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

Koji Kishida

1. Introduction

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.