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Because of the declining birthrate in Japan and the increasing life expectancy, the Japanese population is aging rapidly. The pyramidal population structure of the 1950s became cylindrical in 2000, and will be an inverted pyramid in 2050. The number of children under 15 years old has been decreasing for 22 years while that of people 65 years old or older has been increasing. In 1997, the number of the elderly (15.5%) outnumbered that of children under 15 (15.4%) (AS May 5, 2003). As of 2004, 14.03 percent of the population is under 15 years old and 19.24 percent of the population is 65 or older (AS August 5, 2004).
In 1996, for the first time after the war, the population between 15 and 64 years old started to decrease, from 87 million to 73 million in 2020; it is expected to be 54 million in 2050. In 1995, the ratio of people under 65 years old to those in 65 or older was 5.8 to 1, and will be 2 to 1 in 2050 (Nihon Keizai 1997a:222-229). In 2002, the National Institute of Population and Social Security estimated that the number of the elderly will reach to 35.7 percent of the whole population in 2050, and the ratio of 20- to 64-year-olds to 65-year-olds or older will be 1.5 to 1 (Kokuritsu 2002).
The percentage of the elderly was less than 5 percent in 1950, more than 7 percent in 1970, and more than 14 percent in 1994. The population will shrink after 2006, and therefore, the proportion of the elderly within the population will continue to increase. There were 24.3 million people 65 or older in 2003. It will increase sharply, to 34 million by 2018, and remain between 34 and 36 million until 2060. Consequently the proportion of the elderly will rise sharply from 18.5 percent in 2002 to 25.3 percent by 2014, and then to more than 30 percent by 2033 and to 35.7 percent in 2050. The average age of the population was 41.3 years old, the highest in the world, in 2003, and it is estimated to hit 53.2 in 2050. It took only 24 years in Japan to increase the number of the elderly consisting of 7 percent of the population to 14 percent, compared with 115 years for France, 85 for Sweden, 40 for Germany, and 47 for Britain (Naikakufu 2003c; AS March 1, 2003). About 10 percent of the world’s population is now 60 years old or older, and by 2050, it will be 20 percent. There will be more elderly people than children for the first time. In the United States, 16 percent of the population that is now 60 years old or older is expected to rise to 27 percent by 2050 (LA Times March 1, 2002).
In 2003, life expectancy at birth was 78.33 years for males, third after Iceland and Hong Kong, and 85.33 years for females, the longest in the world. In 2004, there were 23,038 centenarians in Japan (85% women), the largest number on record (AS September 14, 2004). Life expectancy will rise to 80.95 years old for men and 89.22 years old for women by 2050 (Naikakufu 2003c).
The human rights of the elderly are much discussed as the number of the elderly grows. Senior citizens are vulnerable to abuse from caregivers, age discrimination and ostracism. Abuse against the elderly includes negligent nursing care, physical violence, psychological abuse, and economic abuse, as well as sexual abuse. According to a 1993 survey, abuses are caused by strife between the caregivers and the elderly (20%) and fatigue from nursing care (10%). The elderly suicide rate is high. Among women 75 or older, the suicide rate, 41.8 per 100,000, is the highest, and 48.5 per 100,000 for all the elderly aged 75 or older is the third highest, after France and Austria, according to a 1992 survey of developed countries (Yomiuri 1997:92, 94).
In 2002, there were 16,850,000 households with the elderly, 36.6 percent of all households. Among them, 20.2 percent are single-person households, 28.6 percent are households of a couple only, 15.6 percent are households with parent(s) and unmarried child(ren), and 23.7 percent are three-generation households. Usually, the eldest son’s family lives with his parents. Recently the number of three generation households has decreased (50.1% in 1980) while that of two-person households (16.2% in 1980), single-person households (10.7% in 1980) and households with parent(s) and unmarried child(ren) (10.5% in 1980) has increased. The number of the elderly living alone increased from 4.3 percent for the male elderly and 11.2 percent for the female elderly in 1980 to 8.0 percent for the male elderly and 17.9 percent for the female elderly in 2000, and will continue to increase to 12.4 percent for the male elderly and 18.9 percent for the female elderly in 2020 (Naikakufu 2003c; Naikakufu 2004f). Recently a new household arrangement, the “two household family homes” has become popular. The adult child’s family lives on the second/third floor(s) with a separate entrance while the parents live on the first floor.
In 2000, 83.1 percent of elderly men and 45.5 percent of elderly women had a living spouse, while the number of unmarried elderly is 1.7 percent for men and 3.3 percent for women. The divorce rate has risen to 2.2 percent for men and 3.5 percent for women. The number of the elderly living with children was 47.1 percent in 2002, which is decreasing, while the number of the elderly living in households of a couple only was 35.1 percent in 2002, which is increasing.
As a person ages, he or she becomes more likely to live with a child. While 40.4 percent of men and 40.9 percent of women 65-69 live with their child, 51.8 percent of men and 66.8 percent of women 80 years old or older do so. Among the elderly couple households and the households in which an elderly person lives alone, many have a child who lives within walking distance (15.3%), less than one-hour away (39.4%) and more than one-hour away (35.5%). Almost half (46.9%) meet every day or more than once a week. Among those 60 or older, 43.5 percent want to live with their child and grandchildren (down from 59.4% in 1981), as of 2001 (Naikakufu 2004f).
During the postwar period, the nuclear family has been created by non-successor male siblings while many successor children stayed at home with their parents or live near the parents’ home. The number of the nuclear family had increased to 1975 from the middle of the 1950s and then did not increase much. According to a 1993 survey, after marriage, almost one fourth of couples (23.2%) live with the husband’s parent(s), and 7.7 percent live with the wife’s parent(s). Furthermore, 50 percent of married couples live within thirty minutes of a parent’s home (Kōseishō 1998:104-105).
Elderly households consisted of only 65 years old or older person(s) or those with an unmarried person younger than 18 years old. In 2003, the average annual income of the elderly households was 3,046,000 yen, about half of the average households, 6,020,000 yen. However, the average annual income per person in the elderly households is 1,953,000 yen, compared with 2,135,000 yen per person in the average households. The whole income, 3,046,000 yen consists of earned income (19.1%), pensions (69.8%), rent/land income (5.4%), interests/dividends (0.5%), social welfare benefits besides pensions (1.7%), and others (3.5%) (Naikakufu 2004f).
According to a 2002 survey, the average value of financial assets per household with two or more people is 13,110,000 yen. Household heads who were 70 to 79 years old had the most assets, 18,840,000 yen, including postal office savings, bank savings, stock market holdings, bonds, and insurance savings. Household heads who were 60 to 69 years old had 17,760,000 yen, those who were 50 to 59 years old had 14,840,000 yen. Household heads who were 20 to 29 years old had the least assets: 2,980,000 yen (AS March 12, 2003).
In 1999, the average capital of residential lands and houses of the elderly households was 42,506,000 yen. As of 2002, two thirds of the elderly (61.4%) agree that real estate should be bequeathed to children, while 15.6 percent think real estate could be sold, rent or mortgaged if they wish. Younger people among the elderly tend to agree with the disposal of real estate for their own benefits (Naikakufu 2004f).
