PART I
AGING IN JAPAN: AN OVERVIEW

3
Demography and Income

Two centuries ago, the manufacturing techniques we call "industrial" began to transform the agricultural and handicraft societies of northwestern Europe. This familiar transformation is still going on in many parts of the world. Greater production meant better nutrition, housing, and sanitation, with the result that life expectancy began to increase. At first, high birth rates led to a population boom; then birth rates fell, and the age structure of the industrial populations began to change dramatically.

The combination of a mature industrial technology and a non-Western cultural history makes Japan sociologically interesting in a number of ways, not the least of which is the problem of population dynamics. Where the veneration of parents is combined with a huge and growing population of aged, how does the society react? Fuji-no-Sato is an attempted solution to the problem these demographic and economic processes produced: caring for one of the world's most venerable populations.

The Graying of Japanese Society

The aging of Japanese society has three distinct features. First, because their industrialization began late, the Japanese were able to borrow methods and materials that the West had taken a century to perfect. Wealth and health accordingly grew rapidly, leading to a dramatic drop in death rates. The growth of the aged population therefore has been recent and rapid. Second, the proportion of the elderly is projected to reach a higher level than in any other nation, probably as a result of complex social, genetic, and environmental conditions. This need not concern us so much as the consequences. Third, an unusually large proportion is expected to be over seventy-five and therefore more frail.

The proportion of over-sixty-five members in the total population is the usual index for the aging of a given nation. This proportion was fairly stable in Japan in the pre-World War II era: 5.3 percent in 1920, when the first national census was taken, 4.8 percent in 1930, and 4.7 percent in 1940. Although the first postwar census in 1950 reported 4.9 percent over sixty-five, just a decade later the rate was 5.7 percent. The new, sharp increase has continued with accelerating speed; it reached 7.1 percent in 1970, 9.1 percent in 1980, and 12.0 percent in 1990. It is projected to reach 16.3 percent in the year 2000, continuing to a high of 23.6 percent in 2020, exceeding the projected highest levels of the Western nations. Table 3-1 illustrates these increases, showing the growing numbers of those in several age groups. One can clearly see from these figures that Japan is now on the threshold of a gray population explosion. Figure 3-1 shows the problem from another angle: the prolonged life expectancy at birth and the average years left to live for those reaching sixty-five in selected years. Note that over a forty-year period, life expectancy rose by almost twenty-five years for women and over twenty-four years for men, giving Japan the world's highest life expectancy at birth. In the same period, the average years left to live for women aged sixty-five stretched by 6.8 years, from 12.2 to 19.0, and for men by 5 years, from 10.6 to 15.6.

The percentage of "old old"—those over seventy-five—in the total aged population was stable at about 25 percent from 1920 until 1950, when it began to grow. By 1960, it was 30.4 percent, and it is projected to reach 55 percent by 2025 (Table 3-2). The impact of this increase of a relatively frail and dependent group will be enormous for Japanese society. The speed of Japan's aging can be appreciated when it is compared with that of major Western nations. The rise of the aged sector from 7 percent to 14 percent in France took one

Figure 3-1.
Life Expectancy at Birth, Years Left to Live for
Sixty-five-Year-Olds (Ministry of Health and Welfare, 1986).

hundred thirty years, in Sweden eighty-five years, in West Germany and Great Britain, forty-five years. In Japan, it has taken only twenty-five years (Figure 3-2).

That these demographic changes have consequences for both social planning and personal experience hardly needs to be said. The nation must develop social services for the aged with an urgency

that allows little time to plan. Some of the many programs that have been instituted already have failed. New strategies are constantly being sought, and some that appear successful from the clients' view are being curtailed because they cost too much. No one knows where such trial and error will lead Japan, but everyone is aware that aging has become a serious social problem, and the media are preoccupied with it.

Meanwhile, the demographic changes are a challenge to the aged themselves, within whose lifetimes expectations of late life have been revised. They were born and grew up in a period when aging was not a significant problem. They survived several wars, only to grow older at a time when their society is seriously disrupted by their age group.

Income

Japan has become one of the strongest economic powers in the world, with a gross national product second only to that of the United States; this situation both exacerbates the older-population problem and helps relieve it. The standard of living for the Japanese has greatly improved in recent decades, but here let us examine how the nation's wealth affects the income structures of the aged, particularly the middle class, with whom we are most closely concerned. The people we are writing about are, after all, those who have most contributed not only to the reconstruction of postwar Japan but also to its current economic strength.

The main sources of income and their changing importance are illustrated in Figure 3-3. This is the nationwide average of so-called "elderly" households—that is, households consisting of either a man over sixty-five and his wife over sixty or of such a couple with unmarried children under eighteen years old. This is the most reliable official information we could get; the financial situation of the aged in three-generation households is difficult to assess because incomes are given per household. It is evident that the average elderly household has become more financially independent since the 1960s. The contribution of earned income nearly tripled from 16.6 percent in 1963 to 44.3 percent in 1981, and, even more dramatically, the role of retirement pensions rose from only 9.1 percent in 1963 to 47.2 percent in 1985. In contrast, the proportion received from children and other relatives fell in the same period from 64.5 percent to 2.5 percent while public welfare support has remained fairly low. Now earned income and retirement pensions together are the dominant sources of support for elderly households, jointly accounting for 86.8 percent of the total income in 1985. However, households of this type are still the minority because the majority of the Japanese aged are living with families of their children (see Chapter 4). However, the separate living arrangement has been growing in popularity and is expected to keep doing so.

The pension system has become an important source of income for the aged and deserves a closer look. Due to the relatively short history of the system, most elderly do not live solely on their pensions (Figure 3-3, Table 3-3). This may be a major reason why the Japanese tend to keep working after their first retirement and may also contribute to the very high rate of co-residence with children.

Figure 3-2.
Growth in Aged Population from 7 to 14 Percent,
Comparison of Six Nations (Ushio, 1989: 4).

Figure 3-3.
Income Sources of Elderly Households (Ministry of Health
and Welfare, 1990).

Figure 3-3 shows a dramatic improvement in pension coverage in 1973. This was the year automatic indexing of benefits to inflation was introduced. The nationwide figure glosses over a complex pension structure composed of a variety of systems with different rules and rates. To get an idea of this complexity, we compare the average monthly amounts of retirement pensions in four major pension systems. As of March 1981, retirees from municipal government were getting the highest amount, $613, followed by $575 for retired national government workers; the average rate was $421 for retired workers in private industry. The amount of the national pension is small, only $92 that year, which reflects the government's tendency to respond to claims of critical need rather than to those of simple equity. If both husband and wife are on the national pension system, their combined amount will be twice the single figure ($184 in 1981), still a far smaller amount than in the other three systems.

