Problem: What problem is this project trying to address?
By 2025, the aging will make up over half of the population in Japan. Japanese society, while highly modern, still grasps onto tradition, especially in regards to the way they care for the elderly population. Sons and daughters place the responsibility for caring for their elderly parents on themselves, and many times, at the cost of their own career advancement or overall life path. This affects women, mostly daughters-in-law, but men are affected as well. Respect for the elderly was a pillar in Japanese society and it is still considered virtuous and respectable to take care of one’s parents. This cultural norm is one reason why suitable nursing homes did not exist in Japan until recently. Placing the elderly in nursing homes or assisted care has been looked down upon and those who do are criticized as shirking their responsibilities.
The refusal to place the elderly population in these homes is due to a number of reasons. Firstly, traditional nursing homes in the 1980’s lacked accessibility for the middle class. Aside from poor quality public homes and extravagant private homes for the extremely wealthy, there were no realistic options for those who wanted to place their elderly in nursing homes but also wanted to make sure they were going to be comfortable and well taken care of.
The alarming reality of a shrinking population and an increase in the number of elderlies should urge Japan to create an infrastructure to secure future nurses and caregivers. However, the Japanese government’s nationalistic attitude does not accept non-Japanese nurses and caregivers. The government has made it incredibly difficult for non-Japanese to certify to be nurses as foreign applicants. In 2010, 254 candidates took the test, and only 3 candidates passed. Similarly, this year (2011), 400 candidates applied and only 4% passed. The government has also made it a rule for the applicants who do not pass the exam to leave Japan immediately. The consensus in society is that the government places an unrealistically high hurdle for foreigners to become caregivers in society.
Even once foreign workers are employed as caregivers, they have more hurdles to overcome. In 2000, the Kaigo-Hoken insurance system, initially only meant to insure incapacitated elderlies, was changed to cover elderlies who needed less care. It is widely recognized that the Shinkoukai-model triggered the law to change so that these homes are economically viable for the users. This insurance system accelerated the nursing care system in Japan, by offering specialized benefits to each elderly individual qualified. While this system was introduced to lessen the burden of caring for elderly patients, it also impacted hiring at the nursing homes, since one mandate of the system was that there must be a written record of every service performed on each caregiver’s elderly patient. This record would then be sent in to be assessed by the insurance and would determine the eligibility and level of benefits for each elderly candidate. The insurance money is sent to the nursing homes and that is used as a part of the operating cost. However, this record must be written in the Japanese language, which prevented numbers of immigrant/foreign caregivers who did not know how to write in Japanese from working in nursing care. This issue, along with low paying wages, and an archaic attitude toward foreigners in Japanese society, contributed to the overall issue of poor nursing care for the elderly.
Solution: What is the proposed solution? Please be specific!
Over the past 25 years, Masue has engineered the field of assisted living. In the early 1980’s, there were only two options available for families who wished to place their elderly in nursing homes. They could place them either in public homes that were extremely poor quality and negatively viewed upon by society, or extravagant private homes that only affluent families willing to spend millions could afford. Masue recognized that in Japanese society there were no viable options for middle-class families. She also recognized that even once she created these options and made them available, she would need to change attitudes and public perception on nursing care. Through her for-profit entity, Shinkou-Kai, founded in 1991 she has single-handedly generated a model that is affordable while retaining quality in the nursing care environment and the services it provides.
To address the stigma attached to nursing homes, Masue decided to ensure that her nursing homes were held to standards that had never been set before. She guaranteed that all of her nursing homes simulated actual homes in terms of level of comfort, décor, service and food. She also ensured her homes were ISO-9001 certified which until then, was the criteria only used to certify and ensure high standards in the hotel and restaurant industry. Her decision to do this not only gave credibility to her nursing homes, but also to the caregivers, whose professional identity were looked down upon and had not been fully recognized until her model spread.
Masue extended her impact by making it a point to employ those who were marginalized in their communities. This included people who were disabled, homeless, and most uniquely, those who were non-Japanese Asian. The non-Japanese Asian women married to Japanese nationals were granted permits to work, however, in comparison to Japanese nationals, they were given lower wages, and were treated as second-class citizens in the workplace. Masue set out to change that. Her employment method, treatment of caregivers, and service to the elderly transformed the caregiving industry and remains intact today.