Before 2000, landlords could not terminate the rental contracts unless the court recognized legitimate reasons, and in this case, landlords had to pay compensation for the eviction. But since 2000, landlords can terminate the rental contracts with the renters. Then the elderly can lease their own house, rent a smaller house or an apartment and live on the difference.
The Ministry of Health, Labor and Welfare established the “reverse mortgage” system as a “long-term life support fund” for low-income persons in 2003. Residents can borrow money up to 300,000 yen a month, up to 70 percent of the evaluated price of their land. In Japan, few elderly people use reverse mortgage because most want to leave their property to their children. The first reverse mortgage system started in Musashino City in Tokyo in 1981. By November 1994, 15 local governments had a reverse mortgage system. In Musashino City, the city loans 80 percent of sale price of a single-family house, and 50 percent of an apartment house, to people who are 65 or older, at 5 percent interest. The elderly can use it for the payment of at-home service with pay from social welfare public companies, or for living expenses, up to 80,000 yen per month. Only 72 households used reverse mortgage in Musashino City from 1981 to 1996 (Yomiuri 1997:287-288).
As of 2003, the proportion of elderly workers was 7.3 percent of the whole labor forces of 66,660,000, an increase from 4.9 percent in 1980, and will reach 10.9 percent in 2015 and 11.0 percent in 2025. According to a 2000 survey, 89.9 percent of men and 59.7 percent of women 55-59 years old, 66.5%/41.5% 60-64 years old, and 51.6%/28.7% 65-69 years old are still working. More than 50 percent of non-working men 60-64 years old, more than 30 percent of non-working women 55-64 years old, as well as almost 40 percent of non-working men and more than 20 percent of non-working women 65-69 years old want to work in order to keep their health, and earn income (Naikakufu 2004f).
The unemployment rate was 4.5 percent for 55 to 59 years olds, 7.5 percent for 60 to 64 years olds, and 2.5 percent for the elderly, compared to 5.3 percent unemployment rate in 2003. The job opening-to-application ratio is 0.23 in 55 to 59 years old, 0.19 in 60-64 years old, and 0.75 in 65 years old or older, compared to 0.70 for the whole population (Naikakufu 2004f). The elderly work for economic reasons (82.9% for men and 71.1% for women), useful life and social participation (5.8% for men, 8.4% for women), health (5.5% for men, 8.0% for women), or because they were asked to or to pass the time (3.2% for men, 8.0% for women), according to a 1996 survey (Kōseishō 2000b:87).
In 2000, male elderly workers are employees (53.2% in 60-64 years old/40.1% in 65-69 years old), self-employed (25.6%/34.2%), officers of companies (13.7%/13.8%), temporary workers (4.5%/6.2%), or family workers (2.1%/4.6%). Female elderly workers are employees (46.4%/30.4%), self-employed (18.5%/24.6%), family workers (18.9%/20.7%), officers of companies (6.3%/6.1%), temporary workers (5.4%/10.2%), and pieceworkers (3.8%/7.5%) (Kōseirōdōshō 2002b).
The revised Employment Measures Law of 2001 makes employers relax the age restriction. The Silver Human Resource Center, established in 1980, provides the elderly with temporary jobs at a set wage. In March 2003, 1,790 centers had 730,000 elderly workers registered. The jobs through the centers were worth 274 billion yen in fiscal 2002 (AS January 3, 2004). Most jobs involved social welfare and household assistance, cleaning, and gardening. Many seniors participate in order to keep healthy. The Lifelong Human Resources Development Center (Ability Garden) established in 1997 provides training, information and counseling for workers.
In 2004, the revised Employment Security of Older Person Act obligates the company to establish the retirement age at 65 years old gradually until 2013 (62 years old in 2006, 63 years old in 2007-09, 64 years old in 2010-12, and 65 years old since 2013). Many electric companies decided to continue to hire people up to 65 years old in 2000. Employers have to provide a plan for the re-employment of those 45 or older when leaving the job at the request of the head of the Employment Security Office. The subsidy is provided for the employers who help those of 45 or older find a job. As of 2003, 71.8 percent of enterprises with 30 or more employees have a retirement system which guarantees employment until 65, including the extension and rehiring systems, however, only 28.8 percent of enterprises guarantee the employment for all who want to work until 65 (Naikakufu 2004f).
After the retirement, many employees continue to work at the same company as contractors. Under the continuous employment systems, the duties of employees do not change much but these wages decline by 30 percent, though wages are still higher than the wages earned by workers in their early sixties with second jobs (Ministry 2000:88). According to a 1999 (companies) and 2000 (workers) survey, about 80 percent companies changed the status of retirees from regular workers to temporary contract workers after retirement, and the companies expect them to mentor younger workers (Rōdōshō 2000:263).
All Japanese citizens are insured by the medical insurance and by pension system. The insurance premium rate in 1999 is about 22.16 percent of total pay, including medical insurance (7.43%), pension insurance (13.58%) and unemployment insurance (1.15%), paid half by workers and employers, in addition to compensation for accidents at the workplaces, paid by only employers (The Japan 2005). Almost 70 percent of social security benefits are distributed to the elderly. The contribution rate for the Employees’ Pension was 17.35 percent point of covered earnings in 2002. It needs to be raised to 31.9 percent by 2025 (Takayama 2003). Due to the shrinking number of babies and the rising number of the elderly, the budgets for pensions will be very tight. In 1985, 5.7 persons in the National Pension and 5.9 persons in the Employees’ Pension supported one beneficiary. However, in 2000, 3.0 persons support one beneficiary of the National Pension, but 1.7 persons in 2025 and 1.3 persons in 2050 will, while 2.8 persons supported one beneficiary of the Employees’ Pension in 2000, and 1.4 in 2025 and 1.1 in 2050 will (Harada 2001:188).
The National Pension/Basic Pension operated by the municipal administration is mandatory for everyone aged 20 to 59, including foreigners, with the flat rate basic pension of a universal coverage. They receive benefits when they become 60 years old, which will increase to age 65 by 2013 for men, and to age 65 by 2018 for women. Only 1 to 2 percent of subscribers fail to participate in the Basic Pension, and 96 percent of people 60 years old or older receive the Basic Pension with an average of 49,000 yen per month.
The National Pension Fund is an optional pension for the self-employed and their spouses (aged 20 to 60), and provides an additional pension to the self-employed who do not have Employees’ Pension Insurance. However, only about 4 percent of the self-employed participate in the National Pension Fund; therefore, most self-employed workers have only National Pension/Basic Pension. Japanese employees receive occupational pensions and/or lump-sum retirement benefits at retirement. Most (89%) Japanese companies provide retirement benefits. In 1997, about half (52.5%) of companies with retirement packages offered a pension scheme, while nearly 90 percent provided a lump-sum allowance. Almost half (47.5%) of all workplaces have only one-time lump-sum retirement benefits, which is usually 39 to 46 months of monthly salary for employees with a full-term of work period (National 2003). Employees with more than five employees and their employers are required to participate in the Employees’ Pension Insurance. Both employers and employees contribute 8.675 percent of monthly salary as premiums, and receive income-related pension benefits. The contribution rate is 13.58 percent of annual income (half by employers and half by employees) in 2004, which will be increased by 0.354 percent a year to 18.3 percent in 2017.