The average monthly amount of a worker's pension in 1981 was about 44.2 percent of the average monthly salary at retirement, which appears virtually the same as the 44 percent given by Social Security in the United States in 1980. However, it is not clear that the figures are really comparable. "Retirement" is likely to occur in a series of downward steps for Japanese workers, so the replacement rate may not reflect the highest salary, as it usually does in the United States. Table 3-3 shows the average 1985 industrial pension in Japan at about $860 which was 39.8 percent of the average 1983 industrial wage, still close to the U.S. ratio of 43 percent.

Japanese workers may receive a lump sum payment in lieu of a pension upon retirement. Although the company pension system is being developed gradually, particularly among larger corporations, the traditional retirement payment is still widely prevalent. According to a study by the Ministry of Labor, a college graduate who had worked for twenty-five consecutive years for a company (one thousand or more employees) received an average $84,896 in 1979 (still using 135Y/$). This was approximately twenty-nine times his monthly salary. Here, too, public workers receive larger retirement payments than other workers. For instance, Musashino City in Tokyo is known to pay the highest retirement bonus in Japan. A low-rank, nonmanagerial worker in this city in 1984 could receive, after thirty years' work, $296,297. However, even an enviable interest rate of 10 percent on this amount would still provide a meager pension in today's expensive Japan. Still, the retirement bonus is an important factor in one's preparation for economic security in old age.

Today's Japanese aged, then, are getting a share of the nation's great wealth. Whether or not that share is adequate is in part a political question, and we cannot answer it objectively. More important for our purposes is the fact that now, for the first time, many Japanese elderly, particularly those in the middle class, can be financially independent of their children. This is taking place when the traditional system of family care of the aged is becoming increasingly problematic, and financial independence may give the aged more control over their options for care and security.

4
Consequences of Social Change

Few generations anywhere have had to cope with social changes as massive as those that have unfolded in the lives of the current Japanese elderly. War was part of daily life among the Japanese, ending in massive destruction and devastating defeat. Equally disorienting was Japan's reconstruction and rise to economic leadership in the forty years following the war. A seventy-five-year-old man in 1990 would have been thirty years old when Japan was defeated in 1945; his generation not only fought the wars but also did the main work of reconstruction. War also produced a large number of young widows and never-married women, and these women without families have now reached old age.

Beneath the technological and political changes, fundamental change occurred in the core social institution of Japanese society, the family. The shift from empire to democracy meant a change in the support system for the elderly. This chapter discusses the impact of that change.

The IE System

Modern Japanese history began in 1868 when the Tokugawa shogunate collapsed and was replaced by the Meiji imperial government. Pressed by the fear that Japan would be subjugated by the Western powers as China and many other Asian nations had been, the new regime had to unite the nation and establish its internal sovereignty quickly. For this purpose, the patriarchical family, or ie , system was formalized and strengthened. In fact, imperial rule would not have been possible without the family system—a system in which support of aged parents was firmly institutionalized.

In 1871, the imperial government issued an order that required every Japanese to be registered in the family record, and this order provided the basis for the 1899 Meiji Civil Code, which formally

established the family system. The household, the official unit of family registration, was defined as the group of lineal related members sharing communal living. Each household head was legally required to report to local agencies such family events as birth, death, marriage, divorce, and adoption. Despite official abolishment of the family system in 1945, the family registration system was maintained and is currently enforced, with the result that every Japanese still has his or her family record. The family registration record (koseki ) is one's documented social identity, a copy of which must be submitted when one applies for school or a job. Even today the household is the basic unit in the Japanese census, which explains why most major demographic surveys are based on a sampling of household units.

This was not a completely new policy. The Tokugawa shogunate had developed a similar system in the seventeenth century through the local branch temples of the major Buddhist sects. The earlier system had other aims, to be sure, such as suppressing Christianity and keeping tax records. But the system was centralized, improved, and given new legal consequences by the Meiji government.

The prototype of the new national family system was that of the ruling bushi or warrior class of the feudal era, which was strongly patriarchal. By carefully enforcing family registration and by legally institutionalizing the patriarchal system across Japan, the imperial government sought to gain tighter control over the people.

Under the ie system, the household head was granted unusually strong legal power and authority over his family members, particularly his wife and children. For instance, he could punish his children by expulsion from the family, a sanction that not only stigmatized the children but also erased records of their family ties. Only outlaws and social dropouts had no such records. A son younger than thirty years and a daughter younger than twenty-five years could not marry without the approval of the household head. In such a patriarchal system, wives too had a very vulnerable status. Because it was essential to have a male successor, barren wives were apt to be sent back to their native families, and the divorce rate in the pre-1945 era was comparatively high for its time.

However, it appears that the household head rarely exercised these prerogatives and did so only under extreme circumstances because he was, at the same time, held liable for the well-being of his

family members. Public disclosure of one's family problems was the last thing the head of a household wanted. When legal power was used, it was not so much due to the wishes of the head as to mounting pressure from kin or neighbors to enforce sanctions. The family system functioned not only as a political unit but also as a welfare unit and protector of household members.

Ideologically, imperial Japan was a family state. The family of the emperor was idealized as a model for other families and used as a metaphor for the state as a whole. The family system was idealized as a model for other institutions. The authoritarian relationship between the household head and his family members was parallel to the absolute relationship between the emperor and his people. The nation was conceptualized as an organized mass of families with the emperor as the ultimate head of all families. Indeed, the Japanese word for nation, kokka , is made up of two words, "nation" and "family," and it was taught that all Japanese were literally the emperor's functional children (sekishi ).

Throughout the pre-1945 period, the imperial government launched a massive moral campaign to consolidate the family system. For this purpose, Confucian teachings that had been the ideological backbone of the feudal warrior family were emphasized. Two key Confucian concepts, ko and chu , were singled out as core concepts for a campaign of moral indoctrination, mainly through compulsory school education and military training. Ko is filial duty, and chu is complete devotion to the emperor. This set of beliefs was the ideological side of the institutional relationship between the family system and the imperial rule.

Ko prescribed four distinct duties for childen (Kawashima, 1957): to show and feel respect toward one's parents, to promote the honor of one's family through achievements, to support one's parents in their old age, and to worship one's ancestors. For ordinary people, however, today as then, ko was taken to mean oya-koko , meaning the third duty. The highest praise of an old person was to say that he or she had a dutiful son (ko ko-musuko ); of an adult child it could be said that he or she showed oya-koko . The worst criticism was to be labeled oya-fuko , lacking filial duty—expressions that are commonly used even today.

When ko was transposed onto one's role as a citizen, it became chu , unconditional devotion to the emperor. This concept was a vital

principle in many areas of citizenship, such as in army service, where one was taught that all orders were given or approved by the emperor himself and were therefore unquestionable.

The legitimacy of the family (ie ) system was supported not only through Confucian moral indoctrination, but also by the civil and criminal codes. The toughest penalties (for example, death or life imprisonment without parole) applied to parricide.

More important for our discussion, however, are the rights and duties regarding support of aged parents in the civil code. Let us compare the old Meiji civil code and the current democratic civil code with regard to the support of old parents.

The Meiji Civil Code (1899)

Article 954: Lineal kin and brothers and sisters have a duty to support one another. It is the same for lineal ascendants of the household head and those of his wife who were in the same household.

