Wentu丨It was good
Editor丨Du Wenwen
Chinese living in Tokyo have never faced their pension problems before.
Until the age of 40, the ward office (similar to the district office in China) sent a list of free medical checkups, including dental, ophthalmology, and cancer screening......
In addition to medical insurance and annuities, her social security in Japan has also begun to automatically pay nursing insurance, paying 1.82% of her monthly salary - nursing care, and she can't move to ask a nurse to help her eat, drink and laze when she is old.
In 2000, Japan's "Long-term Care Insurance Law" came into effect, and long-term care insurance became a fee that must be charged in the same way as pension insurance and medical insurance, and different proportions are paid according to the level of income.
The woman, who still had Thai nude pink blush, a bear hoodie and cookies in her shopping cart, was caught off guard and was about to start paying for the toilet in preparation for not being able to go to the toilet on her own in the future.
This also made her pay attention to the Chinese who work in nursing care in Japan.
Nursing care workers, who are called nursing care workers in Japan, can be promoted to "nursing care workers" if they pass the National Nursing Care Worker Qualification Examination. The job of a nursing care worker in Japan is not inferior to that of an office worker, and the income is even higher.
In 2021, the average annual income of a nurse care worker was 4.92 million yen (240,000 yuan), surpassing the average annual income of 30-year-olds in Japan of 4 million yen (190,000 yuan).
As one of the world's most aging countries, 39 million of Japan's 120 million people are over the age of 65. This means that one of the biggest problems facing elderly care in Japan is the serious shortage of nursing staff. Since September 2017, a "long-term care visa" has been established for young people in China, the Philippines, Vietnam, Myanmar and other countries.
I interviewed several young Chinese people working in nursing homes in Japan.
They are scattered in daycare homes or high-end nursing homes, with the freshness and excitement of newcomers, the depressed face of the disabled elderly all day long, struggling between quitting or staying, and some are happy to find a solace in the moment of caring for and accompanying the elderly.
By 2050, there will be 380 million people over the age of 65 in China, accounting for about one-third of the total population. In the future, how will we take care of our aging family members, and how will we live when we are old? Japan, which is the first to age, may be able to bring some reference samples.
Here's what I had to say:
The old world of the future
Tokyo is a city full of people, and the capillary streets are full of details. My family lives in Koto Ward, and about 10 minutes from my home to the train stop, there is a very small nursing home around the corner, about the size of a bakery.
Several times, I looked in from the glass door, and I could see the head at a glance, and there were more than a dozen elderly people with inconvenient legs sitting in the room, basking in the sun and chatting by the window, like the face of a child who has to go to school, I don't want to go to school but I can't stay at home by myself, and I found it quite interesting.
Every morning, a small van picks up the elderly from their homes, and at 5 p.m., they send the elderly back one by one. On the other side of the street is a small nursery school as big as a bakery. Every morning, parents send their babies in and take them home after work.
The beginning and end of a street, the babies in the daycare class and the grandparents, how similar the two ends of life are. The difference is that those who take care of babies are called nurses, and those who take care of the elderly are called nurses.
Tokyo is the city with the largest number of elderly people in the world, and there are more nursing homes than nursery schools in Japan, and the "Future Old World" was the first to be launched here.
Every year, many people from the Chinese elderly care industry come to Japan to visit and want to know what advanced equipment and concepts are available here. What they originally wanted to see might be a machine that helps the elderly take a bath automatically, a high-tech belt to help the elderly go to the toilet, and a robot that responds to every call, but when they came here, they found that most of the nursing homes were so small and old, even if they were high-end nursing homes, there were dozens of elderly people in them, and they didn't even see the camera.
According to the statistics on the official website of the Ministry of Health, Labor and Welfare of Japan, Japan has a population of 120 million, 18 million under the age of 15, 39 million over the age of 65, and 2.12 million nursing care workers are taking care of the elderly with limited mobility - nursing care workers are in short supply all year round, and a "nursing care visa" for young people in China, the Philippines, Vietnam, Myanmar and other countries came into being.