Since April 1995, employees and their employers have each been contributing half of 1 percent of the semi-annual bonuses, and since April 2003, 13.58 percent is also levied on the bonuses, though a ceiling for the covered bonuses is 1.5 million yen. Persons employed by private companies who have contributed for 25 years or more receive the benefits when they became 60. It also covers disability and survivor benefits. Since the 2004 reform of the pension system, employees 70 or older also pay the premium for the Employees’ Pension Fund, and receive some reduced pension if they earn more than some standard.
The municipal administration organizes senior clubs, associations, volunteer clubs, social activities, hobby and entertainment associations. Senior Citizens Clubs have been organized by neighborhood and district associations, municipal administration, prefectural administration, and the state. In 2003, the Japan Federation of Senior Citizens Clubs had 8,542,000 members from 131,100 senior citizens clubs by neighborhood and district associations (Naikakufu 2004f). Many people in their 60s do not participate in the clubs because they do not consider themselves seniors.
The Senior Citizens Clubs in Marugame City organizes walking, gate balls (200 participants), and mini golf (300) for the promotion of health, a monthly enrichment lecture in the Central Community Center, volunteer activities such as visitation for the elderly and the sick as well as planting and gardening (50 to 60 participants). They have Sports Day and Garden Day. Furthermore, Marugame City has sponsored Hōrai Daigaku, University of the Aged, since 1969. The classes for the 2003-4 school year are provided from June 5, 2003 to March 14, 2004. Anyone 60 or older, who lives or works in Marugame can participate. They pay 2,000 yen per course with textbooks, but the History of Marugame and General Education Courses are free. These classes include Local History (up to 50 students); Flower Arrangement (30); Folk Songs (50); Folk Dance (35); Health Exercise (40); Painting (25); Calligraphy (50); Physical Exercise (35); Handicrafts (30); Folding papers (20); History of Marugame (50); Green Tea Ceremony (20); Physical Exercise B (35); Haiku (30); Old songs (50); Health Exercise (40); Harmony of songs and bodies (40); Old songs B (50); and Folk Dance B (35) (Marugame-shi 2003).
According to a 2003 survey, half of the elderly (52.0%) socialize with neighbors while 40.9 percent only talk with neighbors and 7.1 percent hardly associate with them. More than half (54.8%) participate in health maintenance activities and sports (25.3%), hobbies (24.8%), and community events (19.6%). Furthermore, 12.3 percent participate in classes by a private organization like culture center (5.4%) and public classes for the elderly (3.7%). They participate in learning and social activities through the recommendation of friends (37.0% for men and 48.5% for women), on their own initiative (33.9% for men and 32.1% for women), and by the recommendation of neighborhood associations (28.5% for men and 17.9% for women) (Naikakufu 2004f). Furthermore, many seniors participate in volunteer activities.
The intergenerational activities between seniors and children are promoted by the government. They gather at festivals, events, and other events. As the number of children falls and the number of elderly rises, the transfer of vacant classrooms to facilities for the elderly has started. Schools organize events at the Nursing Home for the Aged, senior adult daycare service centers, and in the neighborhoods, as volunteer activities. City Uji of Kyoto started to convert empty classrooms into facilities for the elderly in 1993. Okura elementary school has one three-story building with 12 classrooms. This building opened a daily nursing care service center on the first floor, at-home nursing care support center and daily rooms the second floor in April 1995 (Yomiuri 1997:157). The three-story building has a 50-bed-capacity nursing home, a Special Nursing Home for the Aged, a 50-member Nursing Home for the Aged, a nursery for 80 children and a home care service center for community elders. The children and the elderly residents participate in the joint birthday party, traditional cultural events such as the rice cake-making ceremony, the Sports Day, and Christmas concert, as well as daily morning exercises (Thang 2001).
There are two types of public health insurance: the occupation-based Employees’ Health Insurance and the region-based National Health Insurance. Those who are not covered by the employees’ health insurance are required to participate in the National Health Insurance, which the municipalities operate. The insured of the Employees’ Health Insurance pays 20 percent of medical costs (30% since April 2003) and dependents pay 30 percent of them (20% if inpatient (30% since April 2003)) with the maximum limitation, while the insured of the National Health Insurance pays 30 percent of medical costs.
Since 1973, people 70 or older do not have to pay for the medical insurance, and the co-payment for the elderly had been reduced. Since 2002, outpatients pay 10 percent of the cost of the drugs, and in-patients also pay 10 percent of the hospital fee, and those above some income level pay up to 20 percent. Also, the age of the subjects will be raised from 70 to 75 years old for five years. The healthcare costs for the elderly rose to about 34.6 percent of all medical costs in 2000. More than half (53.85% in 1998) of the Health Insurance schemes were in the red (National 2003).
The 1995 Child Care and Family Care Leave Law guarantees that employees who take care of family members who need constant care can obtain family care leave for a maximum of three consecutive months. The Law requests employers to institute a family care leave system and shorten working hours. Since April 1999, all employers have been obligated to adopt this system. The employer cannot dismiss the worker who asked for or took a family care leave. According to a 1999 survey, 0.06 percent of regular employees took home care leave (The Japan 2003). In 2002, more than half, 55.3 percent of companies (40.2% in 1999) had a care leave system. Almost half, 42.9 percent of companies (34.1%) had some measures such as short-time working hours system for workers for care (Kōseirōdōshō 2003b).
The 1997 Nursing Care Insurance system started in April 2000 in order to support the elderly and their families as well as to reduce hospital expenses for the elderly. Those aged 40 or older pay a nursing care insurance premium. In return, persons aged 65 or older who are bed-ridden and/or with senile dementia, in addition to people 40 to 64 years of age who need nursing care due to specific age-related diseases are provided with nursing care services. The insurance has been financed by insurance premiums (50%), the national government (25%) and the local government (25%). The local government sets the premium for the insured. The users are classified into six categories (“Assistance Required” and “Care Required Level 1 to 5”), depending on the severity of the care needed. In April 2003, those aged 65 and older (23.85 million) paid 3,293 yen (2,911 yen from the beginning of 2000 to March 2003) a month on national average as premium, and if they use it, they pay 10 percent of the service payment. The remaining 90 percent is paid by government subsidy (50%), the premium fees from those 40 to 64 (32%) and the premium fees from those 65 and older (18%) (AS May 27, 2003).
Through the nursing care insurance, the elderly in hospitals are more likely to be cared for in nursing care facilities and at home. Many elderly have been living in hospitals, so-called “social hospitalization,” because most of the expenses for hospitalization are covered by the National Health Insurance. Many people see sending old parents to nursing homes as an embarrassment, and the houses are too small to accommodate elderly parents. Hospitalization costs about 500,000 yen per month, while a special nursing home costs about 270,000 yen per month (Yomiuri 1997:209-210).
