Two Countries, Two Elder Care Systems

Photo by Sarah Whiting

For many years I have watched my maternal grandparents in Japan, and my paternal grandmother in the United States, receive health and elder care. I have been struck by the drastic differences in cost, levels of services, and attention to patients.

In Japan, there are two main categories of elderly care: “support required,” which has two levels, and “care required,” which has five. “Support required” is for those who can live independently but require minor assistance, and “Care required” is for those who need more significant help with daily activities.

My grandparents in Japan began receiving services at home in 2008, when my grandmother was in the early stages of dementia. They had a care manager who arranged almost everything for them. She was conscientious checking up on my grandparents in addition to the helpers’ visits, and sending my mother frequent updates, which was extremely reassuring as we live so far away.

My grandparents went to “day service” at a local senior center to eat lunch, play games, have a bath, and do rehabilitation work. Home-based help service was also provided, in which a “helper” got them ready for the day, cooked, cleaned, did laundry, did the shopping, and took them to medical appointments.

The average annual salary for a care manager in Japan is $41,000, and for a helper is $31,000. With Japan’s booming elderly population, and a shortage of staff, the government passed a bill to alleviate some of the burden by accepting workers from other countries and allowing them to become permanent residents.

The government pays 90 percent of the costs for these supports, so my grandparents paid about $12 per day for 90 minutes with the helper and eight hours of day service.

In 2009, my Japanese grandmother went to the hospital, then the elder care facility attached next door, where she stayed until she died in 2015. She had the same elder care staff and nurses daily. Because of health insurance, she paid between $600 and $1,000 monthly for a shared room, meals, rehabilitation, exams, and medication.

A few months before he died in 2016, my grandfather entered a care facility. He paid about $1,600 monthly for a private room, meals, rehabilitation, and daily doctor visits.

The government also reimbursed my grandparents through the “high-cost medical treatment” program. Currently, those earning between $15,600 and $37,000 annually are reimbursed for any medical costs over $576.

Closer to Home

On the other hand, since August 2018, my paternal grandmother in Minnesota has stayed in several hospitals and acute and transitional care facilities. None of them have had the same quality of care or personal connection that my maternal grandparents received.

The length of time at each facility is determined by insurance, not on how well her recovery is progressing. More than one staff member said they would have liked her to continue treatment and rehabilitation, but could not because of insurance. Some of the facilities cost more than $300-400 daily out of pocket.

While most of the staff working with her were kind and knowledgeable, they changed almost daily, especially at the hospital. This forced us to repeat her medical history and care concerns with each change of staff, in order to ensure the most appropriate care. Still, care teams occasionally risked her health when they were not aware of her needs. In an attempt to prevent other incidents, family members stayed with her 24/7 for several weeks.

She lived in a remote area near Duluth, with fewer options for quality care, and fell in her home a few times. As a family we made the decision to relocate her to the Twin Cities for better monitoring.

Because insurance no longer pays for her care at a medical facility, we are figuring out how to transport her to rehabilitation and doctor’s appointments.

We have a long road ahead to be sure my grandmother gets the care she needs and deserves.

It is frightening to think about those families who are unable to do that.

Selena Moon is a graduate in history from Smith College and, among other jobs, is a fact- checker for Minnesota Women’s Press.

Did You Know… ?

Cost of Care

According to a report by the Family Caregiver Alliance, an estimated 44 million Americans provide unpaid assistance and support to elders and adults with disabilities. Elderly spousal caregivers who experience care-related stress have a 63 percent higher mortality rate than non-caregivers of the same age.

In Minnesota, the average cost of care for a year: $60,000 for 44 hours per week of home-based care; $48,000 in an assisted living facility, not including services and additional fees; more than $90,000 for nursing home care.

Largest Minnesota Non-Profits

The Star Tribune published in December 2018 the annual revenue of Minnesota non-profits, which includes these health insurance and elder care organizations. The companies’ annual revenue ranges from $177.4 million to $6.7 billion, with CEOs who earn from $438,500to $3.6 million.

#2: Blue Cross and Blue Shield of Minnesota
#3: HealthPartners
#6: Medica
#7: UCare
#17: Presbyterian Homes
#19: Benedictine Health System
#27: Ecumen