If you are willing to come to Japan to take care of the elderly, first come to Japan for 1-2 years of free Japanese language and nursing training, and then arrange to work in a bound nursing home for 5 years, work harder, and get a monthly salary of 10,000-20,000 yuan.
Pick-up and drop-off buses from daycare nursing homes. (Image source: Nursing home official website)
That's how my friend Siqi came to Japan.
Siqi is a post-90s Jilin girl, when she met her, she had just resigned from a large nursing home in Matsuyama, a seaside city in Japan, and moved to Tokyo, pulling two large suitcases, which were all her belongings in Japan for six years. A Chinese elder sister wanted to open a small nursing home in Tokyo, and she was invited to come over to help because she was enthusiastic and experienced in nursing.
In the summer of 2023, they rented a 30-year-old wooden one-family building in western Tokyo, a ten-minute walk from Akishima Station, with a small yard. The first floor is 80 square meters, as an activity area for the elderly, with a living room and kitchen, and the second floor is 50 square meters, which is an office space for employees.
The interior of the house was originally a tatami floor, in order to prevent the elderly from falling, all covered with plastic non-slip mats, bathrooms and toilets were slightly modified, weeds and fallen leaves and debris were removed from the yard outside the house, and artificial turf was also replaced.
The Showa-style house is a bit old, but it is neat and bright, and a warm "old man's home" has been picked up.
The whole people have old age to provide for
There are many types of nursing homes in Japan, and the day care nursing home (Day Service) where Siqi works is a member of a chain of daycare nursing homes, and there are more than 40 of them in Tokyo alone, spread across various neighborhoods, and they call themselves geographically intensive nursing homes.
Unlike many nursing homes to "bigger", "have a certain scale", and use high-tech to assist the concept, this kind of light and small chain nursing homes advocate to be small, and the site is all in a small old-fashioned one-family building, many of which are wooden houses and tatami floors, and a nursing home only takes care of ten elderly people at most.
According to the information on the official website of the nursing home, franchisees only need to invest about 20 million yen (1 million yuan) in the early stage, and the company will send special personnel to help with all the support imaginable such as site selection, house selection, renovation, and personnel training. In this way, three or four people can be gathered, and ordinary people can work hard and travel lightly.
After the infrastructure was renovated, Siqi printed a leaflet and began to visit the CM (Care Manager) nursing care support specialists, who are assigned by the ward office to provide long-term care counseling to each family, and will make a long-term care plan for each elderly person and recommend the nursing home that best meets their needs.
It took them about 2 months from finding the house, cleaning, renovating, adding objects, decorating, making posters, and promoting it to having the first old man come.
The interior of a daycare nursing home (Image source: official website of the nursing home)
Siqi is not tall, with a round and sturdy body, and has previously worked as a karate teacher for children. She likes to take care of the elderly and like to chat with them. I asked her what is the difference between taking care of the elderly and taking care of children, and she said that when taking care of children, she always wants to teach them something, and the elderly are more about companionship.
Most of the elderly in Japan are gentle and polite, and she is surrounded by praise and gratitude from the old people every day, which is a sense of accomplishment that she has never had. An old man folded a diamond ring for her out of paper, and she was happy all day.
The life of the elderly is arranged to be full. In the morning, the nurse will measure the blood pressure of the elderly, take them to do exercises to warm up, and then there will be special oral gymnastics to prevent slurred speech. After lunch, sometimes we play poker, mahjong, paper-cutting, and sometimes make sushi, dumplings, and cooking together, and when the weather is good, we go out for a walk around the neighborhood together.
Siqi will record everyone's physical and mental condition, eating and excretion, and when the old people go home, her work will really end.
But nursing homes are different from kindergartens, accidents and diseases always go hand in hand, the day before was full of vitality and chatting and laughing with her, the old man accidentally fell and passed away two days later. "Old, sick, and dead" is something that needs to be realized slowly throughout a lifetime, but it is so common in nursing homes. She spent a long time digesting aging and death, accustomed to her work as a withering and withering companion of life.
Sometimes, she bathed the old man and changed his diapers, and the old man slapped himself while washing, just because he couldn't accept his old age and disability; A grandmother with Alzheimer's disease no longer knows who she is or where, but when the time comes, she stands up in a hurry and says, "I'm leaving, hurry, I'm going to my father's funeral." "Somehow, she was stuck in such a point in time.
