Mr. Takeshi Yamamoto
Manager, Senior Citizens’ Welfare Division, Public Health and Welfare Bureau, Kobe City Government

Mr. Takeshi Yamamoto explained local government welfare and nursing care policies for the elderly in Kobe, where one in five of the population is now over 65.

One of the largest bureaus of Kobe City Government, The Public Health and Welfare Bureau covers public hygiene, hospital administration and health care. Its Senior Citizens’ Welfare Division researches the social, economic and cultural implications of an aging population, and promotes their lifelong education and active community involvement. 

Each country’s average life expectancy influences its definition of ‘elderly’. In Japan, where life expectancy is 76 and 86 years for males and females respectively, the ‘first stage’ of elderly is defined as over 65, and a ‘second stage’ is from 75 years of age. The ratio of elderly is compounded by declining numbers of younger citizens and a low birthrate, which is leading to a ‘super-aging society’. 

The aged in Kobe City number some 330,000 (21.3%) of 1.55 million citizens, and the figure is increasing by 10,000 a year, set to reach 1 in 4 by 2014, and then 1 in 3 by 2050. 

With this rapid population shift, who is going to support the elderly? In the past, large families and three generations under the same roof meant that families took care of their elders, but increasing single person households (70,000 elderly living alone in Kobe), show that times have changed. A longer lifespan in itself is welcome, but ideas and policies need to stimulate healthy and fulfilling lives for the aged. 

The Kobe City Elderly People Health and Welfare Plan 2010 Late Plan, established in February 2007, has as its target for the elderly ‘to continue their independent life in a familiar local environment’. The plan promotes both increased nursing care and the active participation of the aged in a more elderly-friendly society. It calls for the involvement of local business and communities in encouraging the involvement of the elderly, and it provides them with increased choice over the health and nursing care services they receive. Consumer and legal consultation and information services, as well as local peer support groups are also arranged. 

Volunteer home visits, new local community centers, and education, sport, and employment coordination facilities are available for the aged in Kobe, so that they can remain active and utilize their skills. Senior citizen hobby and volunteer activity clubs for the healthy and active number around 500, with 42,000 members. Senior citizens in Kobe are also informed and interested in health issues, with check-ups and seminars teaching them to stay healthy. 

With longer life expectancy, however, increasing numbers need nursing care. Kobe City has a huge demand for homes for the elderly, and various facilities are available to those who are bedridden, without family care or unable to live alone. 

Under the Public Nursing Care system introduced in April 2000, the cost of care is covered 10% by the user, and 90% by premiums, paid for by all citizens over 40 and central / local governments. The local government role is to assess the needs of the city’s elderly, and then educate, audit and pay service providers. As this scheme is uniform throughout Japan, citizens receive the same standards of care nationwide. In Kobe, 60,000 receive care under the system, but as numbers are rising, so too are the costs of premiums and taxes. As in the case of the national pension plan, the question remains as to how to cover the system’s spiraling costs, and an extensive review is necessary. Practical elderly care and nursing measures included the following in 2007:

- A day service for the elderly to maintain their physical condition, held at regional welfare centers with rehabilitation equipment / machinery. 

- A catering service delivering high nutrition meals once a day to the elderly. (Deliverers also check on their wellbeing, and food consultation services are offered.)

- Funding assistance / loans for home modifications of up to one million yen, in addition to those provided under the Elderly Care Insurance system. 

- Electromagnetic cookers supplied to elderly, to prevent risk of gas fires. 

- A short-stay health care service for aged who require temporary care assistance. 

- Nursing care items for home use supplied to elderly citizens who are bedridden and cared for by family members. 

- Home hairdressing and beauty services for the physically impaired. 

- Licensed home helpers sent to homes of dementia sufferers. 

- House-keeping and daily living assistance provided to those who are bedridden or not covered by care insurance. 

- Transportation services and bathing facilities for those who visit day care centers. 

- Washing, drying and sterilization of bedding for the physically impaired / bedridden. 

Other measures such as non-step buses, apartments with on-site care workers, and an innovative electronic alarm device to alert the fire department for immediate assistance, all further characterize the city’s ideas to promote the safe and active independence of the elderly in society.