Appendix Unique Cases

Case I Social Welfare Services in Musashino City

Development of personal social services in Musashino City
Musashino City is well known in Japan as a pioneer city in personal social services for the elderly, a unique rivers mortgage system and paid volunteer system. etc.

Musashino is a relatively new city that developed as a satellite city of Tokyo. The city is located in greater Tokyo. It has a popilation of about 130,000 peoples. The number of the elderly was 19,087 in 1986, that is 14.5% of the total population. The proportion of the elderly to the total population is nearly the same as the average in Japan. The number of households was 61,124 in 1996.

Musashino City introduced public home-help services in 1961 and meals-on-wheels from 1973. Many voluntary workers help the meals-on-wheels.

In 1975, a special "Yogo" elderly home (intensive care home) combined and integrated with day service center was built. In 1980, domicile care and home-help services were extended to supplement governmental services.

In 1981, Musashino Welfare Corp. was founded and the Corporation introduced a welfare financing system on mortgage (house) for the elderly. This was the first system of its type in Japan.

A paid volunteer system to supplement public home-help services was introduced in the same year.

In 1982, an emergency information system for the elderly supported by neighbors was introduced.

In 1987, at the Kitamachi area, service housing with day service center was built. About 250 voluntary citizens work at the center.

In 1990, an intensive care home, Megumi Home, was built with all private rooms. In Japan, private rooms where one person or a couple live were rare at public intensive care homes. Musashino City was a pioneer in this field, too.

In 1996, personal social services for the elderly and for the disabled were integrated into one section of the city.

In 1996, a local nursing home at Kichijoji integrated with Tokyo Metropolitan intensive care house was built.

In 1996, a new service housing combined with a student dormitory was built at Sakurazutumi symbolizing the city's efforts to assure normal life for the elderly as they would be living with younger people.

In 1996, a neighboring small-scale intensive care home was built.

In 1996, 332 elderly people, or 3.32% of the elderly population, live in intensive care homes.

The total expenditure of Musashino City's budget is 55,980 million yen and personal social services for the elderly is about 10% of total expenditure.

In Japan, still about one-half of elderly people live with their families, the proportion of the elderly who live alone is 11-12%. In Musashino City, only 6.4% of the elderly live alone.

Unique Features of the Social Welfare Services in Musashino City
Personal social services in Musashino City are advanced and unique in the following fields.

First, the city attaches great importance to domicile personal services for the elderly from the early stage of personal social services development.

Second, different from other public services, Musashino City has been active in introducing the advantages of private services without losing the advantages of public services. For example, personal social services in Musashino City and Musashino Public Corp. are market-oriented. Personal social services are flexible and speedy. Staff of social services treat clients as customers and look for needs and demand, visiting elderly' homes.

Third, Musashino City has tried to make the most of the informal secto, such as volunteers and non-profit organizations, without asking too much of them. In this way Musashino City has practiced "welfare mix" and "participatory welfare policy."

Fourth, Musashino City has been eager to practice "productive welfare."

(1)Integrated elderly centers encourage social activity of older people.
(2)Health clubs organized at district level have been active in promoting health.
(3)Volunteers work at day service centers.
(4)A silver elderly manpower center was founded. This center introduces suitable works to older persons who have retired from full-time work but want to work on a part-time base. Some of them work as half volunteers at day centers.
(5)Building welfare facilities and employing workers for social services help to increase aggregate demand and to create employment.

Fifth, the mortgage financing introduced by Musashino Corpo. is an interesting experiment to practice asset policy.

About 80% of Japanese elderly people live in their own of homes. The value of houses is very high especially in and around large cities. Musashino City, located in the Tokyo Metropolitan area, where land and housing prices are most expensive, founded a public corporation and introduced a system to lend money to elderly people who mortgage their houses. The loan is mainly used to have home-help services. When the elderly person dies, the mortgaged house is redeemed. If the inheritors do not pay back the loan on mortgage, the ownership of the house transfers to the Corporation.