After five years of nursing care and countless old age, Siqi summed up the characteristics of a happy life for the elderly: good teeth, not picky eaters, hobbies, and good family relationships. She has seen some elderly people near nursing homes, although they live in nursing homes, their families come to visit every week and take the elderly out for meals and walks. There are also elderly people who are alone and have no one to care about for a year.
In addition to the part covered by long-term care insurance, seniors are required to bear 10%-30% of the cost of the nursing home according to their income.
In the nursing home where Siqi works, the cost of taking care of the elderly is 20,000 yen (1,000 yuan) a day, and the elderly only need to bear 2,000 yen (100 yuan) for themselves. It is also possible to help the elderly take a bath here, which costs 3,000 yen (150 yuan) for a bath, and the elderly only need to bear 300 yen (15 yuan).
Generally speaking, in Japan, regardless of whether you are rich or poor, the Long-Term Care Insurance Act allows the entire population to provide for their old age.
Dementia and disability, the most difficult care
Compared with the long-term nursing home, the long-term work is obviously much more difficult.
Jiujiu, who is single and unmarried, is a post-90s girl who has worked in a "special care" nursing home for four years. Special care, or "special care", is the highest level of care. In Japan, when the elderly in the family have difficulty taking care of themselves, they can first contact the nearest ward office or community health center, and they will send a special person to check the income of the family and the level of care of the elderly, from the mildest level 1 to the most severe level 5, and recommend the type of care and the place to go to the nursing home.
In the mildest case, there can be a special person to help with bathing and housework, buy groceries and deliver them to the door, the so-called "self-reliance support". The most serious is "special care", the elderly are completely unable to take care of themselves, and their families are unable to support them in long-term care, and the most difficult to take care of the elderly will be sent to "special care" nursing homes.
Jiujiu said that it is best to take care of the elderly who are unconscious and unable to move, and it is effortless to move them, and there is no need to persuade them. The most difficult to take care of are the elderly who are conscious but have a very uncontrolled body.
In the "special care" nursing home, you need to respect your wishes, in order to wear diapers for the elderly, some of the elderly have been bedridden and unable to move, but they can not accept the fact that they need to wear diapers, the elderly have to ring the bell more than a dozen times a night, each time the bell rings, they will rush into the room for a long time, help the elderly up from the bed, and help them to the toilet, often have not arrived at the toilet in the process, the old man has urinated, so it is a round of changing clothes and scrubbing, and the night is not stopped. The highest record, an elderly man went to the toilet 27 times in one night.
The "self-reliance support" advocated by the elderly in Japan is that if the elderly are able to move, eat and go to the toilet by themselves, we must help them maintain this function and try to let them solve it by themselves.
The interior of a special nursing home in Tokyo (Image source: official website of the nursing home)
I took care of a special old lady for a long time, and it is said that she was sent by the ward office because of domestic violence. The eighty-year-old lady suffers from Alzheimer's disease, and she looks at Jiujiu with a smile on her face, but her body is blue and purple.
The elderly like to grasp when eating, and the more soup they bring, the more they like to grasp, and they often grasp all over their bodies. When she goes to the toilet, she will raise her legs high, her whole body will be stiff, and nursing care will not be able to help her take off her pants, and she will end up peeing in her pants. She curled up her body when she was dressed, and every part could not be broken.
"It's obviously 90 pounds of weight, but it makes people feel powerless to care for an elderly man of 300 pounds." In the process of care, I experienced the same despair and suffering of the old lady's family for a long time.
In addition to a sense of responsibility, the long-term work of the old man who has lost her judgment and reason also requires her to have the perception between people's hearts, "You must be able to guess what he will do next." "There was an old man who drank a whole bottle of alcohol disinfectant, and when he ran over, it was too late to snatch the alcohol.
Another elderly man with advanced Alzheimer's disease, who is also mentally disabled and disabled, his family can no longer take care of him, his biggest hobby is to eat everything he can find around him, even the wires are not let go, only the mattress and quilt are placed in the old man's room, the scene of pushing the door is always terrifying and heavy, the old man will tear the diapers to shreds, piece by piece "enjoy", mouth, hands, body, wall, quilt is full of excrement.