Article 956: When there is more than one person who has a duty to provide support, it is divided according to their respective capacities. However, the supporter living in the same household should provide support first.

Article 957: When there is more than one person who needs support and when all of them cannot be supported, the support should be given in the following order:

1. lineal ascendants

2. lineal descendants

3. spouse

4. lineal ascendants of the spouse, who are in the same household

5. brothers and sisters

6. others

Article 954 defined the extent of family support, article 956, the duty to provide support, and article 957, the right to receive support. The ideology of the patriarchal family system is clearly stated in these articles. Priority was given parents of the household head over his wife and children, his children over his wife, and his co-resident parents-in-law (a deviant household form) before his own brothers and sisters.

In the ie system, the oldest son ideally succeeded his father and eventually became the household head. His younger brothers were expected to establish "branch" families and his sisters to marry into

other ie households. If one had only daughters, one of them, usually the oldest, remained at her natal household, and when she got married, her husband became a muko-yoshi , an adopted son who took the family name and eventually became the household head in the family registration. If a couple had no children, the usual practice was to adopt a young kinsman and raise him as the eldest son. These practices assured the continuity of the family line, as well as the support of the aged.

The duty of the eldest son to support his aged parents was usually compensated by the passing to him of the largest share of the family inheritance; younger brothers received less and sisters even less than brothers. Despite the strictness of these legal prescriptions, there were very few filial support lawsuits in the pre-1945 period. Yuzawa (1970) attributed this to the effectiveness of moral indoctrination by the imperial government; at any rate, it suggests the prevalence and solidity of the family ethic.

Japan's defeat in World War II changed practically everything about the society in some way or other. The postwar reconstruction started with the dismantling of imperial rule. The old constitution, which had given the emperor absolute power, was completely rewritten, as was the old civil code. A sudden fascination with the idea of democracy brought traditional morality and custom under vehement attack. Because of its crucial role in imperial Japan, the family system was labeled feudalistic and became the target of a new moral campaign. It was under these circumstances that the present civil code was written. Let us look at the articles most relevant to support of aged parents:

The Present Civil Code (1948)

Article 877: Lineal kin and brothers and sisters have a duty to support one another.

Article 878: When there is more than one person who has the duty to provide support, its order should be determined by mutual consultation. When this is not possible, the Family Court makes the decision. Likewise, when there is more than one person who needs to be supported and when all of them cannot be supported, the order to receive support should be determined by mutual consultation. When this is not possible, the Family Court makes the decision.

Here we see the new democracy in its essence. These articles of the new code are highly ambiguous on almost every point at issue,

including the support of the aged. They simply do not prescribe anything in this respect. This often leaves it up to the children to decide who should support aged parents and to what extent. The change is from strict legal prescriptions to legal ambiguities. In other articles, democracy is seen to permeate the heirship as well; a widow can now receive half of her husband's inheritance; the other half should be equally divided by his children. The undemocratic prewar system functioned to support aged parents because the duty of filial support by the eldest son was reciprocated by his almost exclusive rights of inheritance, a reciprocity whose basic structure has been lost in postwar Japan.

Still, the law tells us little about how the ie system actually functions in modern Japan. On the whole, the Japanese are not a litigious people, and they still dislike exposing their family problems in public. The facts that the imperial government had to engage in a massive, nationwide moral campaign and that it had legally to formalize the ie system indicate that there existed a gap between custom and law. The prototype of the ie system was the patriarchal family system of the feudal warrior class, a ruling class that represented only a tiny portion of the predominantly peasant population. The most significant difference between this law and preexisting custom was this: The heads of peasant households had little authority either within or beyond their families; legal power was in the hands of the warrior class; and few peasants had the financial means to control their heirs anyway. Peasant families in feudal Japan were pretty much like peasants in other premodern societies. Differences between peasant and aristocrat continued after the formal propagation of the ie system because the living situation of the majority of the Japanese was not improved much by the change of governments. The imperial government had to launch the Confucian ethics campaign and to establish the legal code in order to consolidate the ie system in all social classes.

There were, of course, great similarities between the ie system and the indigenous family practice. For centuries, the Japanese have placed a strong value on caring for aged parents, not so much because of the influence of Confucianism, but because of ancestor worship, the core of Japanese religious life throughout their history (Smith, 1974). In fact, ancestor worship is so fundamental to Japanese life that it may have been the chief determinant of the treatment that the aged received. The existence of aged parents itself

was a symbol of the continuity of one's family line. There was a readiness among the Japanese to absorb the emphasis on support of aged parents and ancestor worship in the ie ideology.

Today's aged spent their formative and early adult years under imperial rule; hence they were subject to massive moral indoctrination in filial duty, and many of them actually lived up to it. When they themselves reached old age, the mechanism of reciprocity that had guaranteed filial support under the old civil code was lost, and they had to face uncertainty about whether, and from whom, they could count on sustenance. In this sense, the present older generation may be said to have reaped the worst of both worlds.

Changing Living Arrangements

Given the equivalence of co-residence and caring for aged parents under the ie system, a look at changing residence patterns will help us understand the impact of family democracy. Are the elderly still living with their adult children, particularly with the eldest son's family, as tradition would demand? One approach to this problem is to focus on the "lag" phenomenon. Despite the change in the formal social institutions, the old system and its ideology have remained an important, if not the only, frame of reference for many people. This "cultural lag" phenomenon is particularly evident in postwar Japan because clear-cut new norms are not available.

In the pre-1945 period, the aged had scarcely any choice but to live with their own (natural or adopted) son's family. Interestingly, though, the first national census in 1920 reported a high proportion (54.3 percent) of nuclear households: a couple with or without children or a single parent with unmarried children (Yuzawa, 1970). Two reasons may be offered to explain this result. First, life expectancy was low, and the proportion of the aged was quite small, which shortened the duration of the three-generation phase of household composition. Second, the ie system functioned in such a way that only the eldest son remained in the parents' household—sisters married out, and brothers who established branch nuclear families were more numerous than oldest sons.

Rates of three types of living arrangements of the elderly (sixty-five or older) are shown for the period 1960-1985 in Figure 4-1. The term "subhousehold" in the figure means those elderly who are in

Figure 4-1.
Living Arrangements of Those Over Sixty-five
(Soda and Miura, 1982: 73; Ministry of Health and Welfare, 1990).

institutions or living with relatives other than children. In 1960, 87.3 percent of those over sixty-five lived with children, 7.0 percent with a spouse, and 5.7 percent either alone or in subhouseholds. The traditional living arrangement decreased from 87.3 percent in 1960 to 64.6 percent in 1985. Elderly couple households increased from 7.0 percent to 21.6 percent while single-person and other households increased from 5.7 percent to 13.8 percent. Although the rate of co-residence with children continues to fall, this has to be interpreted with caution. First, note that the rate of co-residence is still about four and a half times the American rate. Second, the

rate decrease is more than offset numerically by the increase in the over-sixty-five population, so the actual number of co-resident households continues to increase, as shown in Figures 4-2 and 4-3. Figure 4-2 illustrates the increase of elderly households as a percentage of the 1970 total. Between 1965 and 1986, elderly households grew by 315 percent while the total of all types grew by 45 percent (Ushio, 1989:11). Figure 4-3 shows the growth in numbers of various types of households having at least one member over sixty-five. The co-resident type grew by a half million between 1980 and 1985.

