An Agenda on Population Aging and Caring for Older Persons

in Asia Pacific

Takeo OgawaPresident

Asian Aging Business Center

10 August, 2014. Nishitetsu Inn FukuokaForum on a Conception of Harmonization of Long-Term Care Certificate

between Japan and Indonesia: Beyond a Framework of Bilateral Economic Partnership Agreement

Background of Aging in Asia Pacific

• Looking for a economical wealthy country,• Engaging high productive work• Child-bearing fewer and rearing with care• Living longer• This strategy introduces the economic

development in Asian Pacific countries, although it caused population aging too.

• Not only Japan, but also Indonesia and others.

Economical Growth and Aging in 1970-1995 in Asia Pacific

0

5,000

10,000

15,000

20,000

25,000

30,000

0 2 4 6 8 10 12 14 16 18

Japan

USA

Canada, Australia

China

Thailand

Korea

SingaporeHong Kong

Malaysia

Vietnam

New Zealand

Philippines

US$/Capita

% of 65+

Bubble= PopulationIndonesia

Economical Growth and Aging in 1995-2010 in Asia Pacific1995-2010

0

10,000

20,000

30,000

40,000

50,000

60,000

0 5 10 15 20 25

Japan

Australia

CanadaSingapore

Korea

Hong KongNew Zealand

Philippines

MalaysiaChina

ThailandIndonesia

Vietnam

US$/Capita

USA

Bubble= Population

% of 65+

Economical Growth and Aging in 2010-2030 in Asia Pacific2010-2030

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

0 5 10 15 20 25 30 35 40

Korea

USA

Australia

Hong Kong

Singapore

Japan

China

US$/Capita

Bubble= Population

% of 65+

Canada

0 10 20 30 40 50

World

US

Europe

Malaysia

Indonesia

Australia

China

Singapore

Korea

Japan

20092050

The Ratio of 60+ from 2009-2050

By 2050, 1 in 3 people in

Asia-Pacific will be age 60+

%

Japanese Challenges toward Aging

• 1970s: Universal Social Security System• 1990s: Infra-structure Improvement for the Care-

needed Elderly• 2000s: Public Long-term Care Insurance System• 2010s: Comprehensive Reform of Tax and Social

Security• In the future, 2025~2040, Japanese government will

reconstruct of a resilient country (Sustaining one hundred million population).

• Convey Japanese challenges for developing countries.

Changed and Estimated Population in Japan

83208928

93429828

10372

1119411706

12105 12361 12557 12693 12777 12806 12660 1241012066

1166211212

1072810221

9708

0

2000

4000

6000

8000

10000

12000

14000

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Transition of the Ratio of 65+ and History of Social Security

4.9 5.3 5.7 6.3 7.1 7.99.1

10.312.1

14.6

17.4

20.2

23

26.8

29.130.3

31.633.4

36.137.7

38.8

0

5

10

15

20

25

30

35

40

45

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

目標年次

介護保険

国民年金

国民健康保険

老人福祉法

老人医療無料

老人保健法

ゴ｜ルドプラン

高齢社会対策基本法

後期高齢者医療

社会保障税一体改革

ＥＰＡ

看護介護Aging Society

Aged Society Super Aged Society

Applicability of Japanese Aging Strategies for Future Indonesia

4 3.8 3.6 3.4 3.3 3.5 3.6 3.6 3.84.2

4.7 4.9 55.4

6.3

7.7

9.2

10.9

12.7

14.2

15.8

0

2

4

6

8

10

12

14

16

18

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Japanese in 1990sLong-term Care for the Elderly？

Aging Society

Japanese in 1960sSocial Security？

Perspectives on the Comprehensive Reform of Tax and Social Security

(Ten Thousand)• Medical Doctor 29• Nurses 141• LTC staffs 140

• Clients of LTC 426Within In-home 304

In-Assisted 31In-Institution92

• MD32~34• Nurses 195~205• LTC staffs 232~244

• Clients of LTC 641Within In-home 449In-Assisted Living 61

In-Institution 232~244

2011 2025

Nursing and LTC for Aging • Increasing the Support-needed Elderly on Longevity （Ｉ

ＡＤＬ）• Increasing the LTC needed Elderly in Senility, lifestyle-

related disease, Fall, Dementia, Disability con valescence （ＡＤＬ）

• Division of Labor and Job Development between Nursing and LTC

• Qualification for Securing the Quality of LTC Competency

• Training Programs for Certificating LTC Competency• Trials and Errors for Mitigating the Imbalance of LTC

Workforce Internationally

Recognized Ratio of LTC needed by Age

Japanese Concept of Long-term Care

Social WorkNursing CareLong-term Care

KAIGO

Basic Requirement

Professional

Household Work

Acceptance of Nurses and Certified Care Workers on EPA

Social WorkNursing Care Long-term CareKAIGO

Basic Requirement

Professional

Household Work

Nurse Certified Care Worker

Origins of Nurses and Certified Care Workers of EPA

Philippines

Vietnum

Indonesia

As candidatesAfter National Exam.

Successful ones can engage in Institutional Care

Nurses and Certified Care Workers under the Bilateral Economic Partnership Agreement

Nurse Certified Care WorkerTraining SchoolOn the Job Training

Entry

6-months Language Training

Work & Studyat Hospital

Work & Studyat Nursing Home

2-years Study

Challenge to National Exam.