Faced with such a scene, Jiujiu's initial first reaction was to take out rubber gloves and put them on himself, so as to prevent himself from getting himself when he was supporting the elderly. Colleagues who have graduated from nursing care schools do a different thing, taking out their gloves and putting the elderly person's gloves on first. This made Jiujiu exclaim, "Ah, it's really professional." ”
In Japan, from humanitarian point of view, no matter how uncontrollable the elderly are, they cannot be tied up. The Long-term Care Insurance Act prohibits "physical restraint", but in nursing homes with 1-to-22 night shifts, caregivers are "tied up" by elderly people with dementia and disabilities to the point that they have no chance to breathe.
In Japanese bookstores, nursing care books are carefully categorized (photo by the author of this article)
In the nursing home where Jiujiu is located, in addition to Japanese, there are also Chinese, Filipinos, Vietnamese, and Burmese. My colleague from Myanmar has been in Japan for 5 years, he has never taken a tram, he has not gone out to see Tokyo, he only lives in a small rental house next to a nursing home, but the money he earns in Japan has allowed his family to buy a big house in Myanmar, and he has also bought the vacant land of his neighbor to prepare for the rebuilding of the house, he earned more than 1,000 yuan a month when he was in Myanmar, and he can increase it tenfold or even twenty times when he comes to Japan.
When asked why foreign nurses came to Japan to take care of the elderly, a long-term colleague from Myanmar said, "First of all, I want to improve the quality of life of my family, and secondly, I miss my deceased mother, and I do my best to make up for my debts by treating each elderly person as my own mother......
Jiujiu's monthly salary is about 10,000-20,000 yuan, but in the days of "special care", she almost struggles with negative energy, counting down every day, and there are still 600 days before her resignation...... 400 days...... 200 days ...... One important reason is that you are not eligible to apply for a "Care Worker" until you have worked in a nursing home for 1,095 years.
Although it is very hard, it is more than earning in my hometown in the Northeast. Jiujiu's mother lives in northeastern China and also works as a nurse. Most of the elderly in Japan are young people, many of whom are professional nurses who have passed the national nursing care qualification examination, and most of the elderly in China are middle-aged rural women.
The mother and daughter often talk about the differences in the details of care between the two sides:
In the long-term care, although some elderly people are unable to move, they still try to let him do everything he can do, called self-reliance support, even if he can pick up a spoon and tremble, he will try to let him eat by himself. Mother's experience is more from the efficiency consideration, "how troublesome it is to clean and change clothes after shivering".
In Japan, bed sheets are changed every three days, and a record of eating and excreting is required every day. My mother thought, "It's better for young people to work professionally." ”
There are also common points, such as the elderly who eat excrement, no matter which side, it is difficult to do their duty to wash him cleanly every time, and the nursing staff are afraid that the elderly will suddenly become sick and become a "big injustice" when they are on duty.
Jiujiu plans to return to his hometown in two years to open a small nursing home with his mother, and the experience of working in the nursing home and the exquisite design of objects can also be brought back for reference, such as Japanese shoes for the elderly, anti-choking tableware and other nursing products.
"I only take care of ten elderly people, take care of food and housing, and charge 5,000 yuan per month, so if we can take care of them properly, we will have a good life." It's been a long time.
A high-end nursing home, the service should be like Disney
Compared with the "special care" environment, Japan's high-end nursing homes can be regarded as peaceful and peaceful.
Here, the requirements for nursing staff and nurses are "cheerful and energetic", and everyone is soft-spoken. A figurative metaphor is that the environment should be like a high-end hotel, and the service should be like Disney.
Rui, who was born in the 00s, came to Japan after graduating from high school, and interviewed for a listed company specializing in high-end pension after graduating from university. The company has 19 residential nursing homes throughout Japan, ranging from Mediterranean-style, British-court, and classical-Japanese, to those built in the center of Tokyo and those built by the sea.