The democratization of the family, then, in conjunction with the growing number—and the growing financial independence—of the aged, has been a major factor contributing to the increase in elderly-only households.

The impact of this trend upon people's thinking is of great interest to us, but it is difficult to assess. Whether people favor co-residence or not, for example, is clearly affected by their perceptions of the alternatives and of the costs and benefits of various life-styles. Such perceptions are too complex to be included in the usual surveys, but they are bound to be affected by economic trends, health trends, changing technologies, and a variety of social attitudes. Since 1973, the prime minister's office has been conducting annual nationwide surveys on aging; the 1974 survey focused on the support of aged parents. The results are worth presenting in detail for three reasons. First, this is the most thorough survey on filial support available today. Second, it has two appropriate samples: married men and women in their thirties and forties, who may be in a position to support their aged parents, and men and women who are between sixty and seventy-four years old. Third, the results of this survey have been replicated by other, smaller scale surveys.

Here we would like to introduce two words that are so commonly used that familiarity with them is important in understanding Japanese perceptions. One is dokyo , which literally means co-living; but when this word is used by the Japanese, it essentially means co-residence between aged parents and a family of their child, which generally means the three-generation household. That is, dokyo is the word used to describe the traditional living arrangement of the aged. The other word is bekkyo , literally separate living. This word denotes the nontraditional living arrangement of the aged.

Table 4-1 presents the thinking of adult children as a group regarding the desirability of living with their parents after they marry. Because it is fairly common in Japan for unmarried children to remain at the parents' house until their marriage and because dokyo after marriage generally means the child's commitment to the traditional support pattern, the "after children marry" clause was added to the question.

First, looking at the overall results, 49 percent of the adult children would prefer living together as much as possible. We call this type the dokyo type. Twenty-five percent would prefer separate living while their parents are healthy but living together when they become frail and dependent. We call this the modified dokyo type. Seventeen percent thought that they should live separately if they could maintain high interaction, what may be called the conditional bekkyo type. Finally, 7 percent would prefer to live separately as much as possible (the bekkyo type). The differences between city, town, and country are quite noticeable in that rural residents are the most traditional—62 percent dokyo type versus 33 percent dokyo type in big cities, with town populations falling in between. In the rural-urban continuum, the impact of factors such as the abolishment of the ie system and housing and labor patterns is clearly seen.

The same trend is discerned with educational differences. The higher the education the respondents received, the less traditional they are in their opinion about desirable living arrangements of aged parents. Because urbanization and educational trends are highly correlated, these two factors reinforce each other. Although the rural residents are still strongly oriented toward the traditional dokyo type, the metropolitan residents now have three main alternatives (the dokyo type, the modified dokyo type, and the conditional bekkyo type).

The elderly respondents were men and women sixty to seventy-four years old. Of the total 7,863 subjects, 95 percent had at least one child. Of the 7,471 parents, 75 percent were living dokyo , and 25 percent were living bekkyo . Of the dokyo elderly, 63 percent were living with a son's family, 26 percent with unmarried children, and 11 percent with a daughter's family.

Table 4-2 presents the opinions of the elderly about living arrangements. The answers were precoded as in Table 4-1, but the bekkyo type is composed of an active type ("should live separately as much as possible") and a passive type ("to live separately cannot

Figure 4-2.
Future Estimates of Elderly Households (Ushio, 1989: 11).

Figure 4-3.
Trends Among Three Types of Households with at Least
One Member Over Sixty-five (Ministry of Health and Welfare, 1990: 22).

be helped"). Overall, 59 percent selected the dokyo type as the most desirable living arrangement, 17 percent the modified dokyo type, 8 percent the conditional bekkyo type, and 14 percent the bekkyo type (5 percent active bekkyo and 9 percent passive bekkyo ).

In terms of age differences—sixty to sixty-four, sixty-five to sixty-nine, seventy to seventy-four—the older respondents were, the stronger their dokyo orientation became, although differences were small. Similarly, there are wide age differences in the other three types of arrangement. Next, regarding the health status of the respondents, which were divided into four categories (healthy, not so

healthy, occasionally bedridden, and bedridden for more than six months), the more dependent the health status was, the stronger the dokyo orientation became. For instance, in terms of their actual living arrangements, dokyo versus bekkyo , 72 percent of the dokyo respondents chose the dokyo type, whereas the opinions varied more among the bekkyo respondents: 25 percent dokyo , 36 percent modified dokyo , 13 percent conditional bekkyo , and 24 percent bekkyo (of which 16 percent was passive and 8 percent active).

Tables 4-1 and 4-2 are both subject to various interpretations. For one thing, bekkyo can mean living in the same neighborhood as one's children, or it can mean living across the country—very different choices in terms of family dynamics. The overall point is that, in comparison with the pre-1945 period in which dokyo was not only normatively prescribed but for nearly everyone a practical necessity

as well, there is now a variety of possible living arrangements for the elderly. The survey we have been discussing cast attitudes in terms of four common alternatives, showing that there is a great deal more to the question than simply whether or not the generations should share a household. Despite the growing complexity of alternatives, however, options for the dependent elderly are still very limited, and many must count on the close support of children when they become frail.

In the end, decisions about where to live, and with whom, are affected not just by the preferences of children and elderly parents, but by many other factors that are rapidly changing in Japan, such as income, cost of housing, health of the elderly, employment of

Figure 4-4.
Trends in Co-living for Three Age Groups
(Ministry of Health and Welfare, 1990: 23).

women (the usual caretakers of old parents), geographic mobility of workers, availability of professional homemaking and home health services, and the range and desirability of living styles.

To illustrate the complexity of the situation, consider Figure 4-4, which shows trends in parent-child co-residence for various age cohorts over time. At first glance, there appears to be a remarkable consistency for each cohort over time, suggesting that the end results are primarily an outcome of preference. But this interpretation would rest on several assumptions that seem unlikely under examination. It assumes that co-residence is unaffected by (1) the growing frailty that accompanies advanced age, (2) the rising pensions and living standards and changing life-styles, (3) the rising cost of housing in cities, (4) the increasing employment of women, (5) the declining fertility rate, (6) the growth of the retirement housing industry, (7) the locally variable improvements in professional support for independent living, and (8) the possible differences in longevity of co-resident versus independent-living elderly.

The rate of co-residence for a given cohort should increase as that cohort gets older and frailer, but this increase may be canceled out by lower death rates among the independent-living, and/or by financial pressures against co-residence, and/or by rising living standards and pensions that allow the elderly more choice in where to live. Pondering the effects of these and other factors, we have to admit that we simply cannot interpret Figure 4-4 with any confidence, nor can we predict what numbers will be added to it in future censuses.

