民國95年第1卷第3期 / Kazuoki Ohara / 1
Current Trends of Housing for the Elderly in Japan
Kazuoki Ohara
Abstract
Now Japan is becoming a “super-aging society” beyond an “aged society”. During last decade, there have been launched considerable political measures on the housing for the elderly, but the turning point is coming. There are many private detached houses of elders in Japan. In order to upgrade the quality of ordinary houses, “Guidelines of Housing Design” devised to cope with aged societywas announced by the government／ministry. From April, 2000, under the Long-Term Care Insurance Law, house adaptation system for the frail elderly was set up, and the needs of it have been increasing. Most of elderly people feel anxious about the future as they need personal care including home help services and care. Elder residents of collective housings want to reserve the service facility in the same building. New types of dwellings have also been developed (senior housing, care house, and group home,…etc.).Based on these recently, the old people’s houses begin to be considereda higher value with the comfortable atmosphere as their homes. Even nursing homes are reorganized into small houseswith home-like scale. The group living is not an institution but a house probably to suit for all variety of elderly people. The scheme, as a new type of dwelling, will become one of the mainstreams of housing for the elderly. There are new trials of elderly-care setting so-called “Takuroujo” which means home-like place for the elderly. The government has decided to support “Takuroujo”trials with some budgets. The facility is a community-based small local care complex, which also encourages some kinds of local activities. The model of the facility supposed to deliver care services to the local people which are Day service, Respite care (short stay), Delivery nursing and Group living (house). Like these, to supply the intermediate dwellings and flexible facilities, which are not categorizedinto general houses or former welfare facilities／institutions, is required.
Key words:elderly, aged society, super-aging society, elderly house, group living
台灣老年醫學雜誌民國95年第1卷第3期 / Kazuoki Ohara / 1
Introduction
The latest 1997 projections showed that the proportion of the elderly would increase from 14.5 percent in 1995, through 25 percent in 2015, to over 30 percent by the end of 2030.
Currently Japan is an “aged society,” having experienced an “ageing society” for only twenty four years. However, with the ratio of elderly people increasing year by year, Japan is heading toward a “super aging society” in which one in every four people will be an elderly citizen.
The term “elderly” usually refer to people older than 65; however, the pace of aging has grown to such an alarming degree that it has become difficult to refer to those in the 60-70 age bracket as elderly people. We are now living in a society where aging is continuously progressing, and even among the loosely-defined “elderly people” there is an increasingly larger group of older-than-elderly citizens. The ever-rising number of elderly people who are physically disabled and require long-term personal (or nursing) care is therefore quickly becoming a pressing issue of paramount importance.
In the past 10 years, various trials and housing projects for elderly people have been implemented. However, a turning point has been reached with regard to these policies, and the time to revise these policies has probably arrived [1]. I would give an overview on the background and development of housing for the elderly and discuss some new trends in this field.
Initial Trend of Japanese Housing Policy for the Elderly
For a long time in Japan various measures have been taken with regards to housing for the elderly. Initially, the main focus was to improve the physical environment of housing through attempts at increasing the supply of housing.
In the public housing sector, the beginning of the 70's witnessed the introduction of households for elderly people, which, as compared to general households, provided a guaranteed larger area. During this period, housing for the elderly was based on the prerequisite of senior residents’ living together with the younger generation (i.e. elderly people’s children). Accordingly, only elderly people living together with their children were eligible to apply for publish housing. However, in addition to the housing units for the above-mentioned cohabitation, the demand for housing units for senior couples living by themselves and for elderly people living alone had reported a rapid growth [2], especially in apartment complexes. As a result, amendments in related regulations were made in 1980 to make it possible for single elderly people to apply for public housing.
Furthermore, it can be said that at the time, the prevailing idea was that the care and specialized services elderly people required were supposed to be provided by their children. Shortly after there emerged the demand for social services delivered to the households of senior citizens living separately from their children. This was the very beginning for the recognition of the need to think of housing policy in terms of a combination of expanding housing supply and providing social services.
Design Guideline: Specifications for Elderly Housing
Japanese housing, especially housing for elderly people, is mostly private-owned. In order to improve the quality of private housing, the Guidelines for Housing Design Devised to Cope with the Aging Society are developed by the MLIT (Ministry of Land, Infrastructure, and Transportation) for designing private housing (these guidelines apply to public housing too).
The guidelines establish housing design specifications aimed at securing a standard level of quality for newly built housing for elderly people. The guidelines, for example, remove non-level floor plans, ensure sufficiently wide doors and passages, and mandate the provision of safety features such as hand railings.
Along with preventing accidents in the house, consideration is given for the use of wheel chairs should a changing physical condition requires it, and also for the ease of movement in and between rooms.
