Janet Morrison is Chief Executive of Independent Age and a member of the Campaign to End Loneliness management group. This month she presented at an OECD workshop on ageing in Tokyo as a representative of the Campaign. In this blog, Janet compares the ageing experience and community support in Japan with the experiences in the UK.
Traditional respect for older people remains intact in Japanese society today. But, as a country with the highest relative older population in the world, it is facing a grave demographic challenge. Whereas older people were traditionally supported in multi-generation households, increasing numbers of older people live alone, without family to support and care for them.
The country was stung by the discovery that the greatest casualties of 2009 earthquake were isolated older people. Due to disability, mobility, communications problems or the lack of family to come to their aid they were least able to escape the inundation. And those who survived remain some of the hardest to re-settle with the appropriate levels of support.
During my stay I visited a number of services, including an intergenerational volunteer scheme, a community hospital, residential and nursing care facilities, and a community lunch club. I met a number of pioneering people who were working to improve standards of social care and reach isolated older people.
Some scenes were inspiring: the dedication and community felt by the older women volunteers reading picture books to rapt primary school children; the joy of watching early morning exercise undertaken by the pre-school children and older people, in a shared care home and nursery facility; the pleasure of seeing a group of older people in a community day centre together with staff cooking and serving their lunch.
And the sheer wonder of integrated health and social care services based in the same community building was beyond envy.
Other settings were simply different to what you would see in the UK. In the care homes we saw residents sharing three to a room, in a very institutional hospital like setting, with little privacy or space. There seemed to be less emphasis on ‘person centred care’ or voice given to individual older peoples’ needs.
There was apparently scant provision of preventative services and domiciliary care enabling older people to stay at home for as long as possible. And volunteer led services and engagement appeared in the early stages of development, compared with the UK.
But these observations should be taken with a powerful health warning. I cannot vouch for the representativeness of the schemes we saw or claim a comprehensive understanding of the health and social care system in Japan. Crucially, there are clearly very different cultural norms at play. Whilst Japanese people have a healthy respect for their elders, Japanese society is one of social conformity rather than individualism, with concepts of need, space and privacy very different to our own.
My main concern about the debates I took part in was the focus on the ageing older people as being a massive health bill liability.
Clearly, this is incredibly significant and important as the challenge to deliver services efficiently and affordably cannot be under-estimated. No doubt further macro analysis will need to be undertaken and a new social contract defined that enables public spending on services for an ageing society to be within the bounds of affordability for a smaller working population.
But there is a danger that these economic arguments about how health and social care will be paid for and delivered in future will over-shadow the imperative for the broader well-being of older people, the value placed on their human capital and contribution to society.
If they are not recognised, the community support and preventative services that can enable independence and well-being will also go ignored. The very services that will help stave off future mental and physical health problems and downstream costs to the economy. This danger is, in my view, exactly the same for the UK as it is in Japan.