Here’s this week’s Media Mix about the difficulties faced by elderly people of limited means when it comes to health care costs. In the column, I cite a lecture given by Dr. Hiroshi Honda where he explains his own difficulties in 2018 trying to find a nursing home for his father, who had serious cognitive dysfunction. Though his father had paid into the kaigo insurance system that has been in place since 2000, there were no openings available at any facility he could find that accepted kaigo insurance. The only alternative was a private nursing home, which he said he couldn’t afford. We have been going through the same sort of situation lately with my mother-in-law, which is one of the reasons I wrote about the matter. Like Honda’s father, my mother-in-law has dementia. Though she is capable of holding a conversation, she “sees” people who aren’t present and tends to repeat herself. The main problem is that her husband, who is younger than her, has decided he doesn’t want to take care of her. Moreover, he won’t pay for anyone else to take care of her. Both he and his wife live on national pension benefits and have no savings. Fortunately, their house is paid for. In essence, the kaigo system should cover my mother-in-law’s care, since that is what it is for, but when she was examined by a kaigo official she was given a grade of 2 on a scale of 1 to 5, with 5 being the most severe. Consequently, she isn’t eligible for anything but the most rudimentary care. In addition to her cognitive dysfunction, she also has serious mobility problems, but since she can stand up (barely) it isn’t considered that bad. In order for her to be admitted to a “special” nursing home that accepts kaigo payments, she would have to have a grade of at least 3, which means the person is for all intents and purposes bedridden. As a grade 2, my mother-in-law could access day services, either at a facility or in her home, but she would likely have to pay for part of these services herself. That is, if they were available. The problem right now is that the kaigo system, like almost all care systems in Japan, is sorely understaffed. Though she is eligible for someone to come a few times a week to look in on her, there is no one available to do that. Also, she can’t drive to a day care facility, so all the money she would save through the kaigo system would go to taxi fares. 

Since her husband (I hesitate to call him my father-in-law because Masako, who is not his biological daughter, hasn’t spoken to him in decades) refuses to care for her, she is practically living alone. She has one son who lives in the same house and who says he will take care of her, but he is unemployed and can barely feed himself. Of course, that is what the authorities want—children to adhere to the  spirit of oyakoko—since they would prefer not having to take on the burden of elderly care, even though everyone over the age of 40 is required to pay into the kaigo system every month until they die. If my mother-in-law were a grade 3, she could get into a special nursing home, and when Masako looked into the matter she found that most, like the one Honda talked about, have long waiting lists, but whereas Honda said he had to wait one year, Masako found that the wait now is more like four years. Private nursing homes typically demand a deposit of at least ¥10 million and then charge around ¥200,000 a month. There are public facilities that accept elderly people of limited means, but, of course, those are also difficult to get into. One solution would be for her to qualify for welfare, which means she could go to a facility and the government would pay much of the cost, but because she lives with her husband she doesn’t qualify for welfare. Masako suggested she get a divorce, which would automatically make her eligible for assistance, since her husband refuses to take care of her anyway, but he also won’t grant her a divorce. In any case, this is what the program does: it forces people to game the system in order to attain the care they need. For instance, her best bet would be to become substantially sicker since then she could enter a hospital and national health insurance would pay for it—or, at least, most of it. That, of course, is a nightmare scenario, but it seems to be a method that a lot of people turn to because they can’t care for their parents or grandparents at home.