However, this refers only to housing that provides the minimum standard of wheel chair accessibility. The fact is that there are still various improvements needed to be incorporated into these guidelines in order to help elderly people with severely physical disabilities to live in these houses continuously. And, in reality, it is difficult to apply the same design specifications to all people. For example, it is impossible to implement a defined standard on the height and position of hand railings. It is better to modify the hand railings to match with the particular physique and movement characteristics of the inhabitants.
House Adaptation – Modification of Private Housing
In April, 2000 the social support system of Long Term Care Insurance was enacted by the law that required the provision of “house adaptation” assistance for elderly people in need of care services. As a result, house adaptation is becoming commonplace, and the number of people taking advantage of this system has been increasing.
Through this system, up to \200,000 is provided for house adaptation with insurance covering 90%. Though it does not fall under the category of housing policy, the support system does help ensure the quality of housing. Preventive adaptation is needed not only to help elderly people live safely and comfortably but also to provide positive emotional support for the elderly inhabitants and their families. However, this system is applicable only to elderly people requiring long-term cares. In principle, elderly people capable of self-support must cover the full cost of house adaptation themselves. At the present only a limited number of municipalities in Japan have implemented any kind of policies to help self-supporting elderly citizens. Promulgation of such policies, however, can be expected to become increasingly necessary in the future.
Moreover, to ensure the proper and effective implementation of house adaptation, it is imperative to establish a system in which every members who may contribute to the better housing for elderly people, such as architects, building contractors, physical and occupational therapists, visiting nurses and home-helpers, can collaborate in seamless teamwork [3].
The Need for Additional Care Services in General Housing
Even now, however, elderly people worry about whether they will have access on a daily basis to nursing care when they require the service in the future. Many of them prefer to stay in their present homes even there is no access to the needed long-term care services. It is the same in private housing as in apartment complexes.
In response to this simple demand, the MLIT started in late 1980’s to incorporate special considerations, notably care services for elderly people, into the policy for public housing system. The MHLM (Ministry of Health, Labor and Welfare) has also taken corresponding measures to improve on the housing for elderly citizens.
At present, thanks to the joint efforts of MLIT and MHLM, there are many types of housing for elderly people.
First, the policy that initiated the "Silver Housing Project” in 1987 established the formula for providing public housing in conjunction with regional Day Service Centers, and started in earnest to provide housing that maintained the lifestyle of elderly people. The 90’s witnessed a continuation of this movement with the advent of “senior citizen housing” from public housing corporations and “private old peoples homes” from the private sectors.
One of the welfare facilities that was institutionalized in 1989 through the merger of small-scale housing facilities and day care centers resulting from the depopulation of agricultural communities, is the “Living Welfare Center for the Elderly.” This leads to the recognition that integrating housing facilities with day care centers is desirable.
In the early stages, housing policy began and ended with a focus on the physical supply of housing - “housing that even elderly people can live in.” More recently, it has evolved to the level where it is believed that housing in combination with some kind of care service is indispensable – “housing for the wellbeing of elderly people.” In this manner, numerous “Special Collective Housing for the Elderly” institutions have been developed as public assistance projects. Examples given are “Silver Housing (Projects)” of public housing and “Care Houses” of old peoples home institutions. All of these have been an experiment in providing housing with care services for the elderly.
From Institutions to Housing – A New Trend in Residential Homes
With regards to the recent development of old people’s homes, the point has been reached where a high standard in housing efficiency is required. The standard of area for the subsidy has increased gradually over the last several years, and accommodations too have shown a tendency to be converted into private rooms. There is a policy to make all rooms private in the construction of future facilities.
The incorporation of small-scale nursing homes has come to be regarded in a positive light, and the creation of a homelike environment and atmosphere has come to be accepted as “the way it should be” for housing facilities for the elderly. Presently, even with nursing homes, providing care in a small scale and a homelike manner is recommended. There is also a growing trend to provide subsidies to construct facilities that can be sub-divided into small units.
In summary, on the one hand, housing facilities for elderly citizens are gradually being "residentialized" through social welfare policy. On the other hand, the housing policy has progressed from the supply of houses to the supply of houses integrated with essential supplementary services, and the trend has been, so to speak, institutionalized. Both trends indicate the growing demand for the merger of institutions and houses that in turn signifies advancement in the development of housing for the elderly.
Group Living
A new development that is gaining attention today is group living for people with dementia (the systemic Japanese name is “group home”). Since the government started to subsidize group homes in 1997, the number of housing units at group homes in Japan has surpassed the goal set by the government (3,200 units) and is continuing to increase. Neither an institution nor a housing project, a group home epitomizes the trends that encourage both “residentialized” facilities and houses unified with care services [4].
