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Japan’s Working Poor: Low Pay Threatens Quality of Elder Care
Translation by John Junkerman
Hiratate Hideaki's essay on Japan's Working Poor highlights two issues that are likely to be with us for some time: how to provide social support for increased numbers of elderly, and how to cope with growing income inequality. A first step of course is to recognize that the problems exist and are connected, and this article is helpful in that regard. By "us" I refer both to people in Japan but also around the world where so many societies are aging at a fast pace, where disparities in income and wealth are growing, and where welfare and retirement systems are being cut back.
The jobs occupied by the people Hiratate introduces are for the most part the new creations of an ambitious piece of social legislation. The irony is that Japan was a leader in adopting a government supported, mandatory Long-Term Care Insurance system in 2000. At the time, Germany and Israel were the only nations to have put in place LTCI systems. In Scandinavian nations, municipal governments had earlier implemented comprehensive long-term care systems. The system, which provides differential institutional and community-based care for every Japanese over age 65, is based on mandatory contributions of wage earners beginning at age forty. The system provides up to 90 percent of costs for a wide range of services, shifting care for the elderly from the family to the state and society. It is complex to administer and costly, but has the potential to offer crucial social and medical support to people who will need it.
Hiratate's report, however, exposes a serious problem in the system as it functions. A social insurance system is being staffed by people who themselves are not properly insured or supported. Rising social and economic inequality is widely recognized in Japan as a serious issue. It is discussed in the current election for the LDP party president (and next Prime Minister), and will likely be an issue in a general election that may take place this fall or next winter/spring. It remains to be seen whether either major party will take steps to improve the condition of these caregivers or Japan’s poor. Andrew Gordon
Four years ago, Yoshizawa Kyoko, 56, quit her job as a public employee in the countryside to become a home helper for the elderly. She had grown tired of the monotony of her job and hoped to do something on the front lines of social welfare that would “be of use to people.”
Yoshizawa (like all other workers described in this article, her name has been changed) now works for a “helper station” run by a social-welfare corporation. Her hourly pay is 800 yen (about $6.60). Her annual income as a public employee was about 8.5 million yen ($70,000), but the most she has made as a helper has been 1 million yen ($8300). There are no raises, and no annual bonuses. And last June her income suffered a further blow.
One of the clients for whom she provided services on a visiting basis entered a nursing home, while another, suffering from Alzheimer’s, was hospitalized. Fees for care giving are paid for services performed, so a drop in the number of clients leads to reduced pay. She is waiting for new clients, but it takes time to make arrangements. Her monthly income, which had been about 90,000 yen ($750), has fallen to half that level.
Living under the Threat of Bankruptcy
It’s impossible to live on 40,000 yen a month, and Yoshizawa has taken on part-time work at a group home. The job pays 800 yen an hour for five hours a day. She’s also taken a night-duty position at a care facility that pays 8600 yen per shift. Still, patching together her various jobs, she earns only 140,000 yen ($1170) a month.
Yoshizawa ends each month in the red. She owns her own home, so she doesn’t pay rent, but food and utilities run 100,000 yen. She’s not provided insurance coverage, so she pays 58,000 yen annually for national health insurance. She’s managed to make ends meet by dipping into the retirement bonus from her previous job, but that money is close to being exhausted.
Divorced some 20 years ago, Yoshizawa has raised two daughters on her own. The older daughter is now on her own, though she has not found steady employment. Her second daughter, who is disabled, is still in school and lives at home. Her disability pension barely covers school and commuting expenses.
Yoshizawa does not regret quitting her previous job. “I’ve just got to work like crazy,” she says, but she spends her days in uncertainty over her children’s future and her own.
Cases such as this are far from unusual. Ms. A, 51, was at a loss eight years ago when her husband died, leaving her with two sons, one in high school and the other in grade school. Her own mother was bedridden, and she decided to obtain a 2nd grade helper’s certificate.
Ms. A’s hourly pay is 1140 yen. But she brought her mother back home after she failed to adjust to life in a nursing home, which limits the number of hours she can work. With various welfare payments included, her monthly income amounts to 137,000 yen ($1140).
Her older son is now in college, the younger in high school. She has used her husband’s life insurance to pay college expenses. Daily expenses are covered by her care-giving income and survivor’s pension. The family barely manages to eat, and with the burden of looking after her mother, Ms. A is unsure how long she’ll be able to keep going. She’s afraid that if she collapses physically, the family will have to go on welfare.