As of May 2003, 2.89 million people (including 100,000 of people 40-64 years old) receive nursing care insurance service. More then one tenth (11.6%) of about 24 million aged 65 and older received it. Among them, three-fourths (74%) stayed at home and one-fourth (26%) are in the institutions. They include 2,084,000 in home, 345,000 in the Special Nursing Home for the Aged, 265,000 in the Health Services Facilities for the Aged, 139,000 in Medical Facilities for the Aged, 39,000 in group homes, and 24,000 in Care House. The number of those in group homes of senile dementia increased 60 percent and that of the Special Nursing Home for the Aged increased 34 percent for a year from April 2002.
After the implementation of the Nursing Care Insurance Law in 2000, they can apply for the Special Nursing Home for the Aged without a referral. The Special Nursing Home for the Aged provides care and a place to live for 50,000 to 60,000 yen a month, and therefore, admission is competitive (AS October 1, 2003). In 2002, the recipients of the nursing care insurance service consisted of 2.7 percent of the whole population 65-69 years old, 6.2 percent in 70-74 years old, 13.0 percent in 75-79 years old, 26.5 percent in 80-84 years old, 43.5 percent in 85-89 years old, 62.8 percent in 90 years old or older (Naikakufu 2004f).
According to a 2002 survey, people 65 and older want to be cared for at home (43%), in a hospital (18%), in a Special Nursing Home for the Aged (12%), and in a child’s house (4%). They want the caregiver to be a child (53%, down from 71% in 1997), spouse (53%), and child’s spouse (25%, down from 38%) (AS May 26, 2003). According to a 2001 survey, the main caregivers are their relatives in the home (71.1%), including their spouse (25.9%), their child (19.9%), and their child’s spouse (22.5%), and other relatives (7.5%), and the corporations (9.3%) (Naikakufu 2004f).
In 1989, the government established the Ten-Year (1990-1999) Strategy for Promotion of the Health and Welfare Services for the Elderly (Gold Plan) in order to increase in-home nursing care services. Home help services include visiting nurses, short-term stays at nursing homes, day-care services, bathing services, and caregiver support. In the 1994 revised New Gold Plan, the government raised its targets for the improvement of basic services by 1999. From 2000, a new five-year plan, “Gold Plan 21” continues to develop the health and welfare services for the elderly.
Helpers, hired by patients in the hospitals took care of patients in the hospital until 1997 when the Ministry of Health and Welfare prohibited this system, and planned to increase the number of professional nursing care helpers hired by the hospitals. At the request of the family, family members became nursing care helpers at hospitals. In 1993, almost 40 percent of 10,000 hospitals in the nation relied on nursing care helpers, and 40,000 helpers took care of 70,000 patients. The medical insurance paid a part of the cost but the patients pay mainly for their expenses, from 100,000 yen per month. Since the government abolished helpers, the hospitals have hired professional nursing care helpers. More men are becoming nursing care helpers, and 10 percent of helpers at the Special Nursing Home for the Elderly are men, twice as many as five years ago (Ikui 2000).
About 1.66 million visiting nursing care helpers earned the licenses from 1991 to 2001 (AERA September 8, 2003). According to a survey by the labor union of visiting nursing care helpers, regular home-helpers earn 150,000 to 200,000 a month but many part-timers and registered workers earn 50,000 to 70,000 yen from 1,000 yen to 1,500 yen an hour (AS October 29, 2000). Recently, many local governments have started a semi-paid volunteer system. In 1985, eight housewives and several social workers living in Takamatsu city formed a group to provide nursing care for needy elderly and their families, for a small fee or for points, which they can redeem when they need services. The movement has spread nationwide (Lock 1993:131).
Nursing Homes for the Aged, Special Nursing Homes for the Aged, and Low-cost Homes for the Aged are welfare facilities under the 1963 Welfare Law for the Aged. In 1913, there were only 23 Homes for the Aged, housing up to 30 inmates in Japan. In 1950, the Homes for the Aged were reclassified as public welfare facilities, and in 1960, there were 607 Homes for the Aged. Through the 1963 Law, the Homes for the Aged were incorporated into the new system under a new name, the Nursing Homes for the Aged (Kinoshita and Kiefer 1992:63).
Nursing Homes for the Aged provide light to intermediate care for people 65 or older who cannot remain independent for physical, mental, environmental and/or financial reasons. Since most elderly would rather live with their children, there is a stigma attached to living in a nursing home. Many residents of Nursing Homes for the Aged do not have a child.
Special Nursing Homes for the Aged are for those 65 or older who require constant care. They are open to middle-class families with severely dependent elderly, although priority tends to be given to low-income applications if other conditions are same and space is limited. There are at least 230,000 people waiting to enter the Special Nursing Home for the Aged. After the enforcement of the Nursing Care Insurance Law in 2000, people in need of care can directly apply for the facility and pay 10 percent of expense. The homes are at 97 percent capacity (AS February 5, 2003).
The Low-cost Homes for the Aged are for low-income elderly. They are a type of boarding facility for people 60 or older who have some housing or family problems. There are three kinds: Type A provides meal service, Type B allows the elderly to cook for themselves, and the Care House is for those who have some physical problems and are assisted by home helpers. The inmates are in principle required to pay for their own living expenses. The government covers the administrative costs because the 1963 Law designates the Low-cost Homes for the Aged as welfare facilities. Admission to the Low-cost Homes for the Elderly is based on direct contact between the directors of the Homes and the applicants. The inmates in Care House can receive nursing help from outside caregivers. In 2003, there were 959 Nursing Homes for the Aged with 63,833 inmates, 5,084 Special Nursing Homes for the Aged with 341,272, and 1,824 Low-cost Homes for the Aged with 71,761.
Private senior homes provide living place for ten or more elderly people. The prefectural administration provides some guidance. Charged Homes for the Aged provide residential accommodations for 50 or more residents, in addition to counseling and health care services. There were 694 Charged Homes for the Aged institutions with 42,661 inmates in 2003 (Kōseirōdōshō 2004c).
Due to the increasing number of the elderly who prefer living independently, the demand for private retirement homes and the number of homes has been increasing. In general, the elderly enter private nursing homes when they are still healthy by paying several tens of million yen for the residence until death (AS June 12, 2003). They enter private nursing homes to receive nursing care when they become infirm (40.2%), when children and parents do not get along (26.7%), when they cannot live with children (23.0%), when they do not have spouse (7.1%); and others (3.0%)(Yomiuri 1997:168). After the Nursing Care Insurance system, private nursing homes were recognized as a special facility and receive 70,000 to 250,000 yen per month per resident (AERA October 13, 2003). Therefore, the cost of management becomes stable and may go down. Therefore, the number of private senior houses increased from 173 in 1990 to 694 in 2003 (Kōseirōdōshō 2004c).
