Nonagenarians like Okamura are hardly unusual in today's graying Japan, where 20.2% of the population is older than 65 the world's highest proportion of that demographic. But few of Okamura's peers are as healthy as he is, and as the proportion of elderly in Japan increases it could reach 40% by 2052 the health care costs could be crippling. Japan's low birthrate means that the large families that once took care of aged parents as a matter of course are now rare, and overburdened Japanese households are increasingly turning to the state for help. But with a public debt that is already 1.5 times the nation's GDP after years of deficit spending, the Japanese government is under pressure to find a more efficient way of caring for the elderly.
Dr. Yoshio Saito believes he has an answer: In 1976, Saito founded the Minami Uonuma Medical and Welfare Center an hour and a half north of Tokyo, and he's run it ever since. Saito's center includes the Yairo-en nursing home and a hospital, but his aim is to keep seniors out of both facilities for as long as possible by providing community care that allows the elderly to continue living in their own homes as long as possible. While they're still relatively healthy, nearby seniors can come to the hospital for day-care and checkups; when they become homebound, a team of nurses and physical therapists are available for house calls. An hour or so of home care burns fewer resources than a day in the hospital, Saito points out, and it's the option preferred by his elderly patients. "In Japan, people want to die on a tatami floor at home," says Saito, with characteristic directness. "We should meet that desire. And it's less costly for society."
Today, the relatively isolated and snowbound Minami Uonuma City is old and emptying out; the cavernous bullet train station is literally empty on the day I visit. The hospital stopped offering childbirth services in 2002, and the local economy is on life support. "The government's finances are deficit-ridden," says Saito. "We're under great pressure to control spending."
But through his reliance on community medicine, Saito has managed to keep most of his programs in the black, without sacrificing quality. I accompany one the center's physical therapists on a home visit to an elderly couple who live in a drafty house they built themselves. The 61-year-old husband (the couple asked not to be named) has been mostly bed-ridden for seven years, since he broke several vertebrae in a fall. The visits, which cost around $60 each, are funded almost entirely by the government in keeping with Japan's system of socialized medicine, but they allow the man to continue living at home. It would cost the government around $800 a day to keep him in a hospital.
As the cheerful therapist leads the man for a slow walk down the hallway, his wife explains that nurses, therapists and volunteers stop by their house six days out of the week. Without this, she says: "There would be nothing. We don't know what we would do."
But as Minami Uonuma City continues to age, Saito's programs may be overwhelmed by demand. His hospital is already $1.2 million in the red, and while the Yairo-en nursing home actually makes money, it's well overbooked, with more people on the waiting list than in the superbly equipped home. The national government has been squeezing health-care subsidies, and Saito worries fears the consequences of millions of Japanese baby boomers reaching retirement age this year. "People like us in the outlying areas are suffering now," he says. "But this will be a major problem in the big cities soon. We face a difficult question." Perhaps Japan should find out what Okamura-san is drinking, and order 127 million cases of it.