5
Welfare Homes for the Aged and Emerging Retirement Communities

Following the democratization of the family, Japanese society has begun to develop new living options for the elderly; but the process is so far slow and uncertain. Without confidence in the wisdom and justice of the newer options, the aged, their caretakers, and the "experts" who would replace the old system seem equally hesitant. Long-term living and care environments for the old are developing to meet a growing demand. This is the social climate in which retirement communities are beginning to emerge.

Welfare Homes For The Aged

Under the current Japanese welfare system, all homes for the aged are public and nonproprietary. They are welfare facilities providing basic living necessities, rather than medical facilities providing extensive treatment. The modern welfare facilities started in the 1890s as sporadic philanthropic activities sponsored by Buddhist and Christian organizations devoted to saving the destitute and family-less elderly. Such houses were called yoroin , literally support houses for the aged. The imperial government was reluctant to develop welfare services for its people, particularly for the aged, partly because of the cost and the unfamiliarity of the notion of public welfare, but mainly because of the ideological threat to the ie system that such services implied. The ie system was an integral element of imperial rule, a system under which welfare could in no sense become a public issue. The family was the welfare unit in those days, and the well-being of its members was a private problem for which each household head was held liable. The very existence of destitute and familyless aged was unwelcome evidence of a weakness in the patriarchal system and therefore in the government itself. Pub-

lic support for them was a contradiction of the ruling ideology. Put otherwise, the degree to which the aged were cared for by their families was a barometer of ie ideology and consequently of the soundness of imperial rule.

The familyless old, then, in addition to poverty and insecurity, bore the stigma of political and ideological deviance. Contempt for the residents of yoroin was actively encouraged as part of the indoctrination of filial duty.

Information on yoroin is scarce, as is often the case with stigmatized activities. In 1913 (the last year of the Meiji era), there seems to have been only twenty-three yoroin throughout Japan, whose occupancy ranged from "several" to thirty residents. Between 1913 and 1926 (the Taisho era), thirty-two yoroin were reported to be in existence (Ogasawara, 1982:26). It was in 1932, following the impact of the Great Depression, that the government enacted the first law to provide public support for the destitute, but the law was limited in scope. One hundred thirty yoroin are believed to have been in existence in 1941—apparently the largest number before the end of World War II. As the war escalated, it became increasingly difficult to maintain their operation; so in 1945, only seventy-five were still open.

In 1950, under the postwar democratic constitution, a law was passed that articulated for the first time in Japanese history the citizen's right to live and the government's responsibility to provide minimal support. With this law, yoroin were reclassified as public welfare facilities. In 1950, the number of such facilities in Japan was 170, and it increased steadily to 607 in 1960 (Ogasawara, 1982:34).

June 1963, the date of the Welfare Act for the Aged (Rojin Fukushi Ho), was a turning point in the care of the elderly. The significance of this act resembles that of the Older Americans Act in the United States; both have served as basic frameworks for welfare services to the elderly. The Japanese law has shaped the current system of homes for the aged. Previous yoroin were incorporated into the new system under a new name, rojin homu , or home for the aged. The change of names was calculated to remove some of the stigma of institutionalization, but this was not a particularly successful strategy.

Three Types Of Homes For The Aged

The Welfare Act for the Aged established three types of homes, as well as community-based senior centers. Although yoroin had served only the destitute elderly who had no supporting family, the new system took into account the need for physical care of the dependent aged as well as their economic needs. This was a remarkable departure from traditional welfare services in Japan, which were essentially designed for low-income people.

The first of the three new types of facilities, then, the yogorojinhomu , or elderly care home, is a welfare facility that provides light to intermediate care for those over sixty-five who cannot remain independent for physical, mental, environmental, and/or financial reasons. The old yoroin were all reclassified as yogo homes. Having been originally designed as residential and not intermediate care facilities, they took on a new function that often conflicted with the old one.

Tokubetsu yogorojinhomu , commonly shortened to toku-yohomu , are "special elderly homes," similar to what Americans call skilled nursing facilities, for those over sixty-five who require constant care due to marked physical and/or mental impairments and who cannot be cared for at home. Unlike yogo homes, financial necessity is not a condition of admission to toku-yo homes. Officially, they are open to middle-class families with severely dependent elderly, although priority tends to be given to low-income applications if other conditions are equal and space is limited.

The third type is the keihi rojinhomu , or "limited fee home for the elderly," a type of boarding facility providing those over sixty with services for daily living for a small fee. Keihi homes are divided into two subtypes: type A and type B. The former offers accommodations to those over sixty who do not have families or who are unable to live with their own family and whose monthly income is less than one and a half times the average monthly operating cost per resident. The type B keihi homes waive the strict income requirement and accept those capable of independent living who have other legitimate financial reasons to request housing.

In short, the three types of homes are designed to deal with two types of dependency: economic and physical. Financial necessity is

required for admission to yogo and keihi homes, which are designed primarily for lower-income elderly. Toku-yo homes are designed to be available for severely dependent elderly regardless of their financial situation. Toku-yo homes are the only specially designed long-term care facilities for the aged in Japan, although acute hospitals often serve this function (Kiefer, 1987). The underlying philosophy of the Welfare Act for the Aged is still that family care is the most desirable arrangement for the aged, and it restricts subsidized residential care to those who for some reason cannot be cared for by their families.

Eighty percent of the total operating cost of yogo and toku-yo homes is covered by the national government and 20 percent by the prefectural and local government. Fiscal support goes directly to the homes rather than to the individual residents, and it is not a cost-reimbursement system. Each home operates within a budget set by the Ministry of Health and Welfare. In the 1983 fiscal year, the monthly operating cost per resident in a fifty-bed toku-yo home in Tokyo—where the cost was higher than the national average—was about $780, that of a yogo home in Tokyo, about $479 (Health and Welfare Statistics Association, 1983:167). The residents of keihi homes are in principle required to pay for their own living expenses. The government supports administrative costs because the homes are designated as welfare facilities by the 1963 act.

Admission to yogo and toku-yo homes is arranged through the municipal offices of the Social Welfare Agency, offices also set up by the act. These offices decide whether the applicant should be admitted and, if so, to which type of home. The applicants or their families cannot choose the type of home or its location, and physicians have no official role in the process of admission or assignment. In this sense, admission to a yogo or toku-yo home amounts to institutionalization. Admission to a keihi home is different, being based on a direct contact between the director of the home and the applicant.

Recent Growth Of Toku-Yo Homes

The recent growth of toku-yo homes, shown in Table 5-1, is considerable, rising from only 1 home in 1963, the year the Welfare Act for

the Aged took effect, to 2,125 homes in 1989. Since 1970, about 100 new toku-yo homes have been built annually, amounting to a new bed for every forty-five new elderly added to the population each year.

