Asia Times
Japan befuddled by elderly care debate
By Suvendrini Kakuchi
13 August 2010
(Inter Press Service) TOKYO - Wahyudin dreams of becoming a full-fledged caregiver, if not a certified nurse, in Japan. But the Indonesian worker must first pass the required Japanese-language national certification examination, which is far from easy.
Until then the 29-year-old Wahyudin, a registered nurse in his home country, will remain a caregiver trainee in an elderly-care facility in Yamada city in western Tokushima prefecture, where he has worked since arriving in Japan two years ago.
"It’s a long shot but there is no other way I can push my career forward and build a stable future [unless I pass the test]," Wahyudin, who uses one name, said of the examination.
Passing it would give him the professional caregiver status that would allow him to be hired by any hospital or nursing home in Japan. He can also expect higher compensation.
The language examination is designed to ensure integration into Japanese society and meet professional standards, but few foreigners manage to pass it. Now, those who work with the elderly in one of the world’s fastest aging societies say it is time to take a second look at this requirement, given Japan’s rapidly growing need for caregivers, many of whom come from overseas.
"Expecting foreign caregivers and nurses to pass the difficult examination in Japanese is unfair and smacks of discrimination," said Tsutomu Fukuma, spokesman for the Japanese Council of Senior Citizens Welfare Service, a leading nursing care provider.
"The system has disappointed them and many are giving up on staying in Japan, which is not what we want," he said.
As it is, the Health and Welfare Ministry says the number of Japanese caregivers, most of them middle-aged, is declining. There were 350,000 workers in the healthcare system in 2009, down from 400,000 three years ago. Younger Japanese are not entering the sector.
Japan has 13 million people aged over 75, or 10% of its population of 127 million. In 2025, that age group is projected to grow to 22 million people - and the government predicts that the country will need more than two million caregivers by then.
This is why Japan has been turning to foreign caregivers, but they are not finding it easy to stay for too long in the country. At present, foreign nurses and caregivers are allowed to work in Japan for a maximum of three and four years, respectively. During this period, they must study Japanese and pass the certifying examination that they can take only once.
Because Japan is officially a closed labor market to foreigners, it has different agreements with countries that allow a certain number of "trainees" each year to come work for specified periods of time.
Wahyudin, for instance, came under an economic partnership agreement (EPA) signed between Japan and Indonesia in 2008. A similar pact was signed with the Philippines, another major provider of caregivers here, in 2006.
There are 570 Indonesians and 310 Filipinos working in nursing or elder homes in Japan. A total of 254 have taken the nursing examination, but only three - two Indonesians and one Filipino - have passed and acquired full-time employment status.
Among others, caregivers and nurses seeking professional certification in Japan are lobbying the government to allow foreign examinees to use dictionaries during the test to help them with unfamiliar technical terms and Kanji or Chinese characters, one of three scripts used in the Japanese language, or Nihongo.
But beyond the examination itself, caregivers rue the limited time they have to study the language.
"It’s really hard for us to reach the level of language needed to successfully sit for the exam," said Wahyudin, who has just one hour or so a day to review his Nihongo owing to his busy work schedule. He is getting formal language training, but he said this is far from adequate even with the six-month government-subsidized language course.
The situation of the elderly in Japan also reflects changing norms that have seen more young adults living away from their aging parents. In fact, the number of Japanese who are over 65 years old, living alone and with no one to look after them, numbered more than 4.6 million as of June 2009.
To many, this highlights even more the need for more caregivers, but not everyone agrees.
Professor Keiko Higuchi, a member of the government panel of welfare advisors, said Japan’s caregiving system should instead encourage the elderly to lead more independent lives. "I am not against accepting foreign caregivers or nurses. But before we start opening the doors [to them], Japan must ensure that its nursing care for the elderly continues to focus on helping them to help themselves," she said.
Yukiko Okuma, a well-known author on nursing care for the elderly, sees Japan’s EPAs with Indonesia and the Philippines as a quick fix.
"The EPA with Indonesia is a quick remedy for the labor shortage we face in the welfare sector. As a result, we now have a system that faces the risk of lowering Japan’s nursing standards to accommodate more Asian nationals who are themselves not treated fairly under the scheme," she said.
Okuma adds that today’s situation is also a product of a society where women, especially wives and daughters-in-law, have traditionally taken care of aging parents, leading to "a poorly recognized and underfinanced welfare system" in Japan.
"Japan’s welfare for the elderly must be viewed as a national priority, where workers are treated well by giving them good salaries, paid vacations and other employment benefits, whether they are Japanese or Asians," she said.