What Japan Can Teach America About Family Caregiving

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One after another, three young social work students stood up and tearfully shared their experiences of growing up caring for grandparents with dementia in their family homes. Later, a middle-aged physician talked with pride about frequently visiting his still-healthy, 94-year-old mother to support her choice to live in her own apartment. These were prime examples of “filial piety”—the millennia-old, ingrained tradition of devotion to elders—that I had anticipated.

But there was much I didn’t expect. A social work faculty member ruefully described the growing phenomenon of adult children who had moved to the big city for jobs and no longer wanted responsibility for their aging parents, alone and isolated in their home villages. Such careerists had divorced themselves morally and emotionally from their parents, leaving it up to local government to tend to them.

These were the sharply contrasting attitudes about eldercare that my wife, Julia L. Mayer, Psy.D., and I heard during a recent visit to Japan. We had been invited to give lectures on aging and resilience at the Kanagawa and Tokyo campuses of Tokai University as part of a year-long celebration to mark the founding of the university’s Faculty of Health Management, an ambitious, interprofessional program of professors, researchers and clinicians from a broad array of medical and social sciences. The divergent sentiments we heard at our lectures offered lessons—and perhaps a glimpse into the future--for America’ aging families and caregivers.

This was my first trip back to Japan since I spent a college semester there in 1979 to study its Confucian culture. I found much that was still familiar to me, including the country’s sometimes jolting blend of old traditions--such as its love of tatami mats and hot springs baths--with the ultra-modern--such as uncannily efficient subways, ever-present vending machines and green tea Kit Kat bars. But the Japan I knew from nearly 40 years ago has gone through an extreme demographic shift because of increasing life expectancies (now 4 years longer than in the U.S.) and decades of low birth rates. (There are supposedly more pets than children in Japan today and more diapers sold for adults than babies.) It is now far and away the most rapidly aging nation in the world with about the same population as when I was last there (120 million) but triple the proportion of people over 65—over a quarter of the population. That number is expected to rise to an astounding 40% by 2060. U.S. senior citizens, in contrast, now comprise 15% of our population and will top out at only 20% in 2030.

Japan has been whipsawed by its demography and is consequently experiencing contradictions and ambivalence about eldercare. In the 1990s, many Japanese women were overwhelmed with caregiving and work duties; reports of caregiver abuse of older relatives began to rise. The government responded in 2000 with a mandatory long-term care insurance program for all Japanese over age 40, as well as the introduction of such community-based services as case management, adult day care centers, and home companions. Today, the tradition of “sansedai kazoku” (three-generation households) still exists among 60% of the populace. But, according to a 2014 Pew Research Center survey, 87% of Japanese think aging is a “major problem” for the country (the world’s highest percentage) and only a third of them believe that families should bear the “greatest responsibility for the elderly.” (Thirty-six percent think it’s the government’s job.) There have been more and more highly publicized cases in which family caregivers murder the parents they’re caring for and then commit suicide. Filial piety, it seems, is on the wane.

What can Americans learn from Japan’s struggles? Here are two thoughts:

When the number of aging citizens reaches certain thresholds, societies must respond with increased services: If there was any country whose long tradition of family values would have sustained its commitment to eldercare, in my mind, it was Japan. But the sheer volume and needs of the old began to crush even stalwart Japanese. Its government responded accordingly and appropriately. When America’s aging “problem” increases in the next 15 years, will our local, state and federal governments respond with the same compassion and thoughtfulness? I hope so but am concerned. As with Japanese society, there will be dire consequences for U.S. individuals and families if we don’t devise and pay for the right supports.

When governmental supports are put in place, family commitments change: Because of Japan’s long-term care system, including increasing numbers of residential facilities, more Japanese feel entitled to have the government support their aging parents. That is a radical departure from Confucian tradition. Could the same happen in the U.S. if our long-term system was greatly expanded? Would Americans have less compunction about walking away from a perceived caregiving “burden” if they knew that the safety net for their parents was actually safe and strong? I don’t know the answer but expect that, as our caregiving systems necessarily change in the next two decades, our family values will, too.

Barry J. Jacobs, Psy.D. is a clinical psychologist, family therapist and the Director of Behavioral Sciences for the Crozer-Keystone Family Medicine Residency Program in Springfield, PA. He is the co-author (with his wife, Julia L. Mayer, Psy.D.) of AARP Meditations for Caregivers—Practical, Emotional and Spiritual Support for You and Your Family (Da Capo):

Follow me on Twitter: @drbarryjjacobs

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Email: barryjjacobs@gmail.com

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