In sharp contrast, Table 5-1 shows that the number of yogo home beds grew slowly from 1963 to 1975, then began to decline. The 673 yogo homes in 1963 were old yoroin that had been reclassified by the new law. Thus, yogo homes inherited problems such as old, poorly constructed buildings and multibed rooms with minimal privacy. Also, despite the official redefinition of yogo homes as intermediate-care facilities, they have continued to function as residential facilities. As a result, relatively healthy and moderately impaired residents live together, a fact that complicates administration. The Ministry of Health and Welfare decided that yogo homes built since 1973 should have single- or double-occupancy rooms, which greatly increased their cost. After 1976, new yogo homes were not to be built except under special circumstances; rather, efforts should be made to remodel the old multibed wards into single or

double rooms at many yogo homes. These facts explain the decline of yogo home beds.

Growth in the number of keihi homes has been steady but slow—about 660 beds per year, or one bed per 400 elderly—since 1963. Their role remains minor compared with toku-yo and yogo homes. The combined total of residents in the three types of homes in 1989 was 238,122, approximately 1.7 percent of the total over-sixty-five population. During the same time, the rate of acute hospitalization in this age group has been stable at about 4 percent. All the homes have high occupancy rates (Soda and Miura, 1982:229). Despite the increase of toku-yo homes, they are still in short supply, and their occupancy rate is virtually 100 percent, the highest of all three types.

The various processes by which people are institutionalized in toku-yo homes are not well studied. One survey (TMIG, 1981) yielded the following results: In 1980, ten out of the total of forty-nine toku-yo homes in Tokyo were chosen, representing a range of different sized institutions. Of 1,442 residents, 36.2 percent came from general hospitals, 32.1 percent from yogo homes, and 25.3 percent from their own residences. The socioeconomic background of the residents from general hospitals and private residences was not reported, so it is not certain how many of them were middle class. Apparently, when residents of yogo homes become more frail, they are admitted to toku-yo homes for the same reason they were admitted to yogo homes: the lack or inability of families to care for them in the first place.

The Japanese government has made strenuous efforts to build toku-yo homes since 1963, but the need for more persists. For instance, in 1980, there were an estimated 438,000 netakiri (bedridden) elderly in Japan excluding those in toku-yo homes (Health and Welfare Statistics Association, 1983:161). In general usage, the word netakiri applies only to the aged whose health is so deteriorated that they need extensive care, usually around the clock. Of these netakiri elderly nationwide, approximately 74 percent had been disabled for more than six months at the time of the survey.

As pointed out, toku-yo homes are the only specially designed long-term care facilities that provide skilled nursing care for the aged in Japan. There are no proprietary nursing homes. One way to cope with the increasing demand for long-term care is to keep

building toku-yo homes, but this would be an expensive solution. The Japanese government suffers from huge fiscal deficits and has been enforcing stringent constraints on all social programs, and those for the aged are the most drastically affected. In order to build more toku-yo homes, individual payments probably would have to be greatly increased. This would be difficult because it would mean a drastic departure from the traditional view of welfare. Welfare, for the Japanese, has meant social services for low-income people, which should be in principle free of charge. In this sense, the very existence of toku-yo homes is contradictory to the Japanese welfare system because financial necessity is not the primary admission requirement. There is wide agreement that individual payments should be maintained at a minimum level. The introduction of even partial payments by toku-yo residents was possible only after public protests and political struggles between the ruling Liberal Democratic party and the opposition parties. The more populist parties opposed the policy, fearing that such payments by "welfare" beneficiaries would be a foot in the door for a more general rollback of welfare benefits. If the present Japanese political climate holds, these fears may be justified. The individual payment system may eventually be widened to include recipients of other social services as well.

Victims of the policy debates, families with severely dependent aged, are and will continue to be left pretty much on their own. At best, they can get moral support from others in the same predicament. Many middle-class families, or their aged parents themselves, are now able to pay for care at toku-yo homes even if it means paying substantially more than the current maximum payment. It may be a serious financial burden for them, but it may in some cases be preferable to the stress of having bedfast or disoriented parents at home.

Acute Hospitals

Until recently, the only institutional alternative to toku-yo homes was acute hospitalization. Japanese medical insurance systems include full coverage for those over seventy years old. This, together with the shortage of nursing facilities, helps account for the extremely long stays of elderly in acute hospitals. In 1984, the average stay of the over-sixty-five was eighty-eight days (compared with

eleven days in the United States). Even with the relatively low staffing patterns and cost of Japanese acute hospitals, the cost per day for the average over-sixty-five patient in 1978 was $51 (versus $400 for U.S. Medicare patients that year). This is an unacceptably expensive solution. In 1984, there were 820,000 elderly in Japan's acute and geriatric hospitals. Indeed, 131,000 or 30 percent of the 438,000 netakiri elderly, were hospitalized at the time of the survey in 1980.

The long acute hospitalization stays of the elderly were possible because (1) the public medical insurance system required very low out-of-pocket payments and (2) the system functioned in such a way that longer hospitalizations and more treatment resulted in more profit for the hospitals. As a consequence, some hospitals, called rojinbyoin , or hospitals for the aged, had a high proportion of elderly inpatients. Technically, rojinbyoin are simply hospitals wherein the aged exceed 60 percent of the total inpatients, and few have special qualifications for treating the aged. Rather, they are a consequence of the interaction between the shortage of toku-yo homes and the special medical insurance system for those over seventy years old.

Since February 1983, however, this use of acute hospitals for what is in effect long-term care has been discouraged by a new law, the Rojin Hoken Ho, or Law for the Health of the Elderly. Under the new law, acute hospitals are reimbursed on a diminishing schedule—the longer the stay, the lower the rate. More recently, cost ceilings also have been set on specific in-hospital procedures, giving hospitals further incentives to discharge chronically ill patients earlier. Intermediate nursing care, rehabilitation, and other low-cost strategies for continuing support of these discharged patients are being developed and studied, but as yet no one knows how well the 1983 law will work. It seems to have had some effect on the inflation rate of health costs, however. Whereas costs had been increasing at an average annual rate of 23 percent between 1973 and 1983, in 1984, the increase was only 8.9 percent, and in 1985, it dropped to a mere 2.7 percent (Ushio, 1989:9).

Cost-Efficient Measures

The growth of the frail elderly population, coming as it has during a time when families are shrinking and health care costs growing,

has forced the Japanese health authorities to innovate. They have had to look for models of low-cost care, and they have sought such models in Scandinavia and to some extent the United States.

A new overall strategy, based on deinstitutionalization, has developed. The national government now encourages municipalities to create improved rehabilitation and home support for the disabled elderly and improved outpatient services for the ambulatory. Day care, in-home help and home nursing, respite beds in hospitals and nursing homes for those usually confined to bed at home, and intermediate nursing care beds are included in the array of encouraged services. Day-care centers provide meals, medication supervision, and some rehabilitation therapy. Workers from these centers also make home calls to help with bathing, meals, and other needs of the homebound. In 1979, there were only 20 such day-care programs in Japan; by 1986, there were 210, and the growth continues. In the same period, the number of respite beds nationwide grew from 5,840 to 37,346, and the number of home helpers in local agencies from 13,12o to 23,555 (Miyajima, 1986:35-36).