(6)The philosophy that prompted Musashino City to introduce the system was normal life for all. Based on the philosophy, Musashino City has been promoting reform of the city so that the elderly and the disabled can enjoy a normal urban life. High Mobility Plan is now going on. The "Move Bus" introduced by the city is designed to enable elderly people to ride it easily.

As a pioneer in welfare activities in Japan, Musashino City has contributed to the development of the social welfare policies in Japan.

Case II Welfare Town Mitugi

Integral Approach to Social Welfare Policy
Mitugi Town in Hiroshima Prefecture is another pioneer community that has succeeded in integrating institutional care with domiciliary care, and health and medical services with personal social services for the elderly.

Mitugi Town has a population of about 8,300 people. Its elderly population is about 24% of the total population. The town's population is declining and it is estimated to drop to 7,840 in the year 2000. In the meantime, population aging will accelerate further until the proportion of the elderly population reaches 30%.

Mitugi established an integrated community care system whereby the town government and hospitals cooperated in founding a center to provide the populace with health, medical and personal social services. Mitugi Town Health Management Center is a symbolic facility of integral approach to welfare.

This center began its operations in 1984 when the health units of the welfare section of the town, the welfare and national health insurance units of the residents service section, and the home helpers affiliated with the Social Welfare Council were transferred to the general hospital in order to coordinate their work with the medical care services of the hospital. The center serves as an important base for health and welfare services by functioning:
-to protect the health of the residents
-to give information services on health so as to enhance residents' health consciousness
-to offer necessary advice
-to help the residents diagnoses and receive medical treatment at eary stages through health screenings
-to provide domiciliary care and rehabilitation training to help the elderly maintain and recover their physical and mental functions.

The town has emphasized the importance of domiciliary services and expanded its domiciliary care support system. Following domiciliary (in-house) services are introduced and extended.
a) Home-visit nursing station for the elderly
b) Home-help service
c) Day-care service
d) Short-stay service
e) Home-visit nursing
f) Home-visit rehabilitation training
g) Home-visit guidance
h) Other in-home services

Supply and lending of utensils and aids for the disabled and the elderly
Meal service
Emergency communications system
Refurbishment of houses
Bathing service

As a result of these integral policies, the number of bedridden elderly people has declined from 56 in 1980 to 14-19 in and after 1985, while elderly people living at home increased from 1,489 in 1980 to 1,867 in 1992.

Welfare Bank in Mitugi Town
Mitugi Town is known for its unique Welfare Bank system. This is a social exchange system of services. Individuals who, while they are young and strong, help the elderly in need of care can accumulate points that will make them eligible to receive care when they need it in the future. The contents of services provided by this system are:
a) Domiciliary care services
Household work assistance - transportation, feeding food, etc.
Care assistance - house cleaning and washing, meal preparation, garden cleaning, shopping, etc.
b) Institutional care services - Visit to health facilities for the elderly, etc.
c) Meal service - cooking and distribution of meals

In Mitugi Town, the non-profit, non-governmental Social Welfare Council and volunteers have played an important role in supplementing government services and enhancing the quality of life of the elderly.

Volunteer activities, as well as the family's function integrated with personal social services and related activities are most important activities in the informal sector in providing care services for the elderly. People's participation in welfare activities is desirable from the viewpoint of participatory welfare, welfare mix and productive welfare. Volunteers activities in Musashino City and Mitugi Town must be evaluated as pioneer activities toward a new type of welfare society mentioned at the beginning of this article.

Case III Vintage Villa in Yokohama

Service Housing Built by Public Housing Corporation

Homes and Housing for the Elderly in Japan
Housing facilities for the elderly who need care and home-help services in Japan can be classified into the following four categories.

1 Long-term care homes for the elderly (called Tokubetu Yogo Rojin Home)
This type of housing is similar to old people's homes or nursing homes in Europe. Besides, for low-income elderly people, there are Yogo Rojin Homes, which will be changed into Tokubetu Yogo Rojin Homes in future.

