Japan is experiencing a booming business…but not the good kind.
As we’ve reported elsewhere, the country’s population is rapidly aging. This has contributed to a series of problems, such as a rapid decrease in population, and an increase in adults who are forced to become virtual “shut-ins” to care for their parents. Looming in Japan’s near future is what one might call “the 2030 problem” – i.e., it is predicted that, by the year 2030, one-third of Japan’s population will be senior citizens. The implications of this are stark, and have prompted the government to tackle the issue on multiple fronts.
But the aging population has also resulted in a new problem: kodokushi (孤独死) – literally, “dying alone”. People who either never had kids, or who have lost contact with them, or whose family have simply moved to other areas of Japan, increasingly find themselves isolated in their old age. Sometimes, they pass away silently in their own homes. They usually aren’t found for days or even weeks afterwards, when a telltale sign – the piling up of mail, communication from concerned relatives, or the telltale smell of rot in an apartment building – prompts neighbors to call the authorities.
According to Japan news site Asahi Shinbun, kodokushi has no official definition, and the number of people who have died by themselves is not officially tracked by the government. (A study done by the Nissei Fundamentals Research Foundation put the number at 30,000 a year.) However, the growth can be seen in the growth in the estate liquidation (遺品整理; ihin seiri) industry. Asahi followed one such company, Yuushin, in the city of Chikushino in Fukuoka Prefecture, as it entered one such residence:
ドアを開けると血のにおいが鼻をついた。合掌し、清めの塩をまいて入室すると、遺体があった浴槽に固まった黒い血だまりが広がっていた。台所には飲みかけの缶コーヒーと割れた湯飲み。においが近隣に広がらないよう窓とドアを閉め切った部屋での作業に、３人のスタッフはたちまち汗まみれになった。
福岡県内の２階建てアパート。１階の１Ｋの部屋で７月末、一人暮らしの６０代男性が亡くなった。管理会社が遺体を見つけたのは１カ月後。警察による遺体の搬出後、遺品整理業者が部屋の片付けにあたった。
「だいぶきちょうめんな方みたいですね。それにおしゃれ」
When we opened the door, the smell of blood struck our noses. We clasped hands in prayer, sprinkled purifying salts and entered the room; a congealed, black pool of blood spread out from the body in the bathtub. In the kitchen, a can coffee ready to be drank and a broken teacup. The three staff members doing cleanup were sweating in the room, as they’d shut the windows and doors to prevent the smell from spreading into the neighborhood.
It’s a second floor apartment building in the middle of Fukuoka Prefecture. A 60 year old man passed away in a room in a 1K apartment** at the end of July. It was a month until the property management company found him. A cleaning company was hired after the police took out the body.
“He seemed like a methodical man. And stylish”[, said Honda Hidekazu, a Yuujin staff member].
(**NOTE: Apartments in Japan are noted by the number of bedrooms, followed by the extra rooms available. E.g., a “1LDK” is a one room apartment with a living room, dining room, and kitchen. In this case, “1K” is an apartment with just a kitchen, a bathroom, and a single large room that usually doubles as a bedroom and a living room. See this diagram for an example room layout.)
Companies like Yuushin charge apartment owners and municipalities a fee for their services. Fees are offset by the recycling of the deceased’s furniture. Yuushin had started as a car reclamation company, but demand in the market for estate liquidation services began increasing in 2012, and so the company shifted gears. The company increased its staff from three to 10, and handles around 20 cases a month, and is getting requests, not just from Fukuoka, but from Tokyo and Osaka to boot. Yuushin says that its busiest time of year is end of the year, when family who can’t contact relatives realize that something has happened.
From Career Woman to Living in Filth: The Role of Neglect in Dying Alone
A few months ago, the magazine Shuukan Josei PRIME published its own take on the kodokushi phenomenon – one that shows that the issue cuts across social and class boundaries. The editorial staff of Shuukan Josei points to an apartment building in Tokyo’s Shinjuku district called “The Building of Lonely Deaths” (孤独死のアパート). Residents live in squalor, paying around USD $300 to $500 for rent depending on how long they’ve lived there. Most everyone in the building receives some sort of public assistance.