An important component of the move toward deinstitutionalization is a new type of facility geared toward rehabilitation and community support. The first twenty of these rojinhoken shisetsu , or "geriatric health facilities," were completed in 1988, the target being some two hundred thousand beds by the year 2000. The new facilities, to be built by licensed hospitals and welfare organizations, will take as inpatients transferees from geriatric hospitals and will at the same time provide outpatient services to impaired elderly in the communities. Inpatient services would focus on essential medical care, daily living support (meals, dressing, bathing, medications), and rehabilitation (occupational and physical therapy).

One serious problem with the growing care system is that no distinct yardsticks have yet been developed for placement of the frail or ill elderly person. Rather, the emphasis has been on trying to keep as many out of hospitals and nursing homes as possible, without a clear sense of what is most appropriate in a given case. As we write this, the 1983 Law for the Health of the Elderly is about to undergo review, with an eye to adjusting and clarifying its provisions.

In sum, for the middle-class elderly, still healthy and financially independent, or for those in middle age, there are few alternatives

but relying on one's own children when it comes to the care they may eventually need. There are the toku-yo homes, but they are in short supply, they carry the stigma of welfare and of family failure, and access to them is not controlled by the consumer. In other words, there is little security in this alternative.

Nor is the family a secure source of support, even for the middle class, as dependence upon adult children has grown increasingly problematic in recent decades. Dokyo , the traditional living arrangement for the support of aged parents, has been declining. There is a growing ambiguity about filial responsibilities. At the same time, the elderly themselves are becoming more independent, financially and psychologically. Japanese society has yet to provide a realistic alternative to the traditional dokyo arrangement. It is against this background that retirement communities are now emerging in Japan.

Japan is, on the whole, a tight-knit society. Education is uniformly high; transportation, data processing, and communications technology are efficient; and social values are relatively homogeneous for a modern culture. However, the speed of Japan's aging, and the magnitude of the social changes that have come with it, have brought confusion in their wake. Caring for the elderly has become not only an economic and technical problem, but a communication problem as well. We must begin our discussion of retirement communities with an explanation of the nomenclature—something unclear to the average Japanese as well.

Retirement Communities

Confusion Over Names

The three types of homes for the aged just discussed—yogo , tokuyo , and keihi homes—are public in the sense that they are designated welfare facilities with fiscal support from national and local government. The welfare act that created them, however, has one minor clause that describes another type of facility—the nonpublic, residential facility for the aged. Such facilities are called yuryorojinhomu or yuryo homes for the aged. Yuryo literally means fee chargeable; residents of these homes must pay all their expenses because there is no public fiscal support.

This clause, which seems to have been an afterthought, defined yuryo homes for the aged as "facilities which continuously house more than ten elderly and provide them with necessary services for daily living, including meals, and which are not designated as welfare facilities by the Welfare Act of the Aged." This is a "blanket" clause, added to regulate all types of residential facilities already in existence. As such, it creates a terminological problem to the extent that it designates not a homogeneous group, but a hodgepodge of widely different entities.

Early yuryo homes were small-scale homes run by philanthropic individuals, small groups, or nonprofit charity organizations (shakai fukushi hojin ), quite different from the retirement communities emerging now. They functioned much like keihi homes, charging low fees and catering to those whose income, although small, exceeded the upper limit of eligibility for keihi homes.

That these old yuryo homes and modern Western-style retirement communities are lumped together and officially classified in one category results in a communication problem. The modern retirement communities have no widely accepted name of their own. This may not sound like a problem to Americans, who have their own profusion of names for retirement housing—"life-care facility," "residential home," "adult community," "senior housing," and so on—but at least these phenomena have existed for a few decades now, and most people are aware of them. The Japanese terminology problem is made worse by the confusing presence of welfare law at the very root of the concept of retirement housing.

The advent of retirement communities was probably not in the minds of the architects of the 1963 act because the first units were not built until the early 1970s. In 1974, the Ministry of Health and Welfare issued revised guidelines on yuryo homes to the prefectural governors. In these guidelines, a yuryo home was redefined as "a facility that provides residential accommodations for more than fifty residents, age sixty or older, and which also furnishes such services as counseling, leisure activities and health care. Meal services are not necessarily required."

In 1980, a retirement community in Tokyo went into bankruptcy, the first case in this industry. The incident became a major social issue and was highlighted in the mass media because the residents

lost much of their investment, which in many cases was probably their life savings. The incident also triggered the formation of a study group on retirement communities within the Ministry of Health and Welfare. Under the ministry's strong leadership, the National Retirement Housing Association (Zenkoku Yuryo Rojin Homu Kyokai) was established in February 1982. Twenty-five facilities managed by thirteen organizations joined the association at its inception, and many others have joined since. Although the majority are modern retirement communities, the membership includes yuryo homes, too. The association is expected to become the watchdog of the industry and to take the lead in developing quality standards for retirement communities. Since 1990, the association has taken the initiative to develop an insurance system protecting the investments of retirement home residents.

Guidelines for the size, design, construction, management, staffing, and services of yuryo homes were revised and expanded in 1981, 1986, 1988, and 1991. Now all planned yuryo homes must apply to the National Retirement Housing Association, which evaluates the feasibility of the plan and has the power to disapprove it. Local authorities are now also empowered to require the correction of problems in existing facilities. Some prefectures, including Saitama near Tokyo, are trying to enforce tougher regulations than those established by the ministry.

This is a dramatic change since the mid-1980s. As recently as 1985, there were no national guidelines for the construction and operation of yuryo homes and no attempt to differentiate the more modern retirement communities from the old style homes. Neither the Retirement Housing Association nor the local governments had authority to regulate retirement housing, and anyone who had the capital could, in theory at least, develop such facilities by simply registering with the local government. The Ministry of Health and Welfare recognized the need for more retirement housing, but it took the attitude that because these were not welfare facilities, they should not be regulated. It is perhaps inevitable that the public is increasingly aware of problems surrounding the construction and operation of such facilities as their number increases, and that regulation follows. Meanwhile, regulation has had the effect of improving the image of retirement housing in the national con-

sciousness. The phrase yuryohomu has lost its original meaning for most Japanese and has come to stand for the more modern type of facility now being built.

The "Silver Business"

In 1982, when our research began, there was a great unfilled demand for retirement housing, a need for appropriate living conditions for middle-class elderly who were neither sick nor destitute but could not or preferred not to live with children. No official count was available of the number of existing units designed to fill this need because many builders did not belong to the Association of Retirement Housing, and many did not register with their prefectural governments as required by the 1963 Welfare Act (another measure of its ineffectiveness with respect to housing). In 1982, Soda and Miura counted ninety nonwelfare facilities (including both yuryo and more modern types), housing 6,813 residents. These ranged in size from 10 residents to 400. The following year Kinoshita attempted a survey of the major retirement housing developments that were fully operative nationwide at that time. He found thirty-one of them, including seventeen of the "life-care" type, with a full range of support services for frail residents, and ten of the "condominium" type, designed for basically healthy people. Nearly all of the thirty-one had been built within the preceding decade (Kinoshita, 1984:108-110).

