvement of humans.

The Japanese experience of ageing is unique and varied, but presents a foretaste of the future for many post-industrial societies.

The "Happy Active Town" of Kobe, 20 years after a major natural disaster, is one example of a place where public policy, housing and technology converge to create solutions for an ageing society. Its mechanisms to support the passion and commitment of the people working and living there can teach other societies how to age with dignity.

  • Marco Amati is Associate Professor of International Planning, Centre for Urban Research, Marilena Kavoura is Manager, Industry Linkage, Martyn Jones is Associate Professor of Social Work, and Robin Goodman is Professor of Urban Planning, Deputy Dean, Sustainability and Urban Planning, at RMIT University.
  • This article first appeared in theconversation.com, a website of analysis from academics and researchers.
A version of this article appeared in the print edition of The Sunday Times on January 31, 2016, with the headline 'Japan offers lessons in embracing longevity'. Print Edition | Subscribe