“Care-giving work,” Yoshizawa declares emphatically, “carries heavy physical and psychological burdens and stress, but the rights of workers as specialized laborers are not recognized.”
Rampant Violations of Labor Laws
According to a survey by the Care Work Foundation on the working conditions of care workers in 2005, 72.7% of visiting caregivers work under temporary contracts and 72.5% are paid by the hour. These hourly payments add up to an average monthly income of 90,000 yen. According to another survey, released in 2004 by the Central Social Insurance Promotion Council and the National Confederation of Trade Unions, some 69% of these workers made less than 100,000 yen per month.
Underlying these low wages is an insecure employment structure. This structure is epitomized by the registered helper system. Certified helpers register with an agency and are dispatched to client homes to provide physical care and living assistance. Most of these helpers are dispatched from their own homes and travel directly to and from the client’s residence. Because it is possible to do this kind of work on a part-time basis, it has spread rapidly, particularly among housewives. According to the 2004 survey, 63.2% of visiting care work is performed on this basis. It is highly insecure work, with income falling when clients are hospitalized or die.
Care workers’ wages are paid from the elderly-care stipends provided by the government. Care-providing agencies must earn their office and administrative expenses and salaries from these stipends as well. After the introduction of the Long-Term Care Insurance system in 2000, market forces have come into play that have kept caregivers’ wage rates low. Adding to this pressure is the failure to pay travel time or to compensate for time spent filing work reports. According to the Care Work Foundation survey, only 44.4% of the workers are paid for travel time, and only 42% are compensated for filing reports. In short, oversight on working hours is slipshod, and considerable work time is not reflected in wages. Violations of labor laws are widespread.
Ishii Tadashi, 30, works as a registered home helper in the Tokyo metropolitan area. He can’t make ends meet working for one agency, so he is registered with three. His hourly pay for providing physical care is 1800 yen. He makes about 230,000 yen ($1900) a month, but this includes pay for distributing leaflets part-time. He can manage only one day off a month, and his annual income is 2.6 million yen ($21,700).
Ishii visits about six clients’ homes every day, providing his own bicycle for transportation. Some of the agencies pay a 100-yen transportation allowance, but none pay for filing reports, so he ends up filling out the forms during his care-giving visits. The 2004 home care survey reported top pay rates for physical care of 1500 yen per hour, but noted that “when uncompensated travel time is included, in many cases pay rates fall below the legal minimum wage.”
Responding to this state of affairs, the Ministry of Health, Labor, and Welfare issued a notice in 2004 that directed employers of home care workers to adhere to the requirements of the Labor Standards Act. The notice specifically indicated that travel time to clients’ homes should be treated as work time, as should be the time required for producing administrative reports, time on stand-by, and time spent in training.
However, paying these allowances from the elderly-care stipends provided by the government puts a financial squeeze on the home care agencies. In exchange for compensating for travel time, hourly pay rates have to be reduced. To improve the status of the home care workers would require increasing the elderly-care stipends so workers could be hired as regular fulltime employees, with government assistance provided to ease the burden on the elderly clients. These issues go to the heart of the Long-Term Care Insurance system itself.
The Low Social Status of Care Workers
Nursing homes, geriatric health facilities, and group homes are also characterized by low wages and heavy workloads.
Ms. B, 50, worked at a group home run by a social welfare corporation in the Tokyo metropolitan area. She earned 1000 yen per hour on an 8-hour shift that required her to be at the home for nine hours. Her monthly income was no more than 120,000. She made ends meet by dipping into her savings.
The work was arduous. On the night shift, she had to deal with wandering dementia patients. This stressful work wore on her, and she suffered severe headaches and nausea at the end of her shift. The burdensome work led to high staff turnover. Particularly, the men who served as home director bore heavy responsibilities but were paid less than 300,000 yen per month. During the four years Ms. B worked at the home, five directors came and went. Among them was one who left in a state of clinical depression.
The Japanese Trade Union Confederation (JTUC) conducted a survey of workers at elderly care facilities that was released in January 2005. The survey reported an average annual income of 3.76 million yen ($31,300) for regular employees, and 2.27 million yen ($18,900) for full-time contract employees. Some 70% of the surveyed workers complained that the facilities were understaffed for the heavy workload; 57.7% described the work as physically demanding; and 40.2% complained of low pay.