In 1992, the picture is quite different. Seeing the success of some of the earlier developers, a wide variety of institutions have begun to build an increasingly diverse array of retirement housing styles. Indeed, this is now a booming industry, referred to with characteristic sarcasm by the Japanese press as the "silver business" (shirubaa bijinesu ). These private ventures now represent a spectrum of cost and living standard options, of financing plans, and of health and supportive service packages, with individual developers tending to specialize in one segment of the market. Figures 5-1 and 5-2 show trends in the numbers of retirement facilities and residents, respectively.

At the most supportive end of the spectrum, one finds many life-care facilities, the type represented by Fuji-no-Sato, which we describe in detail. Here the developer makes a commitment to make

Figure 5-1.
Number of Retirement Facilities, 1982-1989 (Nikkei Business ,
1991: 196). • = For-profit (1983-1986 = no information)

Figure 5-2.
Number of Residents in
Retirement Facilities, 1982-1989
(Nikkei Business , 1991: 196).

available at the facility the basic health care services needed as long as the resident lives there. The configuration of such services varies from place to place, but the builders of Fuji-no-Sato have actually set the standard for the industry, and many of the features we describe here can be widely found throughout the silver business. In general, these life-care facilities, the oldest of which dates back to 1975, require that entrants be at least sixty years of age and that they are healthy enough upon entrance to live independently in their own apartments. Entrants are required to pay an endowment fee upon moving in, as well as a monthly operating fee during their stay. Since the late 1980s, the growing array of silver business concepts has been further complicated by the emergence of private skilled nursing facilities, confusingly called yuryotoku-yo .

At the low end of the support spectrum, one finds congregate housing of the condominium type, with few or no health-related services, although some of these provide a nurse on the premises full time. Accordingly, entrants must sign an agreement that they will move out when they can no longer live independently in their apartments. The minimum age for admission may be as low as forty-five in these facilities, the first of which was built in 1971.

For historical interest, we mention one other type of facility that was popular in the early stages Of retirement housing development but proved financially too risky and has not thrived as the other types have: the so-called "life-guarantee" type. These are similar to life-care communities in type of service and design, but the residents pay only an entrance endowment, not a monthly fee. The Tokyo community that went bankrupt was of this type. The life-guarantee system is very vulnerable to inflation and other contingencies in expenditures because the system does not have the flexible financing of the monthly fee. In the case of the oldest life-guarantee community, for example, the management was not prepared for the inflationary oil shock of the 1970s. The facility stopped accepting new residents in 1973, and it is said that it operates with a large deficit (reportedly $13,333 per resident in 1983 alone). Because it is owned by a large life insurance company, it has avoided bankruptcy. The Ministry of Health and Welfare now discourages this system of operation, and no retirement communities begun after 1975 have adopted the life-guarantee system. Many life-care facilities in the United States have suffered a similar fate, partly

because the average life span of residents in this type of setting is longer than the national norm.

The Image Problem

The financial problems of the life-guarantee communities are no longer a serious issue in the silver industry as a whole, but they illustrate a tenacious problem that stalks any effort to provide senior housing in Japan: the historical connection between age-homogeneous communities, on the one hand, and poverty and ill health, on the other.

Because of the history we have sketched, people who can afford senior housing tend to look upon it as an acceptable way of handling increasing dependency as they age. Some form of long-term care is therefore expected by the typical potential resident. The only available research to date concerning the level of demand for retirement community space is a 1982 survey of 712 retired business executives and public school teachers in Tokyo (Japan College of Social Work, 1982). As selection criteria, 73.3 percent of these respondents mentioned medical and health care services, 54.2 percent mentioned reliable and safe management, 33.8 percent mentioned comfortable living accommodations, and 28.4 percent mentioned good interpersonal relationships among the residents.

Although the advertising of U.S. retirement communities emphasizes an active way of life, the Japanese focus is on health care services. Even condominium-type communities, which lack all but the most superficial services, make these services their sales point, although potential residents know they will get only minimal health care there. The lack of standards is serious for the life-care and life-guarantee systems precisely because residents expect long-term nursing. Usually, the entrance contract does not make clear what health services are covered by the entrance fee or how much the residents will have to pay out of pocket when they become ill. Furthermore, the type and extent of care varies from one community to another, making it extremely difficult for the potential residents to make realistic financial plans for their declining years.

During the first decade of the silver business, there seemed to be little awareness of these problems on the part of the retirement

housing industry. Little attention was paid, even by life-care and life-guarantee facilities, to estimating the future needs of facilities for supportive services and skilled nursing beds as their resident populations declined in health. In the last five years, however, the problem has become clear, and builders of most newer communities are aware of the need for such planning. The builders of Fuji-no-Sato seem to have evolved a workable model and continue to provide examples of successful planning to the industry as a whole.

We now turn to the "welfare" image problem. As we have said, retirement communities are ordinarily referred to collectively as yuryo homes for the aged, a term that originally meant welfare facilities for lower-income elderly. The term rojinhomu (home for the aged), the generic name for yuryo , toku-yo , yogo , and keihi homes, has an even worse image for the average Japanese. A home for the aged is a place where the few unfortunate elderly without family support have to spend their last years. A new social entity should have a new name and image.

Partly for this reason, in spite of a clear need for housing of this kind, the occupancy rates of the early retirement communities averaged about 75 percent in the early 1980s, threatening future financial stability. The life-guarantee community that went bankrupt after one year had an occupancy of only 32 percent.

However, despite this problem, there is an indication that the retirement community is gradually coming to be known as a possible new alternative for old age. Even in 1983, the social demand survey cited earlier reported that among retired business executives and teachers, 97.1 percent were aware of the existence of retirement communities, whereas 61.5 percent were aware of yogo homes, 30.2 percent of toku-yo homes, and 20.9 percent of keihi homes.

More and more retirees seem to be aware of the benefits of age-homogeneous communities and appear willing to use them. But there is still considerable debate and confusion over the ethics of senior housing as a business venture . The feeling is still widespread and strong that something is wrong when the elderly are not housed and nursed by their families. It is tragic enough when the government must do this as a service to the destitute, but when even the affluent aged must offer money for their security, the situation borders on the grotesque in the public mind. Massive changes in the demographics, economics, and politics of aging sim-

ply have not been absorbed into the ethical norms of the culture. There is a sense that private business should stick to doing what it does best—making profits—and that this is incompatible with the needs of the elderly. The problem is by no means alleviated by the Japanese news media, most of which continue to represent retirement housing as a slightly scurrilous industry.