Challenge to National Exam.

Graduate=Certified

Special VisaFor 3 Years

Special VisaFor 4 Years

Special VisaFor Graduation

Results of Accepting Nurses and Certified Care Workers at March, 2014

AccumulatedImmigrants

AccumulatedExaminees of National Exam.

AccumulatedSuccessful Candidaters

Nurses2008-2012

４４０（１００％）

１７４０（３９５．５％）About 4 times/capita

１２５（１９．９％）

Certified Care Workers2008-2013

６０８（１００％）

５１９（８５．４％）

２４１（３９．６％）

December, 2002: Those who immigrated until 2002 on EPA are working in Japanese hospitals and Facilities after successful National Exam; Nurses 60/629 and Certified Care Workers 22/933.

Deregulation on the Basic Policies for Economic and Fiscal Management and Structural Reform

• Expanding Acceptances of Foreign Companies • Expanding Acceptances of Foreign Workers • Prolonging the Length of Stay for the Technical

Intern and Expanding to Care Workers• Lifting of a ban for Employing Foreign Domiciliary

Workers

• How coordinate a framework of ＥＰＡ and new deregulation policies.

• Harmonization on the Life-long Education System.

Basic Policies for Structural Reform

Social WorkNursing Care Long-term CareKAIGO

Basic Requirement

Professional

Household Work

Technical Intern

Maid

LTC Workforce in Neighborhood Communities: A New Agenda

• Establishing Professional Partnership• Enhancing the Self Management with

Developing Techno-aide• Supporting Family Carers and Constructing

Comprehensive Service Stations• Improvement the Literacy of LTC for regional

volunteers and Establishing Coordination Center

• Community Business Incubation

Japanese Integrated Community Care System

Long-Term Care Network in the Community in Yogyakarta

VOLUNTEER

Sub village

Older person Family

Community Volunteer

Small shops

Population and FP Field

staff

Community

LeaderHealth Center

Village-Subdistr

ict

Red cross

Hospital

Institutional Care

The Bed Bath is Common with Each Other Country

The Relaxation is Differ with Each Other Country

The Common Point of LTC Training

• In order to realize “Aging in Place”, the LTC will be provided in neighborhood communities.

• It needs not only for professionals but also family carers, community volunteers, non-skilled workers and all generations to be trained of the LTC literacy.

• The “Train the Trainers” program should be installed for the professional education internationally.

Certified Nurse in

Nurse

Nurse Aid

U

Unqualified Care Givers

Japanese Qualification System of Nurses and Certified Care Workers

Home Helper 3

Home Helper 2

Home Helper 1

Certified Care Worker

Certified Care Worker in

Geriatrics & Gerontology

Geriatric Nursing

Care Manager

Aborition

Capacity Building forFamily Carers・Volunteers・All Generations

Dementia Care?

海外から

Preparing Career Grading System of LTC

Certified Care Worker

Technical Intern

Certified Nurse in

Nurse

Nurse Aid

Unqualified Care Givers

Unqualified Care Givers

Ideas of Harmonization

Certified Care Worker

Certified Care Worker

in

Unqualified Care Givers

Unqualified Care Givers

Kadar

NurseDiplomaⅠ

NurseDiplomaⅡ

Nurse DiplomaⅢ

Japan Indonesia

Level １

Level２

Level ３

Level ４

Level ５

Level６

Level ７

Level ８

PramuruktiCapacity Building of LTC

TRAIN the TRAINER

Toward Global KAIGO from Japan

• Environmental Improvement for Hygiene and LTCThe Support Center for LTC Intern, Sanitary ware, & Coordinator for Assisted Living.

• Culinary Arts for LTC and Oral HygieneCutting, Thickening, Presenting, Chewing Power-up, & Teeth Brushing

• Changing Position based on Body MechanismAncient Japanese Martial Arts, Slow Fitness Exercise, & Brain Training

Study of Foreign LTC Methods

• Jamu in Indonesia• Massage in Thailand• Laughter Yoga in India• Inclusive Networking for Promoting LTC in

Neighborhood Communitiesex. Kadel/Posiandu, Pramrukti, Nurse/Puskesmas

Next Step

• Let’s start collaboration of exchange program for training the trainers.

• Let’s declare a proposition for establishing a training center for harmonization of long-term care and aging studies in Fukuoka-city and Jakarta and Yogyakarta.

A Proposal of the Training Center on Asia Pacific Aging

• With/beyond EPA, an acceptance framework of foreign LTC workforce should be considered.

• The technical intern program should be improved on its criticism.• A common field of LTC for the Elderly should be neighborhood communities

(patches) in Asia Pacific.• LTC institutions and hospitals should take responsibilities not only acute and

terminal care but also for research and development and teaching LTC knowledge and skills for preventive and rehabilitation care.

• The competency of the geriatric nursing and the LTC should be integrated in the lifelong education system and its accumulated career should be evaluated with each other.

• The LTC job should be redesigned for clarify its needed knowledge and skills.• The trainer of trainers who teach LTC should be exchanged on bilateral exchange

program. • In order to Harmonize LTC certificate, a training center should be established both

in Japan and in Indonesia.