Abstract
This paper examines the geography of delivering social services for the elderly in Japan. Recently, the aging of the Japanese population has become a serious issue, and it is estimated that the rate of the population aged 65 and above will continue to rise. Accordingly, the necessity of providing a wider range of long-term care for the elderly has grown in Japan. With this in mind, the central government initiated a national strategy of promoting social services for the elderly in 1989-the Plan -until 2000. Then, in 1990, the Diet revised the Law for the Welfare of the Aged. It requested that local governments elaborate their own regional plans by 1993 concerning the expansion of services throughout the 1990s. The revision also specified that municipalities would be responsible for providing the services. These changes raised the possibility that social services for the elderly would vary in both quantity and quality among municipalities. In 1993, under this law, local governments drew up their own regional plans specifying their level of service goals by 2000. Since the sum of the services of all local governments exceeded the previous goal of the Plan, the central government revised its previous plans and created a New Gold Plan.This paper focuses on the spatial development of nursing homes, which represent a typical form of institutional care in Japan. In 1963, the Law for the Welfare of the Aged institutionalized nursing homes. Under this law, a nursing home is a residential accommodation for elderly residents aged 65 and above who depend on other persons' help because of physical disability or dementia. In Japan, the construction of new nursing homes requires government approval.The Ministry of Health and Welfare (MHW) established guidelines for the promotion of services for the elderly and notified local governments in June1992. Regarding nursing homes, the guidelines state that the number of beds shall be a little over 1% of the population aged 65 and above. However, the MHW instructed small municipalities to jointly build nursing homes after establishing that a home that is too small will be inefficient. To avoid the spatial concentration of nursing homes in a particular area, the MHW ordered Prefectural governments to divide the area into several planned areas and to determine a target figure of beds for each area. By this approach, the MHW attempted to equalize the ratios of beds per older population among planned areas.The results of this paper are summarized as follows:The numbers of nursing homes and their beds have increased consistently. It was estimated that the number of beds amounted to 300, 000 in 2000. This increase was the result of the national strategy pursued since 1990. The construction of nursing homes was considerable in the late 1990s because of the 2000 time limit. The degree of growth was especially remarkable in metropolitan cities and very small towns.The level of service provision (LS) is measured by the number of beds per 100 people aged 65 and above in an area (for example, municipality, planned area, or Prefecture). Among the 346 planned areas in Japan-the spatial standard for the location of nursing homes-there was a five-fold disparity in LS in 2000. This high LS was especially obvious in the planned areas- that is, areas located in the periphery of Japan or its islands. The extent of this disparity, however, was eased when compared with 1993, the year the local plans were drawn up. Consequently, it was concluded that the policy target aiming to equalize the level of service provision among planned areas on the whole succeeded during this period. From a regression analysis, it was also significant that the degree of improvement varied among Japan's 47 Prefectures.The author considered that it was too broad to regard a planned area as a spatial standard for the location of nursing homes.
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