Introduction: Care work in an ageing society

Peterson (1999:43) wrote over 20 years ago that: ‘Aging has become a truly global challenge and must therefore be given high priority on the global policy agenda’. Today, the world, in both developed and developing countries, is ageing (Shetty 2012). When the World Health Assembly was held in May 2016, 194 countries expressed the idea that every country should have a long-term care system. Although there are still few countries that have such a system, care services for elderly people are operated under various systems by each of these countries (World Health Organization 2019). In Japan, the Long-Term Care Insurance System (LTCIS) was introduced in 2000. Under the System, care services by qualified workers, such as Certified Care Workers (CCWs) and Home Visiting Care Workers (HVCWs), are covered by insurance. Despite the implementation of the system, there are some problems and challenges associated with these and other workers in this sector, as will be explored in this chapter after first setting a context.

The response to ageing in Japan

While the ageing population is growing globally, Japan in particular can be described as a super ageing society. It is expected that one-third of the population will be over 65 years old, and one of the fifth will be over 75 years in 2025 (National Institute of Population and Social Security Research 2017). There is also a tendency for single or married people to live apart from other family members, when incidences of elderly dementia are increasing. Concerns over such circumstances have been expressed since the 1990s, and different ways of caring for the elderly have been sought. Traditionally, families have taken care of the elderly, but currently family care is considered to be difficult. For example, Zarit and colleagues (1986:261) wrote that ‘caregivers perceived their emotional or physical health, social life, and financial status as suffering as a result of caring for their relatives’. The family's shape has also changed – from the extended family to the nuclear family – and care provided outside the family is now a requirement. In the past elderly care was provided within the framework of the Medical Insurance System (MIS), which led to an increase in medical costs.