Japan's Burdened Care Sector Looks Outwards for Help

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Andy Nelson / The Christian Science Monitor / Getty Images

A care worker puts a hand on the shoulder of a resident at a group home for the elderly in Nagareyama, Japan, in September 2008

Tsuneto Nakamura is an ambitious young man who jumped into Japan's booming care-service industry at 24. Given the nation's aging population, Nakamura thought caring for the elderly had a lot of room for growth, and much to teach him. "There's so much we can learn from these experts at life," he says. "I enjoy that."

But recently, as manager of the Yokohama branch of a major Japanese nursing-care service company, Nakamura's enthusiasm has started to wane. His staff provides its elderly customers with 24-hour at-home care, helping them eat, bathe, and use the bathroom. On a busy day, each staff member makes home visits to seven or eight clients, driving to different neighborhoods to spend about 30 minutes at each home. It's hard work, and in the eight years that Nakamura has worked for the company, 30 employees have left. "People come with a dream but they quit," he says. "It's physically tough and doesn't pay. I have no way of stopping them." The raise in Nakamura's own salary has been less than .5% since he started. (See pictures of the global financial crisis.)

Unfortunately, Nakamura's predicament is an increasingly common one in Japan, where the turnover rate in the nation's large care-giving sector hit just over 21% in 2007. It's a part of Japan's long struggle to manage its aging population. Ministry of Health, Labor and Welfare (MHLW) research projects that the Japanese population over 65 will grow to 32 million in six years, or over 26% of the population, and the Ministry says about half a million additional caregivers will be needed to take care of them.

Help may be on the way. The troubled industry got a small boost in August, when 204 Indonesian professionals — mostly experienced nurses — arrived to work at over 100 Japanese care centers and hospitals as part of a new economic agreement between Japan and Indonesia. The program plans to bring about 800 more Indonesian caregivers to Japan over the next two years — an unprecedented move in a country that has never allowed foreign labor in this large sector before. "The question is whether the labor shortage can be solved by Japanese hands alone," says Yuko Hirano, associate professor of health sociology at Kyushu University. "We need to partially rely on foreigners. This program is a big step for Japan."

The Indonesian workers who have already arrived are now studying Japanese in six-month intensive language courses at training centers throughout the country, paid for by the government and their future employers. They are set to begin work in February, but workers who want to stay in the country longer term have to pass a national examination — in Japanese — which only 48.2% of Japanese pass yearly.

The program has been a welcome change for Tatsumi Nakayama, who works at the elderly care home Michinoku-so in Aomori, a 4-hour train ride from Tokyo. Unlike companies in more urban areas, Michinoku-so hasn't yet had difficulty keeping a full staff, but they know that they could. "Applicants for our jobs are decreasing every year. What would happen after five years? It's very bleak," says Nakayama, a 25-year veteran of the industry. That's why the company decided to hire two Indonesia caregivers through the new national program. "I believe there are many things we can learn from one another," says Nakayama. "We'd hire more if other nations decide to dispatch their people."

Japan has gradually been opening up to accept foreign labor. The latest data from the National Statistics Bureau shows there were over 772,000 foreign nationals working in Japan in 2005, up 12% from 2000. But not all segments of society are comfortable or set up for a large immigrant workforce. "The Japanese legal system doesn't assume that foreigners will settle down to live and work with the Japanese," says Hirano of Kyushu University. "That's been an obstacle to bringing foreign workers into the medical and care-service fields." Shiro Kawahara, president of the 60,000-strong Nihon Careservice Craft Union, says his industry isn't ready to manage foreign manpower, especially when problems like low pay and overly demanding labor need to be solved first. "We've been working to improve the work conditions," says Kawahara. "This can drag us down. Japanese could lose jobs."

There's also some question of how communities around the nation will react to the new workforce. Many Japanese perceive the nation as ethnically homogeneous, despite the fact that Chinese and Korean minorities have been living here for most of last century. According to a 2006 survey by the Women's Association for the Better Aging Society, nearly 60% of elderly patients prefer to be cared by Japanese caregivers. Even Nakayama, who is looking forward to welcoming his new staff, says, that "kerchiefed Indonesian women will stand out" in his rural area. Police in Aomori visited his facilities after they heard Nakayama would be employing non-Japanese workers. "Most foreigner labor in Japan has been in the manufacturing. Now they'll be more visible," says Wako Asato, associate professor of sociology at Kyoto University. "It'll be challenging."

But there isn't much time to demur. If Japan doesn't feel comfortable inviting foreign workers into this sector, other nations like the U.S., Canada and Taiwan do — with open arms. "They are at much more advanced stage with accepting foreigners," admits Asato of Kyoto University. In 2006, the Philippines signed an agreement with Japan similar to Indonesia's, but the Filipino students later interviewed by Kyushu University's Hirano last year weren't interested. Without an attractive package from Japan, Hirano fears none of the high-caliber Filipino nurses will want to come.

Still, the new program, however small, has given some beleaguered workers hope. Aomori's Nakayama says, "Yes, it costs us more money and more work, but it's worthwhile." The world will be watching.

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