Watase Kenji, 31, works at a nursing home in Tokyo. There are 80 residents in the home, and some 60 others use the home for short stays and daytime services. Assisting with feeding, toileting, and bathing is physically demanding, and a good number of the workers suffer from back problems. There are frequent accidents where residents fall from their beds and break bones, adding to the psychological stress of the work.
Watase has been involved in elderly care for six years. Prior to that he worked as a day laborer in construction and package delivery. His monthly income then was only 60,000 yen ($500), and he received support from his parents. When the Long-Term Care Insurance system was introduced in 2000, he began working as a caregiver, hoping to find stable employment. He has certification as a care manager and social welfare provider, and finds the work rewarding.
However, Watase’s monthly income, including allowances, is only 190,000 yen ($1600). He lives alone in a $450-a-month apartment. His finances are not tight, but he is unable to save any money. Workers at his nursing home in their 50s make no more than 200,000 yen a month, and complaints about the low pay are common.
The JTUC survey reported that some seven in ten workers “take pride in their work,” but just over 40% felt that their work was “highly valued by society.” The low social status of care work is a reflection of the low pay and heavy workloads. That care-giving is considered an extension of volunteer work rather than specialized labor is a measure of the frail state of Japanese social welfare.
The Deteriorating Elderly Care Workplace
Komatsu Kazuko, 44, works in a geriatric facility run by a medical service corporation in Aichi Prefecture. There are 30 service providers in her workplace, and nearly half of them are Filipino and Japanese-Brazilian women. These women, employed through a temp agency, earn 1100 yen an hour. Komatsu reports that the number of foreign temporary workers has increased over the last two years.
The reason for this increase lies in the substandard work environment. The salary for regular employees at this facility amounts to around 200,000 yen in take-home pay for a man in his thirties. In addition, sick days are not compensated. If an employee takes a sick day, his or her salary is cut by 10,000 yen. Thus, despite the risk of spreading colds among the elderly residents, employees will work even with a fever, covering their mouths with sanitary masks. Further, because of the shortage of regular employees, workers are required to take night watch duty eight or nine times a month. There is one caregiver assigned to each floor, responsible for watching over thirty or forty residents. There is time to nap, but attendants are unable to rest out of fear that there will be fights, falls, broken bones, or wandering incidents among the residents. Stress levels are high, but when Komatsu requested changes, the manager brushed her off, telling her she could quit and look for work elsewhere.
Despairing over these inferior working conditions, some six or seven regular employees quit each year, and they have been increasingly replaced with cheap temporary workers from overseas.
Deteriorating working conditions for employees leads inevitably to reduced quality of care. According to Komatsu, there have been incidents of physical abuse where residents are strapped to their beds, and neglect of toileting and other care. She also reports that there are cases of night-watch attendants drinking on the job and neglecting their duties. When she brought these problems to the attention of management, she was told that employees would simply quit if they were reprimanded.
Geriatric care facilities are supposed to perform an intermediary function between home care and hospitalization. However, at Komatsu’s workplace, filling beds takes priority during admissions conferences, and care plans are drawn up without regard to the actual level of care required.
“The facility is run for profit,” Komatsu says, “and no effort is made to train employees. I think poor working conditions are responsible” for the deteriorating quality of care in the facilities. Employees who make constructive suggestions are given the brush off and friction within the staff is common, she reports.
Care-giving facilities are sustained by the devoted work of their employees. When the Long-Term Care Insurance system was introduced, it was intended to provide employment for care workers, but turnover has been increasing. This is a result of neglecting to guarantee proper treatment and compensation, to say nothing of working to improve the status of the care worker as a specialized professional. Bringing in additional workers from the Philippines is under consideration, but this will not solve the fundamental problems.
Reform of the social insurance and medical system has made the environment for the elderly increasingly difficult. By forcing care workers into the class of the working poor, Japan’s frail social welfare policies have abandoned the elderly.
Hiratate Hideaki is a journalist. This article appeared in the January 12, 2007 issue of Shukan Kin’yobi, as part of a series on Japan’s working poor that Hiratate has written. Posted at Japan Focus on September 22, 2007.
This article was translated by John Junkerman, a Japan Focus associate and documentary filmmaker living in Tokyo. His recent film, “Japan’s Peace Constitution,” has been screened widely in Japan by groups dedicated to defending Article 9. “Japan’s Peace Constitution” is distributed in North American by First Run Icarus Films.
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