The Japanese old age home is not comparable with the Swedish old age home (Ålderdomshem).  Only the very poor elderly who get the social allowance can live here.  Most of all the residents here do not need care for their daily life. In 1990, 85,269 elderly live at the old age homes in Japan.

The reasons why they live here is as follows.

  The number of very poor elderly is decreasing recently in Japan, so the need of the old age homes is also decreasing. On the other hand, the need of the nursing homes (1 will explain next) is increasing rapidly. The Ministry of Health and Welfare has the plan to rebuild the old age homes to the sheltered housings in the future.

  Overall responsibility for the care of the elderly in Japan rests with the state. Government and Parliament legislate and formulate guidelines for how the elderly shall be cared for and who shall bear responsibility for the various services.

Japan ' s smalIest units of local government , the 3 , 600 municipalities - "Shi", "Tyo", "Son" in Japanese - administer the social services. Responsibility for the running and shaping of health and medical care rests mainly with the regional units of local government, the 46 county councils - "To" , "Dou" , "Hu" , "Ken" in Japanese-".

   The work of both the municipalities and the county councils isregulated by legislation.

In 1992 more than 700,000 "Bedridden Elderly" and more than one million dementia elderly exist in Japan. But the number of the nursing home's beds is 162,000. This number is only 1.08･-･. of the population aged 65 and over in Japan. So it is quite common that here exist a very long waiting list and the elderly must wait one or two years until they succeed to stay at the nursing homes. Japanese Ministry of Health and Welfare has the plan to build 80.000 more nursing homes (total 24.000 beds) until 2000. The population over 65 is 24 million in 2000, so it means that l% of the elderly over 65 can stay at the nursing homes.

The definition of the nursing home for the aged -Those elderly who have the severe mental or physical handicap, for example "Bedridden Elderly" , and those who always need care and have difficulties to stay at home are supposed to stay at the nursing homes for the aged. There is no means test. In general the age of the elderly who stay there is over 65 years old. There is no economic restriction. So even rich elderly can live there. But the monthly fees charged by nursing homes are income-related. There is no housing-allowance in Japan.

<1>History of Nursing Home in Japan

According to the survey of the social welfare institution in 1987, for the last one year 135 new nursing homes for aged(8,624 beds) were built. And this increase is under the governmental plan - which plans to increase 10,000 beds at the nursing homes for the aged every year - . Now about 20.000 elderly are on the waiting list for the nursing homes for the aged in Japan, so in order to fulfil the governmental plan , it is necessary to increase the 10,000 beds every year. 

And this survey also shows the following reasons why elderly moved to the nursing homes for the aged.

  "Social Reason" usually means the conflict with the family. This statistic tells the difficulty of the care by the families Actually 47.4% of the elderly move to the at home in Japan. nursing homes for the aged from their own homes and 38.5% moved from the hospitals.

Recently the elderly who live at the nursing homes for the aged have become older and older and their staying period has become longer and longer. And more and more dementia elderly live there .

As a result, the care needs have increased rapidly and the lack of the number of the stuffs at the nursing homes are serious problem to keep the care quality. And another problem is that longer and longer staying period require the quality of life at the nursing homes for the aged and the single room is needed recently. In the past most of all the rooms at the nursing homes for the aged were 4-8 beds in one rooms. Recently some of the new built nursing homes for the aged have l0% single rooms, but most of the time these single rooms are for the severe senile dementia elderly.

One of the difference between the Swedish institutions and the Japanese nursing homes for the aged is that most of all the Japanese nursing homes for the aged are "Private" in Swedish classification . The special non-profit-making organization so called "Welfare Foundation" build and run the nursing homes for the aged. When they build the nursing home, the government pays one fourth of the construction costs and the municipality pays one fourth also. And the "Welfare Organization" themselves pay the half of the construction cost. Moreover running cost is subsidized by the government. So in Japan the nursing homes run by the "Welfare Foundation" are called "Public", not "Private", because in Japan "Private" means the business catering nursing home s o r t he nursing homes which have got no subsidy f rom government . If they get subsidy of the running cost from the government, they are classified "public" institutions in Japan. I will explain the private service in Japan in chapter 7.

The average nursing homes accommodate about 100 elderly. And the monthly running cost at the nursing home is 250,000 YEN(16,700 SEK) per place per month. This is cheaper than that of the Swedish nursing homes - 20,200 SEK per place per month -. But biggest reason is that the residents at Japanese nursing homes need not so much care as those at Swedish nursing homes. 

The monthly fees charged by the nursing homes in Japan are income-related and maximum 250,000 YEN (16,700 SEK) . The rest of the care cost is subsidized by the municipality and the central government . And t he central government have t he responsibility of the care at the nursing homes. Most of all the stuffs at the nursing homes work for the "Welfare Foundation", not for the municipality.

The average nursing home accommodate about 100 elderly and the number of stuffs is as follows. (Average age of the elderly is about 80 years old )(Japanese Ministry of Health and Welfare official guideline) 

　  So the rat i o between the ca re stuffs and the eldery  is l:0.22.  In Swedish old age home (ålderdomshem), this ratio is about 1:0.52.

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