1922 Health Insurance Law.
1938 National Health Insurance Law.
1944 Workers’ Pension Law (renamed Welfare Annuity Insurance Law in 1954)
1958 Revised National Health Care Insurance Law.
1959 National Pension Law.
1962 All Japan Old People’s Club.
1963 Welfare Law for the Aged.
1967 Law to prohibit age discrimination in employment.
1978 Japan Silver Volunteers for 45 to 75 years old.
1979 Daily nursing care service starts.
1983 Health and Medical Service Law for the Aged.
1985 Revised National Pension Law, the introduction of Basic Pension.
1990 The 10-year Gold Plan. Stay-at-home care support center is established. Low-cost Homes for the Aged.
1995 The Basic Law on Measures for the Aging Society.
1997 Nursing Care Services Law.
1998 The retirement age at 60.
2000 “Gold Plan 21.”
People with disabilities are people “whose daily life or social life is substantially limited over a long time due to physical disabilities, mental retardation or mental disorders” (Article 2 of the 1993 Fundamental Law for People with Disabilities). According to the Ministry of Health, Labor and Welfare, one in 20 people, about 6 million people, have some disabilities. Approximately 3,516,000 (including 189,000 in assisted-living facilities) have physical disabilities, 459,000 (130,000 in the facilities) have mental retardation and 2,584,000 (345,000 in the facilities) have mental disabilities (Naikakugu 2004g).
The 1949 Law for the Welfare for People with Physical Disabilities helps people with physical disabilities to participate in society, and to lead an independent life. An ID handbook is provided to people with disabilities of 15 years old or older, and to the parents of children with disabilities younger than 15 years old. The handbook demonstrates social benefits, rent for daily equipments, and tax exemptions, which are determined, according to the severity. The ID handbooks for people with physical disabilities guarantee that they are entitled to receive counseling services, aid appliances such as wheelchairs and hearing aids, technical aids such as talking machines and bathtubs, rehabilitation training, care service such as a sign language interpreter and Braille translation, employment service, nursing care, and housing.
According to a 2001 survey, the number of people with physical disabilities living at home has increased from 1.314 million (17.9 persons/1000) to 3.245 million adults of 18 years old or older (31.1 persons/1000), including people with orthopedic disabilities (1,749,000/53.9%), internal organ disabilities (849,000/26.2%), hearing impairment and language disabilities (346,000/10.7%), and visual impairment (301,000/9.3%). Almost three-fourths (72.9%) are 60 years old or older and almost half (45.7%) are 70 or older. The disabilities are caused by diseases (26.2%), accidents (17.0%), old age (4.7%), and damages at birth (4.5%). More than half of the people (45.1%) have profound and severe disabilities (first and second levels).
Most people with disabilities can perform everyday tasks, such as eating (87.8%), preparing and/or washing dishes (62.2%), going to the bathroom (80.9%), taking baths (72.8%), putting on clothes (77.6%), cleaning (64.8%), washing (61.9%), turning over in bed (84.2%), moving around in the house (81.2%), going out (63.6%), and shopping (56.9%). Most of those who need help are cared for by their families. However, when they go out, they are concerned with the inconvenience of transportation and building facilities, and the danger of traffics. More than two-thirds (63.9%) receive public disability pensions (54.3%) or other kinds of pensions (9.6%) (Kōseirōdōshō 2002d).
Children with disabilities are children “whose daily life or life in society is substantially limited over the long term due to a physical disability, mental retardation, or mental disability” (Article 2 of the 1970 Fundamental Law for People With Disabilities). Learning disabilities have not been yet recognized as disabilities. Most children with disabilities live with their parents or guardians and attend special schools, special classes in regular schools, or regular schools. The government provides an income-based Special Child-Rearing Allowance and welfare benefits for the guardians of the children with disabilities.
According to the 2001 survey of the actual conditions of children under 18 years old with physical disabilities living at home, 81,900 children with physical disabilities were living at home, and the ratio of those children to all children under 18 years old was 3.6 per 1,000. The children were described as having orthopedic disabilities (58.2%); internal organ disorders (17.3%); hearing impairments and speech impediments (18.6%); and visual impairments (5.9%), including multiple disabilities (7.3%). Almost two-thirds (63.9%) had profound and severe (first and second-degree) disabilities. The causes of disabilities are damages at birth (17.3%), diseases (14.8%); accidents (2.4%); others (16.7%); undetermined (37.6%); and unknown (11.2%). About half of these children can perform daily chores, such as eating meals (64.7%), going to the toilet (50.3%), taking a bath (47.0%), and dressing themselves (52.6%). Most of them are cared for by their parents. Most of them can turn themselves over in bed (82.1%) and move around in the house (72.8%). About half of them (56.3%) need help when they go out (Kōseirōdōshō 2002d). In 2000, 8,115 physically disabled children under 18 years old were residents in assisted-living facilities (Naikakufu 2004g).
The Japanese government provides free public education for all children with disabilities in elementary and middle schools under the School Education Law. In 2003, there were 172,000 students, 1.6 percent of the student population, who received special education in elementary and middle schools (Naikakufu 2004g). In 2001, among 56,900 school age children with physical disabilities, 39.4 percent attended regular schools, 38.5 percent attended special schools, 18.3 percent were in special classes of regular schools, and 4.7 percent stayed at home (Kōseirōdōshō 2002d).
There are three types of schools for children with disabilities: 1) schools for children with visual impairments; 2) schools for children with hearing impairments; and 3) schools for children with orthopedic disabilities, mentally retarded children and sickly children. Each prefecture has at least one of each type of special school. Special schools include preschools, elementary schools, middle schools, and residential high schools. The schools for children with visual or hearing impairments have two- or three-year vocational training programs after high school.
The 1954 Law for the Promotion of School Attendance at Special Schools guarantees public subsidies for educational equipment, lunches, and transportation for its students. In 2003, 3,900 students attend 71 schools for children with visual impairments, 6,700 students attend 106 schools for children with hearing impairments, and 85,900 students attend 818 schools for children with physical and mental disabilities, and sickly children. Almost all middle school graduates from special schools went on to high school, mostly the high school section of special schools (Naikakufu 2004g). The cost of sending a single student to a special school in 2003-4 was 9,107,237 yen, ten times more than the cost of sending a single student to a regular school (Monbukagakushō 2004b).
Since 1979, special education teachers have visited the homes and bedsides of elementary, middle school students, and since 2000, high school students (Monbukagakushō 2001). In 2003, 1,447 elementary, 803 middle school, and 1,038 high school students received this visitation education (Naikakufu 2004g). If a child stays in the hospital, he or she receives correspondence education.
In 2003, half of all students with visual or hearing impairments entered two- or three-year vocational courses in special schools, colleges, or specialized training colleges. Only 1.5 percent of 11,500 graduates from schools for children with physical and mental disabilities were admitted to colleges, including specialized training colleges (Naikakufu 2004g).
Special classes for children with disabilities in mainstream elementary and middle schools have been created for children who have mild physical or mental disabilities. Most of the students have mild mental retardation and emotional disturbance, and others have physical disabilities, health problems, speech impediments, and hearing or visual impairments. Parents and the municipal board of education decide whether children with mild disabilities attend regular classes, special classes in regular school, or special schools. In 2003, 59,400 students attended 21,400 special classes in regular elementary schools, while 26,500 attended 9,500 special classes in regular middle schools. Most of them (87.3%) went to high schools after graduation (Naikakufu 2004g).