The merit of combining institutions and houses is exemplified by this kind of group living that has further created new meanings and values, notably the collapse of the fixed relationship between care-givers (health-care staff) and care-takers (elderly residents) typical of traditional institutions, and the actualization of a place where both the givers and takers can live together. Elderly people with dementia in institutions, such as nursing homes, exhibit a tendency to be habitually passive - “institutionalized.” However, when living together in communal spaces, elderly residents are encouraged or even required to do things by themselves and thereby grow to be more active.
Certainly, group living is a possibility with a substantial potential to be developed into an intermediate solution between institutions and houses. I believe that this kind of small group living unit will gain enough recognition in the future to become one basic archetype for housing for the elderly.
New Experiments in Elderly Housing
A new experiment in elderly-care housing facilities is the so-called “Takuroujo,” a homelike place for the elderly. The government has agreed to subsidize this new option of elderly housing, a “small community-based care complex” boasting the additional advantage of encouraging participation into local activities. This new model of housing facility for elderly people is expected to provide integrated care services encompassing day service, short-term (short-stay) care, pick-up service, and group living (house).
Like the community-based complex, satellite care facilities managed or backed up by healthcare institutions like nursing homes or hospitals can be found scattered in local communities. Most of these small facilities are situated in small towns and specializes in providing intimate services to local residents.
Cooperative houses for the elderly form another new trend in Japan and are especially favored by the new senior generation. There are many types of collective living for senior citizens to choose from, and more can be expected to be developed to better cater to the needs of the baby boomer generation as they grow into elderly people.
Conclusion
As Japan is entering an era of super-aging society, the demand grows all the pressing for a system that can respond to the needs for care services and for a total arrangement of housing facilities that is able to deliver such care services.
Even in the development of general houses, there is the need to establish a system in which professionals can cooperate to ensure appropriate adaptation.
The archetype of group living is considered to be an effective and desirable living option for elderly people. This type of elderly house as an intermediary between general houses and institutions has not been provided in large number until now.
As for housing policy, it should not be limited to the simple provision of physical buildings but strive to accommodate more thoughtful and flexible measures, such as ensuring the unification of care services and welfare policy. And supply of intermediate dwellings, which are classified neither as general houses nor welfare institutions, is required.
Notes:
This paper is partially rewritten from the presentation on invited symposia at 7th Asia–Oceania Regional Congress of Gerontology, Tokyo in 2004.
The Chinese abstract was translated by Dr. Shih-Tien Hsu
References:
1.Housing policy towards a super-aging society – From building specification to special needs measures.Geriatrics and Gerontology International, Blackwell, 2004;14(Suppl 1):S210-213
2.Kwak, HS, Ohara, K, et al.: A Study on the Livingstyle of Young and Old Family’s Pair House - in case of the pair-house in Shizuoka City -, Journal of Archit. Plann. Environ. Engng,AIJ, 2002;557:125-132.
3.Minowa, Y, Ohara, K, et al: Study on the House Remodeling Grant System for the Elderly, Journal of Archit. Plann. Environ. Engng, AIJ, 1997; 493:109-115.
4.Åhlund, O and Ohara, K: The Physical Environment of Group Living for people with Dementia-12 Case Studies in Southern Sweden, World Planning, Tokyo, 2000.
[Review Article] / 1日本老人住宅新趨勢
大原一興
摘 要
目前的日本已從『高齡社會』邁入『超高齡化社會』。過去十年間，雖然日本政府對老人住宅方面已經投入相當多的措施，目前正面臨轉捩點。在日本目前有許多分散的高齡私人住宅。為了提昇一般住宅的品質，日本政府部門曾頒布『迎合高齡社會的住宅規劃指導方針』。從2000年四月起實施的「介護保險法」中，衰弱老人的房屋改造制度已被建立，同時這種需求正不斷地增加。大多數老年人對於晚年時包含居家服務與居家照護的個人照護需求感到憂心忡忡。集合式住宅的老人住民要求服務機構能在同一棟建築物內。新型的住宅也因應而生（例如，銀髮公寓、照顧住宅、團體家屋、等）。在這種情況下，老人住宅開始採取營造舒適氣氛如同住家的傾向。即使如護理之家也正嘗試改變成含括小家庭規模的住宅。群體生活並非一個機構而已，而是一種必須考量迎合各種不同類別需求的老年人的住宅。這種體制將成為未來老人住宅規劃型態的主流之一。目前已有一種稱之為『Takuroujo(宅老所）』的老人照顧設施出現。日本政府已決定撥款支持這種住宅方案。這種設施是一種以社區為基礎，同時鼓勵一些地區性活動的小型在地化的照顧組合。這種設施模式預期能提供當地居民包括日間接送照護、喘息照護、護理照護及團體家屋。供應類似如此的中途之家與更富彈性的設施卻無法歸類於一般住宅與前述福利機構有其必要。
關鍵詞：老年人、高齡社會、超高齡社會、老人住宅、群體生活