Oil paintings and flower arrangements can be seen everywhere in the corridors of the lobby, which also change with the seasons, and the pendants in the house are exquisite and unique, which the president brought back from a trip to Nepal. According to the concept of the president of the nursing home, "flowers, green, wind, light, and water must be felt everywhere." ”
There are nurses and nurses 24 hours a day, doctors come to check the body every week, senior chefs are busy in the kitchen, Italian and French meals are optional, and various activities such as small concerts, film screenings, cultural tea parties and other activities are held regularly, as well as special recovery rooms, gyms, hot springs, dance studios, painting studios, handicraft workshops, etc.
In such a nursing home, 50 elderly people are equipped with 20 caregivers. Of course, the entrance fee is also expensive, ranging from 40 million yen to 150 million yuan (2 million to 7.5 million yuan), and after moving in, you will need to pay a monthly service fee of 300,000-400,000 yen (15,000-20,000 yuan). When some elderly people find that they are already struggling to live independently, they decide to sell their houses, pay the membership fee, and then go in to live in peace for the rest of their lives.
When the elderly decide to join this nursing home, the nursing home will assist the elderly in selling their houses, organizing their belongings, moving, and even bringing their beloved furniture and objects, and the staff will try to decorate the new room as close to the old man's original home.
Residential nursing homes in Japan (Image source: Nursing home official website)
As a newcomer, Rui was assigned to work in Shizuoka, a neighborhood around Tokyo, where there are 20 elderly people over the age of 90. Living to the age of 90 without illness and disaster, you can also pay a high entrance fee, and you can also pay 300,000-400,000 yen (15,000-20,000 yuan) per month for nursing home services.
Old people talk about the past, or settle in New York, or fly with their families to Switzerland to buy Rolex in those days. Even a grandmother who has to undergo dialysis three times a week apologizes to the nurse every time she changes clothes because she can't stand up or lift her arms. "I'm sorry I didn't change my clothes because of me." Frail still wearing necklaces and earrings, must drink black tea at three o'clock in the afternoon every day, add strawberry jam to black tea, use your own knife and fork for every meal, and bring two cups of barley tea back to the room after eating.
If you feel a little unwell, the nurse will immediately receive the medicine to promote intestinal peristalsis. After the stool is normal, the medicine is stopped.
In China, caregivers will call them "Grandpa Li, Grandma Chen" as a sign of friendliness. In this nursing home, no matter how intimate the relationship is, the caregivers are required to call the elderly "guest", which is the conclusion reached by the nursing home's perennial testing, called "guest", and the elderly are the most reassuring and happy.
Caregivers will carefully read the past resumes and stories of the elderly, and chat with them to ask about the past, so as to relieve loneliness and prevent Alzheimer's disease.
Some elderly people moved in after the death of their partners, and there are also husbands and wives who live together. If you are willing to cook your own food, and if you don't want to go to the restaurant if you don't want to move, you can also ask someone to bring the food in. The old people who came in lived until they died, and the old people who had no children were accompanied by nursing homes until they died and were laid to rest.
Rui had a kind of trepidation about this job at first, caring is humble and trivial, can he really take care of the elderly? Can it really handle the eating, bathing, and excretion of the elderly? It is hard to imagine that a bachelor's or master's degree graduate in China would have to put down his body to take care of the elderly, change diapers, bath and change clothes for the elderly.
A year passed, and Rui began to enjoy the job. She feels that her working environment is elegant and comfortable, the workplace relationship is simple, there is no performance pressure, the work is not so busy, she rarely works overtime, the income is similar to that of ordinary company salarymen, and the peace and kindness of the elderly often make her feel that her days are warm and meaningful.
As far as I am concerned, I have not yet fully figured out how I will choose my retirement life in the future.
In general, the way of taking care of the elderly in Japan is very complicated, for example, the "Long-term Care Insurance Law" solves the most critical cost problem, the various levels of nursing homes on the streets and alleys provide places for the elderly in different situations, the high degree of specialization of nursing care workers, and the cultural habits of Japanese society to be polite and afraid of troublesome others, so that the friction between caregivers and the elderly is much smaller, and it is so complex that it needs to be supported by all aspects of the entire social system.
But it is also extremely simple and simple: there are old people to support, and people are treated as human beings.
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