Since 1993, the government has begun to integrate children with mild disabilities into regular classrooms. Children with mild disabilities are placed in regular homeroom classes and learn general subjects. These children also have access to a resource room, special classes, or special schools, depending on the severity of their disabilities. For example, children with hearing difficulties in the regular class attend the special class for hearing-impaired children where they learn how to speak, listen, and use a hearing aid. Special supplementary lessons cannot exceed more than eight unit-hours a week (Zenkoku 2000:7). The number of these children reached 33,700 (including 930 middle school students) in 2003. These children had been diagnosed with speech impediments (82.4%), emotional disturbances (12.4%), hearing difficulties (4.7%), and amblyopia (0.5%) (Naikakufu 2004g).
However, not all such children who seek integrated education have access to regular schools. Many mainstream schools lack facilities and services for children with disabilities. School facilities are not barrier-free for children with wheel chairs or other mobility problems. To decide which schools in their jurisdiction should make the renovations to accommodate for students with disabilities, each municipal board of education now appoints a Committee of Advisors for the Schooling for Disabled Children, consisting of teachers, physicians, and psychologists. The Committee advises parents on the best interests of the child, and makes recommendations to the board as to the kind of school that disabled children should attend. The board of education makes the final decision, and can legally deny access to the mainstream schools, citing inadequate accommodation and staff. Regular schools have no obligation to accommodate all children with disabilities.
The legalization of integrated education helps create more accessibility for disabled children who desire to attend regular schools. In the United States, public school facilities in the United States are required to be barrier-free under the 1968 Architectural Barriers Act. The landmark law for special education, the 1975 Individuals with Disabilities Education Act and its amendments mandate that all children with disabilities between 3 years of age and 21 years of age shall receive a free, appropriate public education. If a public school lacks the services, the school district must pay for the child to attend a private school approved by the state. The Supreme Court decided in March 1999 that public schools must pay for nursing care in class for severely disabled children. Schools may hire paraprofessionals or aides to provide the service. In 2000-2001 school year, 95.8 percent of disabled persons 6 to 21 years old receiving education service for the disabled attended regular school. Among them, 46.5 percent spent at least 80 percent of the day in a regular classroom, 29.3 percent spent 40 to 79 percent, and 19.5 percent spent less than 40 percent of the day in a regular classroom. Three percent spent time in separate facilities, 0.7 percent were in residential facilities, and 0.5 percent were at home or in a hospital (National 2004).
Exchange programs between disabled children in special-education programs and children in regular classes have been recently promoted as part of human rights education. Interaction with disabled children helps children learn tolerance and acceptance of people with disabilities, and to eliminate prejudice and discrimination. It takes time for able-bodied children to become accustomed to children with disabilities. However, children must have become accustomed to seeing and speaking to disabled children in order to understand and respect them. The exchange programs also help disabled children meet and befriend other students. However, despite the support of the board of education and the government, these exchange programs are more like annual special events, and the children have little time to build friendships with each other.
In 2003, 11.9 percent of the graduates of special schools for children with visual impairments, 25.5 percent of the graduates of special schools for children with hearing impairments, and 19.3 percent of the graduates of special schools for children with physical and mental disabilities entered the workforce (Naikakufu 2004g). The rate of employment for high school graduates from special schools has always been low, and the recession has only made their employment more difficult. Even those who have obtained certificates to work in massage, acupuncture, and moxibustion through vocational courses in special schools have trouble passing the national examinations because these occupations have become more popular among those without disabilities.
Responding to the low rate of employment, high school sections plan to introduce more vocational courses. Only four out of 23 schools for mentally retarded children in the high-school section have vocational courses. The MOE added courses in information science to the Course of Study in 1999. Follow-up service for job hunting is necessary to provide children with disabilities with the opportunity to find a job. For example, the municipal government of Kunitachi City provides after-care classes for disabled high school graduates who have not obtained a job. They learn vocational skills, participate in exchange programs, and join a network of youths with disabilities (Nihon Shakai 1988:407).
People with disabilities are legally guaranteed equal employment opportunity. The 1993 revision to the 1970 Fundamental Law of People with Disabilities was amended as follows: “[People with Disabilities] are guaranteed to have an opportunity to participate in all kinds of social, economic and cultural activities as members of society.” In addition, people with disabilities are eligible for a special employment quota. The 1960 Law for the Employment Promotion of People with Disabilities and its revisions stipulate that public and private employers hire a certain percentage of people with disabilities. Employers who do not meet this requirement are liable to be fined, and employers who do meet the requirement receive subsidies. The revised Law of 1997 requires public organizations to meet a 2.1 percent quota, and obligates private corporations of 56 full-time employees and more to meet a 1.8 percent quota for people with physical and mental disabilities. People with mental retardation were, for the first time, included in the quota system. In June 2003, 2.19 to 2.49 percent of state, prefectural and municipal employees and 1.47 percent of employees in private companies were people with disabilities. Regular employees with severe disabilities are counted twice. Employers have to report the number of disabled workers to the Public Employment Security Office annually. The Office identifies companies that have failed to meet their quota and releases the information to the public. Almost 60 percent of private companies failed to meet the 1.8 percent quota (Naikakufu 2004g). The government plans to add people with mental disorders to the quota for the employment (AS December 14 2004).
Companies with 301 or more employees that do not meet the quota requirements have to pay a fine of 50,000 yen a month to the Levy and Grant System for each person that is short of the quota. The funds collected by the System are used for the payment of rewards, 27,000 yen a month per disabled employee to the companies with 301 or more employees that exceeded their quota, and 21,000 yen a month per disabled employee to the companies with fewer than 301 employees. The funds also provide grant money to companies with disabled employees in order to make the facilities accessible to those employees and to provide them with assistants (Naikakufu 2004g).
However, employers are not legally obligated to make their facilities accessible to people with disabilities. Such accommodation may be prohibitively expensive, especially in small- and medium-size companies where most disabled people work. The funds from the Levy and Grant System and public subsidies help these companies the necessary renovations that make their facilities accessible.
In the United States, the Americans with Disabilities Act (ADA) demands that businesses provide their employees and customers with disabilities with “reasonable accommodations.” The business does not have to change its existing facilities to make them ADA-accessible. However, when the business builds or expands a new facility, it must make its entrances, exits, and restrooms accessible to people with disabilities. Unlike the Japanese system, there is not a quota system for people with disabilities in the employment recruitment process; however, the Equal Employment Opportunity Commission (EEOC) prohibits discrimination in hiring on the basis of disability.
The Public Employment Security Offices and the Regional Employment Centers for People with Disabilities provide employment counseling, vocational training, and employment rehabilitation measures for all disabled adults and children. They learn in vocational training schools for disabled people and the Centers for the Development of Abilities and Skills. In 2003, 11.9 percent of the graduates of special schools for children with visual impairments, 25.5 percent of the graduates of special schools for children with hearing impairments, and 19.3 percent of the graduates of special schools for children with physical and mental disabilities entered the workforce (Naikakufu 2004g).