Most of the costs of Tokubetu Yogo Rojin Homes are financed by tax. Out-of-pocket payment by residents is about 7% of the total costs. The out-of-pocket payment is related to his (or her) and his family's income, the out-of-pocket payment of low income people, therefore, is zero or quite reasonable.

2 Service housing (called "Care House")

3 Pay Service Housing                More than 20,000

These are special service housing that are roomy and offer high-quality care and domiciliary services. Vintage Villa in Yokohama belongs to this category.

4 Health service facility (called Rojin Hoken Shisetu)
This facility is a new type of facility that was originally intended to be a rehabilitation facility that belongs to E in the Chart below.

However, as most residents stay a long time, they are not so different from long-term care facilities. The main difference is that (1) long-term care facilities are classified as personal social services, while Rojin Hoken Shisetu belongs to medical service. (2) Rojin Hoken Shisetu have more health care function than Tokubetu Yogo Rojin Homes. (3) While the resident's fee is income related at Tokubetu Yogo elderly homes, at Rojin Hoken Shisetu out-of-pocket paymenst are not income-related, though the fee for very low-income residents is exceptionally lower. Therefore, Rojin Hoken Shisetu may be classified as D or I in the Chart above.

5 Hospital for the elderly
One of the problems in health care and personal social services is that many elderly hospitalized people stay for a long time at hospitals even after they no longer need to stay for medical care. This kind of hospitalization is cynically called "social hospitalization." Social hospitalization occurs because the out-of-pocket payment is cheaper than that of long-term care homes except for the very low-income class. In Japan, the number of hospitals is relatively more than that in OECD countries, while the number of long-term care facilities for the elderly is less than that of those countries. One of the purposes of integration of health-care service for the elderly with personal social services is to cope with this problem.

Service Housing and 'Vintage Villa'

In Japan, there are pay (not covered by social security) elderly peoples' homes and service houses mainly in the private sector, where bout 20,000 people live in 280 collective houses. These houses are built and managed by mainly profit-making companies and most costs are financed by the revenue from residents. Generally speaking, this type of service home for the elderly is more roomy and comfortable than other types. The problem of private homes is expensive rent and deposit money or foregift. In the Tokyo metropolitan area the deposit or foregift is more than ¥30 million for a flat and rent is more than ¥80,000-¥130,000 per month.

The former governor of Kanagawa Prefecture, Nagasu, was eager to practice the philosophy of normalization and integral approach to social welfare policy. Vintage Villas were built by Kanagawa Housing Corp. to realize collective housings with care services based on this philosophy.

Vintage Villas were to provide roomy and comfortable flats with care and service to allow the elderly to live a normal life at more reasonable costs than that of private ones. The first Vintage Villa was built as one of the apartment houses in a new town in Yokohama City, which has a population of more than 3 million people. The functions of Vintage Villas were similar to service housings in Sweden. Each flat is roomy (41.56m²-60.84m²) and comfortable equipped with air-conditioning, bathroom, small kitchen and alarm system. Common facilities include swimming pool, dinning room, lounge, health-care center, large bathroom, multuse hall, hobby room, library corner, club room, Japanese room where residents can enjoy tea ceremony, lobby and drawing room.

A medical doctor visits the villa once a week and a nurse or nurses stay at the villa around the clock. When a resident needs intensive care, care services are provided without additional costs, for intensive care costs are paid in advance when the resident begins to live in the villa.

The facilities and services are well designed and equipped. The environment is convenient and full of greenery. The quality of life and services at the villa are excellent. The problem is high costs for residents.

Kanagawa Public Housing Corp. has built two similar Vintage Villas in Kanagawa Prefecture. They are as expensive as Yokohama Vintage Villa. Main reasons for high costs are 1) high land price, 2) high building costs, 3) expensive intensive care service costs, 4) exclusive facilities, such as swimming pool, restaurant, lounge and special Japanese room and 5) government subsidy is negligible. How to provide roomy and comfortable houses with reliable care services is one of the major tasks of personal social services.

Costs that a resident has to pay are;

---

Back to Index