Housing for Elderly Persons -- Reconsidering the Role and Function of Special Skilled Nursing Homes

In Tales of Tono (Tono Monogatari)， ethnologist Kunio Yanagida describes an old village custom of casting away 60-year-old people into the denderaya， the wilderness that will be their final resting place. In the daytime， the castaways would come to work in the fields， earning bare sustenance; and at nightfall they would return to their resting place. To this day， local expressions used for commuting to and from work (haka-dachi and haka-agari) are thought to derive from the word for grave (haka). The Tales of Tono were chronicled by Yanagida in 1909 based on interviews with a local resident named Kyoseki Sasaki.

Almost a century later， Japan has implemented a new long-term care (LTC) insurance system that provides universal coverage for the elderly. The system， which shifts the burden of care from individuals and families to society， represents a huge leap in the quality of elderly welfare from the old days. But in a sense， while no longer being mercilessly cast away， elderly persons today are still compelled to choose to leave home and live in a facility. This choice， which comes from a strong sense of obligation not to burden one’s family， in many ways resembles the haka-agari of old. Of course， we are not saying that facility care is at fault here; the withholding of care and other rampant cases of elderly abuse painfully demonstrate the need for such facilities. But there is something deplorable about a situation in which elderly persons move into a facility simply to await death. This paper examines issues regarding housing for the elderly and the provision of long-term care.