Someone asked me about the type of work Tetsu does and how he is involved with nursing care... No photos today.
Tetsu has spent 30 years or so working in convalescent care, basically in the office doing accounting work. For the past 10 years he held the position of office head of the convalescent home but as of last November he has changed workplaces and has different responsibilities.
Until a couple of years ago Japan's policy was retirement at age 60. The government is having trouble with their pension plans and they have now given the option of working until 65, as they say "on commission" which means that the person has the same responsibilities at lower salary... which seems strange to me but we have to live with it. ANYWAY, Tetsu is 62 now and has only two or three more years of work. He opted to change positions within the same convalescent care group and now he heads 7 care "centers". (It used to be he was in charge of 19).
Breaking down the 7 centers... Two are Day Service Centers. One is a Group Home. One is a Home Helper Station. One is a Care Manager Office. One is an Assistance Center for the Handicapped. And one is a All Around Community Assistance Center. Tetsu no longer has much to do with the convalescent homes (two), and Short Stay Centers (two)... I don't know what else is connected with the overall care group...
Day Service Centers are just that... Elderly from the community are picked up by the Center and delivered for a day of activities, bathing, lunch, and general chatting time. Tetsu drives one of the vans every morning and picks up different people depending on the day. There are of course care workers with him. Tetsu really seems to enjoy these morning rounds and being with the elderly, chatting with them as he drives and joking with them. After that I guess Tetsu is mostly in the office running things from his desk though he seems to have given himself the responsibility of being the in-house photographer. The many workers at the Day Service Center have the job of bathing the guests one by one and I'd say that this is probably the foremost service that is offered. Most of these people get to the point that they can no longer get into a bathtub without help or just don't wash up themselves very well and that is the reason families begin to use the Day Service Centers. The other reason of course is that many of these elderly just can't be left at home all day long alone while their families go off to jobs and so they are "guests" of the Day Service Centers.
Group Homes are live in facilities mainly for people with dementia. The group home Tetsu is affiliated with has 18 people living there; two units of 9 people each. There is staff on duty at all times and where the residents can help, they do small jobs like fold laundry, sweep porches, serve lunch, occasionally even help in the kitchen.
A Home Helper Station is the hub point for certified helpers who go out to homes daily on an hourly basis and care for in-home elderly. Japan is trying to keep elderly at home as long as possible and so this is a huge part of health care nowadays. The Helpers may do cleaning or shopping or cooking and a few with more qualifications will help with bathing or toe-nail cutting etc. Tetsu's mother has a regular Home Helper who comes two or three times a week to do cleaning and shopping and we are TRYING to get Obaachan to use Day Service at least once a week so that she doesn't have to worry about slipping in the bath... But Obaachan is balking at that move. She finds the Day Service Center activities to be belittling and the lunches untasty (she went ONCE). She also didn't like the idea of putting her clean clothes into a basket that previously had been used by another guest... unsanitary she complained. Obaachan's Home Helper is having her own problems though as Obaachan complains that the Helper doesn't clean well enough or her shopping skills are not thrifty enough. Each Center has its own problems with their users...
The Care Manager Office is for qualified Care Managers who set up Day Service or Home Helper use for elderly who are registered with them. I THINK Japan allows each Care Manager to serve up to 50 elderly, working out who is entitled to what service according to the level of care needed. All persons over 65 are eligible for Care Manager service and each elderly person is rated (if they wish!) for a level of care... I think there are 6 levels... And depending on the rated level, that person can have a certain number of days of Day Service Care or maybe can use Care Taxi service a certain number of times a month or whatever. If a person needs a lot of care (dementia or bedridden) then they pay a minimal amount for all the services available. If their rated level is lower then they must pay out of pocket if they want extra care. Tetsu's mother is quite upset that she wasn't rated higher (which actually is good, right? It means she is considered still independent in a lot of ways) and thus if she wants to use the Care Taxi Service 8 times a month rather than 6, then she has to pay more. Or if she wants the Home Helper to come 4 days a week instead of 2, then she has to pay out of pocket. She thinks that is not fair.
The Handicap Aid Center is for mentally disadvantaged adults (not necessarily elderly) who use a service similar to Day Service. They do crafts and every year Tetsu buys me some of their beaded work at the general bazaar the nursing group has.
The All Around Community Assistance Center helps coordinate a person's needs between the Day Service Centers, the Short Stay Centers etc. For example; a family has an elderly mother who is unreliable staying at home alone during the day. The family might call the City Office asking for advice and they will be referred to their nearest All Around Community Assistance Center. At the Center someone will help assess the amount of care needed and will offer to introduce the family to a Care Manager who will then be responsible for that person's care coordination and scheduling rating sessions. From there the family and elderly person will decide, along with the Care Manager, how much care they can afford or need.
And Convalescent homes are just that though I am sorry to say not as pleasant nor luxurious as many of the convalescent and assisted care living facilities are that I have visited in the States. But they are not as expensive either and the cost is determined by the person's pension or owned properties. So for the same care some elderly pay a lot and some pay absolutely nothing.
Short Stay programs are for temporary care when the primary care giver just needs a break for a few days or a regular full night's sleep. Sometimes the family will have to go away for a few days (an out of town funeral) or plan something but they can't leave the elderly person at home. I think the number of days Short Stay can be used is limited.
And besides all that there are those Care Taxis and Meals On Wheels. Tetsu's mother uses both of those... The Care Taxis take her to the doctors or she could even use it to go to the beauty parlor if she wished... The Meals On Wheels deliver a lunch box to her 6 days a week but she finds the meals monotonous and so I think she is registered with two different kitchens for alternate days. She also is eligible for doctor's home visits and a massage service.
Whew. I don't know if I understood all that myself and am not sure if I've got it all right even. I know that when I have been in the States, I am surprised to find that there is no way to get even a temporary Meal On Wheel service for my mother (my brother's family was going on vacation for a week and I just wanted someone to bring my mother a meal for four days... No could do). Recently Marcy has been overwhelmed with my mother's care and the doctor suggested Home Care but I guess Marcy vetoed that as it costs too much and must be paid out of mother's pocket. In that way Japanese care for the elderly is VERY convenient. Tetsu's mother pays very little for all the care she gets.
And as an aside... Since my children's day, the health care for children has changed in our city also and now children under 12 get free health care. I'm afraid I only heard that over the grapevine so I'm not quite sure about that either but anyway, though Japanese socialized medicine has its faults it also is a godsend in some cases.
Queenie.... Do you anything to add to all that? Have I led people astray with the above assessment?