According to a 2001 survey, the employment rate of people with physical disabilities from 15 to 64 years old is 42 percent. They work as full-time employees (17%), self-employed workers (8%), family workers (2%), board members of a company or an organization (4%), temporary workers (3%), home workers (1%), workers at a vocational aid center (1%), and workers at a workshop (1%) (Kōseirōdōshō 2003c).
As of 2001, there were 2,086 vocational aid centers and small-scale social welfare factories for disabled people with 80,526 working positions. The workers at vocational aid centers are not employees so they do not receive the benefits of employees. They receive money for work about 20,000 yen per month. In 1947, the vocational aid centers for disabled people started for those who had been injured during the war, 12 vocational aid centers for 12,000 workers in nine prefectures. Some vocational aid centers have dorms. The vocational aid centers for people with mental retardation were first opened in 1993. The social welfare factories started for physically disabled people in 1972, for mentally retarded people in 1989 and for mentally disabled people in 1996. According to a 1992 survey, the work in vocational aid centers includes manufacturing (66%), agriculture (8%), service industry (6%), retail and food industry (2%), and others (18%). About one percent of them moved to general work. Moreover, people with serious disabilities living at home who have difficulty at working at vocational aid centers commute to day service workshops, more than 5,000 small-scale workshops (with 10 people or so), many of which are unauthorized and receive some subsidies from the government (about 2,785 workshops, as of 2002). They perform simple tasks (Naikakufu 2003e; Maruyama 2002:61-66).
According to the 2000 survey of people with mental retardation living at home, there are approximately 329,200 people with mental retardation, including 93,600 children under 18 years old, in addition to 129,900 people, including 8,700 children under 18 years old, in assisted-living facilities (Naikakufu 2004g; Kōseirōdōshō 2001a). Most people with mental retardation were diagnosed before entering elementary schools, and carry an ID handbook. Mental retardation is applied to people diagnosed with Down’s Syndrome or severe conditions, not to people with learning disabilities. The 1995 Law Concerning Mental Health and Welfare for People with Mental Disabilities (the revision of the 1987 Mental Health Law) guarantees rehabilitation centers, maternity clinics, dormitories, and welfare homes for people with mental retardation.
Many mentally retarded children attend special classes in regular schools, and some children with epilepsy or children under medication may go to special schools for mentally retarded children. Among mentally retarded people 15 to 64 years old, half (49%) work as full-time employees (12%), temporary workers (5%), self-employed workers (0.4%), family workers (2%), workers at a workshop (15%), and workers at a vocational aid center (12%)(Kōseirōdōshō 2003c).
Among approximately 460,000 people with mental retardation, about 130,000 live in the facilities for people with mental retardation. Once they enter the institution, only one percent would leave the facilities and live in the community. More than half of them remain in the facility for ten years or more. Since 2003, the disabled have been asked where and with whom they want to live. Also, the facilities have to make an individual support plan for them with the agreement of those living there and if they want to live in the community, the facilities have to support them (AS March 9, 2003). From the end of the 1980s, the deinstitutionalization movement started; however, it has not made much progress, because of the insufficient budgets and the inadequate preparation to welcome them into the community. Miyagi Prefecture started to help adults with mental retardation in the facilities move into group homes and others in the communities on a large scale, by building 100 group homes and the support system together with the police, the fire department, and medical organizations (AS November 24, 2002).
Mr. and Mrs. Yamada (pseudonyms) operate a textile workshop for people with mental retardation, and organize the Center for the Workshop Employment for People with Disabilities in Marugame. They have employed people with disabilities since 1982. In 1998, there were 13 mentally disabled workers among 45 employees. Mr. Yamada emphasized the independence and social participation of mentally retarded people through their employment. He asked their parents not to take them to work, and encouraged mentally disabled workers to commute by themselves. He assigned tasks according to their ability. One worker who has a profound degree of mental disability sorted clothes into two different sizes. Some workers have learned to use scissors and sewing machines. Two workers operated sewing machines, another two workers used pressure machines, and one worker cut clothes, while another two workers removed thread from clothes. After lunch, they cleaned the workshop by themselves. All disabled people, including those whose work was valued at 300 yen a day, were paid 1,000 yen a day.
Mr. Yamada gives all applicants a two-year probationary period in his workshop. If they cannot, he consults their parents. If their siblings will not take care of them after the death of parents, he recommends placing their mentally disabled children in an appropriate facility sooner rather than later.
According to the 1999 survey of people with mental disorders, among 2,040,000 people with mental disorders, 330,000 patients were hospitalized and 1,710,000 outpatients lived at home. They include 670,000 with schizophrenia and paranoia, 440,000 with affective disorders, mood disorders, 420,000 with neurotic disorders, neurosis, and 240,000 with epilepsy. In March 2003, 256,000 persons with mental disorders have had an ID handbook since 1995. Since April 2002, the local government has provided home help service for people with mental disorders (Kōseirōdōshō 2001b; Naikakufu 2004g).
According to a 2003 survey, 41 percent of people with mental disorders from 20 to 64 years old are employed as full-time workers (10%), temporary workers (9%), self-employed workers (4%), family workers (4%), board members of a company or an organization (3%), home workers (0.2%), workers at a vocational aid center (6%), and workers at a company with vocational training (3%) (Kōseirōdōshō 2003d).
According to a 1998 survey, 51,000 people with mental disorders worked at private enterprises with five or more employees, including 13,000 who developed the disorder after their employment. About half of them (46.9%) worked as part-timers, and the average salaries ranged from 70,000 to 150,000 yen. Almost half of companies (44.4%) said that workers with mental disorders in their companies did not have any problems fulfilling their professional responsibilities. Furthermore, 684 persons with mental disorders lived and worked in 25 vocational aid centers with dorms (in 2001), earning an average of 9,650 yen a month in 1997. In addition, 4,257 persons with mental disorders commuted to the 183 daily vocational aid centers and earned an average of 24,000 yen per month. Moreover, 348 persons with mental disorders worked in 12 social welfare factories and earned 74,000 yen a month on average. In 2001, 4,775 persons with mental disorders enrolled in 232 training centers for social adaptation, and 4,941 participated in 208 vocational aid centers for the people with mental disorders (Kōseirōdōshō 2001b; Naikakufu 2003e).
According to a 1997 survey, the public regarded people with mental disorders as “different” (37%), “scary” (34%), and “gloomy” (22%). Compared to the results of a 1983 survey, the respondents have more compassion towards the conditions of people with mental disorders. Fewer people than in 1983 thought that people with mental disorders could not live independently or that the mental facilities were for preventing people with mental disorders from causing violence. It is noteworthy that 16 percent of respondents have more positive views toward people with mental disorders, mainly because they had a chance to meet such people (AS October 11, 1998).
