With its aging population, Japan desperately needs people to care for the elderly. However, shady business practices are pushing staff to the limit – with dire consequences. In one recent episode, staff at four nursing homes quit simultaneously after working conditions deteriorated.
How did things get so bad? Blame greed.
Aging population
Japan’s population is aging. Currently, the elderly, those over 65, make up 30% of the population. One in ten people is over the age of 80.
With such a large elderly population, their care has become a paramount issue. Many adult children buckle under the weight of caring for their parents. The responsibility forces them to quit their jobs and social lives. Many also do not live near their parents, with younger generations moving to large cities for career opportunities.
Some elderly people are childless, with few familial options for care. The elderly who try to go it alone are at risk for injury and death. Those who die in isolation are often not discovered for days or even weeks. With no family to care for them or families that can not handle the burden, care has been increasingly outsourced.
A booming business
The outsourcing of elderly care has led to a booming industry. Daycare services care for the elderly during the day while family members work. Care workers visit the homes of the elderly to provide various services.
Then, there are full-time live-in nursing homes. Some of these are more like retirement villages. The residents may need a bit of vigilance around medications, getting proper nutrition, and social stimulation. Others are more involved with staff providing round-the-clock care for those incapable of doing it themselves.
The customer base is large and propped up by government subsidies, so the opportunities for a lucrative business are plenty. However, many companies seem out to make a quick buck, taking advantage of the workers, the families who trust them, and the residents.
Understaffed and unpaid
In September, staff at four nursing homes in Tokyo’s Adachi ward, Yokohama, and other locations simultaneously quit after not receiving wages. At the Adachi facility, over 30 staff members quit in the two months prior.
A former worker said high turnover was the norm. The staff member said that when they joined in January, ten people had already resigned. The facility had only opened the previous October.
A facility in Chiba had all of their staff quit between July and September. The company paid staff late or not at all. The former worker says they recall not receiving pay in March and having to hound the head office for payment in May.
With no staff left the residents were all hastily moved to other nursing homes. In some cases, the government had to step in to find appropriate placements for those left behind.
Residents not properly cared for
Along with non-payment, overwork was a key reason for the resignations. The Adachi facility had a single person on shift to watch over 50 to 60 residents. Usually, this many residents require around seven staff members. With that many people, the person couldn’t care for everyone.
The building was three stories high. This meant that, often, no one was on two of the floors watching residents or available for emergencies.
They were so understaffed that care workers could not address residents’ hygiene. Staff often left residents in soiled diapers the entire day. They did not receive a bath for an entire month. No one changed the sheets or cleaned the rooms.
Most of the elderly residents were also on medication. Despite the dangers of improper or missed doses and mix-ups, it was a common occurrence. Staff received no training, nor was there a system in place to track accurately who received the medication and what they needed to take. With so few people working, staff often failed to distribute medication at all.
Neglect led to death
Beyond hygiene, there were also nutrition issues. Initially, residents weren’t even provided with breakfast. Those with their own money would line up at a cup ramen vending machine to stave off hunger. Even when food was provided to them, it seemed corners were cut, with bread and yogurt being served repeatedly.
These sparse lunches may not even have been eaten. Residents who needed feeding assistance were left to their own devices.
The lack of proper care and nutrition proved fatal for some. One male resident died from malnutrition. The staff member said she felt that calling it malnutrition softened what was tantamount to starvation. The facilities overall had a high death rate. Many residents died soon after moving in.
How did it get so bad?
There are many unanswered questions about how the nursing homes ended up in such a state and why wages weren’t paid. The answers won’t be coming from the head office, though. The company head is avoiding the media. Someone who says they are a volunteer and have no information answers calls to the office.
Former staff says the answer is greed. In contrast to the actual residents’ rooms, a large, clean room was shown to potential clients. By offering the rooms for the very low price of 100,800 yen (USD $665) a month the company quickly filled the new facilities. That’s half the cost of most nursing homes’ monthly fees.
The lower costs attracted those who were struggling financially, with a large portion of the residents receiving some form of welfare. This meant guaranteed payments from the government.
Almost anyone could move in. Even sick people who needed hospitalization moved in as long as they could pay the fee.
The nursing homes also offered home visits for non-residents, which made them eligible for further government subsidies. But the stretched-thin staff were unable to fulfill that obligation as well.
Finally, the head office hired staff with no background or training and deliberately understaffed facilities to keep costs low. There was no middle management on site to oversee the day-to-day. Only one person to process payments, and no one to report issues or accidents to. This may have kept costs low but led to a dangerous environment for residents and impossible work conditions for care staff.
The government responds
The government does not run private facilities but conducts checks to ensure the care homes are meeting standards. The Ministry of Health, Labor, and Welfare (MHLW) issued notices to local governments advising them to be more diligent in their evaluations.
In addition to the safety and health inspections, the Ministry said, local governments should also check the financial records and solvency of private care homes. They should also conduct evaluations of the facilities within the business’s first year so that similar cases do not occur.
With people’s lives and livelihoods on the line, one hopes that the new oversight guidelines prove effective.
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Sources
老人ホームで職員一斉退職 “安定的運営を”国が指導徹底 通知. NHK News
《見捨てられた老人ホーム》東京・足立区で「人手が回らず餓死者が…」News Post Seven
