In Japan, dying alone is the new normal

TOKYO — Itoko Uchida, 82, was counting on the nephew she raised to support her in old age. He refused, forcing her to pay for a sponsor to join the 420,000-long queue of Japanese waiting for a nursing home bed.

With no relatives willing to help, the Tokyo widow had to spend $7,600 on a professional service to be her guarantor and assist with an application to a nursing home, she said. An erosion of traditional Confucian values in Japan means fewer elderly are being cared for at home by relatives — a fact neither Uchida nor Japan’s government were fully prepared for.

Japan, with the world’s highest proportion of retirees, can’t build nursing homes fast enough. By 2025, one in three citizens will be 65 years or older from 12 percent of the population in 1990, the Organization for Economic Cooperation and Development estimates. A lack of long-term care facilities means seniors increasingly risk living alone in ill-equipped homes or suffering abuse in the care of resentful relatives.

“The system is designed for the 1970s, when multiple generations lived together and family caregiving was thought to continue forever,” said Hiroshi Takahashi, a professor of health sciences at the International University of Health and Welfare in Otawara City. “But that’s not the reality now.”

By 2030, the number of seniors living alone, like Uchida, will increase 54 percent to 7.2 million household units from 2010 levels, according to the National Institute of Population and Social Security Research in Tokyo. Elderly-care costs will more than double to $212 billion a year by 2026, the health ministry estimates. That threatens to overload the world’s second-most indebted nation.

From now through 2030, an estimated 470,000 seniors will die alone in Japan unless more investment is made in caring for them, Takahashi said. “Society and the system will blow up around 2025 without a drastic change,” he said.

Japan may be a harbinger of a bigger crisis. Confucian- influenced societies from Vietnam to South Korea are grappling with the conflicting demands of modernization and traditions that venerated the elderly and obligated families to care for them, the Center for Strategic International Studies said in a report in July.

“The family is already under increasing stress from the forces of modernization,” the Washington-based center said. “Over the next few decades, massive age waves are due to engulf the region, slowing economic growth, driving up old-age dependency costs, and heaping large new burdens on governments and families alike.”

China has already sought to protect these values, passing a law last year allowing parents to sue children for failing to visit them. In South Korea, the number of suicides among people ages 65 years and older more than tripled in a decade to 4,406 in 2011, according to the latest available data from Statistics Korea. The increase was probably spurred by an economic slowdown and the erosion of traditional family support, the OECD said.

Worldwide, the proportion of people older than 60 years in populations is increasing more than three times faster than the overall growth rate. Within five years, adults 65 years and older will outnumber children younger than 5 for the first time. By 2050, there will be 2 billion people 60 years or older, from 605 million in 2000, the World Health Organization said.

By 2040, almost 40 percent of the population will be at least 60 years old in Singapore, South Korea, Hong Kong and Taiwan from 14-to-18 percent of the population in 2010, according to United Nations Population Division. The proportion will be 29 percent in China by 2040, from 12 percent in 2010.

The growing demands of the elderly may be stoking violence toward them. In 2011, 21 seniors in Japan were murdered or died from neglect, and the number of elderly people abused by family members jumped 32 percent to 16,599 from 2005 levels, according to health ministry statistics.

After Uchida’s husband died, her 60-year-old nephew stepped in to assist with her application and sponsor her long-term care. The help stopped when his wife intervened, said Uchida, who is 22nd in line for a bed in a nearby home.

“I stressed his marriage,” she said. “He’s also getting old and fearing he may not get help from his son, who lives far away, closer to his wife’s parents.”

Uchida paid for support from the Four-leaf Clover Association, a non-profit group that helps about 200 people in Tokyo and Kobe complete applications and attain the requisite sponsorship for a place in a nursing home.

The number of seniors seeking sponsorship for nursing homes is increasing about 10 percent a year, said Hideyuki Ogasawara, senior director at Kizunanokai, which provides a similar service.

In 1980, 53 percent of people older than 65 years in Japan lived with their children, according to health ministry data. In 2010, that proportion was down to 18 percent.

Japanese are increasingly eschewing tradition and opting to live independently, according to a 2008 government study. Thirty-six percent of respondents envisaged preferring to live with, or close to, relatives in old age, down from 70 percent in 1983.

That preference though has a downside. Almost 15 percent of Japanese “rarely” or “never” interact socially with others — making Japan the least social of societies in the developed world, according to the OECD.

Social networks are breaking down as family members live further apart and can’t afford to socialize, said Katsuyoshi Kawai, professor of social welfare at Meiji Gakuin University and the author of the book Seniors Living Alone in Urban Cities and Social Isolation.

“We cook a lot of food for visitors, give away money for weddings, funerals and to grandchildren — and it’s expensive,” Kawai said. “It’s hard to continue such customs” when the economy is stagnating, he said.

In metropolitan Tokyo, officials in Adachi ward are conducting a district-wide audit of people older than 70 who live alone and any shared households whose residents are all over 75. A bylaw was recently passed enabling the information to be shared with volunteer social workers, police and residents’ groups to circumvent the isolation that’s led to deaths that have gone undiscovered sometimes for months.

In 2006, Japan’s government introduced a law to protect the elderly from abuse and provide support to caregivers. It is also paying subsidies to convert hospitals into nursing homes, building residential care facilities, hiring more caregivers and urging hospitals to allow medical staff to make house calls.

Businesses, charities and local governments are also innovating to help meet the needs of the elderly. Food delivery services for seniors are expected to double in 10 years to 106 billion yen, while the market for food that doesn’t require much chewing will climb 61 percent to 158 billion yen, according to Fuji-Keizai Co., a marketing research firm in Tokyo.

Utilities are also chiming in with products to detect signs of life: Tokyo Gas Co. offers a service to alert relatives to a sudden drop in usage; KDDI Corp. sells mobile phones with pedometers to detect mobility; and Secom Co. markets a GPS system to track movement.

The initiatives are promoting more independent living.

“Our generation has lived separately from our parents, and so wives have enjoyed freedom from their in-laws,” said Toshie Kurita, 69, whose mother-in-law volunteered to move into a nursing home eight years ago.

Kurita, whose husband died two years ago, visits her mother-in-law in Chiba, west of Tokyo, every second week and says she would be happy to hire professional help if necessary.

“If money can solve the problem, that’s the best,” she said. “No one wants to beg their daughter-in-law to care for them when they’re nearing the end of their life.”

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