And, at least once a year, someone in the building dies. The manager keeps tabs on the water meter in apartments; if they’ve stopped, he knows he likely has a case of kodokushi on his hands.
Such lonely deaths aren’t reserved for the down and out, however. Satou-san, a woman in her 70s who lived in a 3LDK “mansion” (condo) in Saitama Prefecture, collapsed on the street one day and was carted to the hospital for treatment. A former legislative secretary with a college education who had done well for herself, Satou-san, suffering from diabetes, hadn’t been taking care of either herself or her surroundings. Shuukan Josei describes her apartment as “piled so high with garbage there was no place to walk”. Satou-san was an impulse shopper, who would order goods from TV infomercials, and simply toss them aside when they arrived. Health-wise, she ate whatever she wanted; with the loan on her apartment paid off and a healthy social security payout, she was able to enjoy junk food at a local restaurant every day, neglectful of the impact it was having on her health.
Yamashita Miyuki, a home health nurse who runs the organization Saezuri no Kai, reports that this level of self-neglect is common in cases of kodokushi:
「いつか、佐藤さんが家の中で倒れて、孤独死しているんじゃないかと気になって仕方ないんです。私たち医療者が訪問できるのは、数日おきなので、毎日様子を見に行けるわけじゃない。一番の心配は、偏った食生活による急死ですね。そのマンションのすぐ近くにファミレスがあるんですが、佐藤さんは、毎朝、ファミレスでとんかつ、ハンバーグを食べているみたいなんです。そんな不摂生な生活をやめようとしない。それで血糖値が一気に跳ね上がるんです。いつ高血糖の発作が起こって、意識障害で倒れていてもおかしくないというくらい、危険な状態になっているんです」
I’ve worried fruitlessly that Satou-san [the 70-year-old woman] would collapse and die alone in her apartment. Since we health care workers can only visit once every few days, there’s no way for us to see these conditions every day. What I worry about most is a quick death brought on by unhealthy eating habits. There’s a family restaurant near Satou-san’s apartment, and every morning, she’d eat tonkatsu [fried pork] and hamburger there. She never tried to stop eating in this un-nutritional way, so her blood sugar shot up. This led to a dangerous situation where it wouldn’t be at all unlikely if she lost consciousness and fell as a result of a diabetic seizure.
Satou-san’s case isn’t even the most extreme: another woman in Chiba Prefecture was rescued from near death after being pulled from a garbage heap in her own home. Her legs had become necrotic and had left her unable to walk.
In cases such as Satou-san’s, these conditions of squalor have some sort of mental health condition as their root cause. Other cases can be more complex. As Asahi Shinbun reported recently, some elderly patients with Alzheimer’s end up alone when they’re unable to separate from their pets, who generally aren’t accepted at adult care facilities. This leaves such people stranded and struggling in filth as they become less able to tend to the animals under their care.
Solutions are Few and Far Between
Satou-san narrowly avoided death on at least two separate occasions. While there may be hope for her, Yamashita Miyuki says that the problem is a tough one to crack. People living in conditions like Satou-san do so because they’ve “given up” and are “waiting for death.” In these cases, it’s up to the person themselves to decide they want to make a change.
But people dying in their own homes is not just a societal inconvenience. Apartments like Satou-san’s, with garbage piled high, are susceptible to catching fire, which can take down an entire apartment building.
The site e-hinseiri.com puts forward a few suggestions of its own. People die alone, say the site’s author, because no one is paying attention to them, and no one is involved in their lives. The site urges neighbors to check in on elderly people living alone, and for family members to check in on their loved ones daily. They also encourage neighbors to pay attention to the conditions of elderly residents they see in the street or in the hallways: is their clothing clean? Do they look like they’ve bathed, and are caring for themselves?
Outside of greater societal awareness, I can’t see another way for Japan to deal with this. Japanese neighborhoods already have a stronger sense of community to them than many American neighborhoods, and I think citizens watching out for one another is the best approach in this situation. Will such consciousness eventually take hold in Japanese society? Time will tell.