The rights of people with disabilities, such as the rights to maintain a minimal standard of living (Article 25), to receive equal education (Article 26), and to work (Article 27) are guaranteed by the 1947 Constitution. Social welfare of people with disabilities has been provided primarily through special child-rearing allowance for parents, and the national pension. The 1986 revised National Pension Law guarantees the same amount of basic disability pensions to all people with disabilities whenever they became disabled, according to the severity of the disabilities. However, basic disability pensions are not provided for those who became disabled while they were not participating in the National Pension before 1986, when housewives and students had an option not to participate in the National Pension. There are approximately 100,000 disabled people without the National Pension, including those who were supposed to participate but did not. In 2002, the Ministry of Health, Labor and Welfare decided to provide basic disability pensions to 4,000 who did not participate because of the student status (AS July 28, 2002).
In 2002, the government introduced the “new basic plan for people with disabilities” (2003 to 2012) and the “new plan for people with disabilities” for the first five years in order to encourage people with disabilities to leave the facilities. Starting in April 2003, people with disabilities are able to select and contract public social welfare services, such as home help service, daycare service, and short-stay service, under the “system of supporting expenses for disabled people” in order to promote independence for people with disabilities. The expenses for the use of these facilities and services depend on the degree of disabilities and their income. The budgets for the system come half from the central administration, and one fourth each from the prefectural and local administrations.
People with disabilities have suffered social discrimination and stigma for a long time. People with disabilities have been regarded as different, worthless, unfortunate, and unpleasant (Yoda 1999:63). The disability problems are a private family matter. Families, especially mothers, usually take care of disabled relatives. The society has been ignorant and indifferent to the rights of people with disabilities. However, as the number of the elderly has increased, the problems caused by disabilities have become more visible.
Recently, the government has championed the rights of people with disabilities, their independence and social participation through the enforcement of “normalization,” integration education, and a barrier-free society. The government inaugurated the 1982 Long-term Program for Government Measures for Persons with Disabilities in accordance with the 1981 International Year of Disabled Persons and the U.N. Decade of Disabled Persons (1983-1992). In 1993, the government enacted a Fundamental Law of People with Disabilities, and launched the 1993-2002 New Long-term Program for Government Measures for People with Disabilities under pressure from international and domestic human rights movements. In 1995, the Action Plan for People with Disabilities: A Seven-year Normalization Strategy (1996-2002), based on the principle of rehabilitation and normalization, has implemented with seven goals: living in communities as ordinary citizens; promoting the social independence of persons with disabilities; promoting a barrier-free society; targeting the quality of life; assuring security in living; removing psychological barriers; and promoting international cooperation and exchange.
In 2000, barrier-free construction is required in buildings of 2,000 square meters or more, such as department stores and hospitals, not office buildings, in the revised 1994 Law for Buildings Accessible to and Usable by the Elderly and Physically Disabled Persons. Furthermore, beginning in April 2000, the requirement for the establishment of a social welfare company has been relaxed, from the minimum 100,000,000-yen assets and its own facilities to the minimum 100,000-yen assets and rented facilities in order to increase social welfare enterprises in the private sectors. The Ministry of Health and Welfare planned to approve about 5,000 facilities, including workshops for disabled people and facilities for nursing home (AS December 10, 1999).
In the community, the local governments have recently supported volunteer activities for people with disabilities. Community volunteers, mainly homemakers in their 50s and 60s and male retirees, have organized volunteer clubs for Braille, sign language, reading on tapes, playing with disabled children, and organizing a get-together.
At school, the exchange programs between disabled children in special education programs and children in regular classes have been promoted as a human rights education program. Interaction with disabled children helps children learn to respect people with disabilities, and to eliminate bias against them. It takes some time for children to get accustomed to being with disabled children. However, it is very important for children to have direct communication and contact with disabled children in order to understand their hardships and become sensitive to their needs. The exchange programs also help disabled children see and befriend many other students. However, despite the efforts by the board of education and the government, the exchange programs are more like annual special events in most schools, and friendship hardly have time to form.
1900 Law for the Protection of People with Mental Disabilities.
1950 Law for the Promotion for People with Physical Disabilities. Law Concerning Mental Health and Welfare for People with Mental Disabilities prohibits the confinement at the house.
1954 Law for the Promotion of School Attendance at Special Schools for Children with Visual Impairments, Hearing Impairments, Physical Disabilities, and Mental Retardation.
1960 Law for the Promotion of Employment for People with Physical Disabilities.
1970 Fundamental Law for People with Physical Disabilities.
1981 The International Year of Disabled People: “Full Participation and Equality”
1983-1992 The U.N. Decade for People with Disabilities.
1986 Fundamental Pension for People with Disabilities
1993-2002 The New Long-Term Program for Government Measures for People with Disabilities.
1994 Law for Buildings Accessible to and Usable by the Elderly and Physically Disabled Persons.
Due to the decreasing birthrate and the increasing life expectancy, the Japanese population is aging rapidly with the rate of the elderly of less than 5 percent in 1950, over 7 percent in 1970, over 14 percent in 1994, and 19 percent in 2003. The number is expected to reach 26.0 percent in 2015 and 35.7 percent in 2050. Almost half of the elderly live with a child, but this number is decreasing. Half of men (51.6%) 65-69 years old, and one fourth of women (28.7%) 65-69 still work, and almost 40 percent of non-working men and more than 20 percent of women 65-69 years old want to work in order to keep their health, earn income, and so on (Kokuritsu 2002; Naikakufu 2004f). The Silver Human Resource Center provides the elderly with temporary jobs in the community.
Almost all the elderly receive the National/Basic Pension. Most self-employed workers have only the National Pension, while employees receive occupational pensions and/or lump-sum retirement benefits at the retirement. All the elderly are covered by the public mandatory health insurance: the Employees’ Health Insurance or the region-based National Health Insurance. Since 2000, the 1997 Nursing Care Insurance system has supported the reduction of medical expenses for the elderly. Nursing Homes for the Aged, Special Nursing Homes for the Aged, and Low-cost Homes for the Aged as welfare facilities, as well as Charged Homes for the Aged provide residential accommodations for the increasing number of the elderly. Some seniors participate in senior citizens clubs and activities such as sports, gardening, volunteer activities, organized by neighborhood associations as well as municipal administration. The human rights of the elderly against abuse, employment discrimination and ostracism from the society should be protected.
Most children with disabilities live at home and attend special schools, special classes in regular schools, or regular schools. The government provides a Special Child-Rearing Allowance and welfare benefits for the guardians of the children with disabilities, based on their household income. People with disabilities are legally guaranteed equal employment opportunity and are eligible for a special employment quota, though employers are not legally obligated to make their facilities accessible. They are entitled to receive the national pension when they reach the age of 20. Since 2003, people with disabilities are able to select public social welfare service, such as home help service, daycare service, and short-stay service.
The government enacted a Fundamental Law of People with Disabilities in 1993, and has promoted the human rights of people with disabilities, their independence and social participation through the enforcement of “normalization,” integration education, and barrier free society in order to reduce social discrimination and stigma. In the community, volunteer activities for people with disabilities have been promoted. Exchange programs between disabled children in special-education programs and children in regular classes are now part of human rights education.
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