Finding and paying for satisfactory long-term care for older people, especially those with dementia or physical limitations is a serious retirement planning problem and one that is almost certainly going to get worse before it gets better.
John Creighton Campbell, professor emeritus of political science at the University of Michigan and a visiting researcher at the Tokyo University Institute of Gerontology, is spending his own retirement years working to solve this problem.
He just completed a study on the Japanese long-term care system, which is one of the most generous in the world. Everyone between the ages of 40 and 65 pays a 1 percent tax on their incomes to fund it and everyone ages 65 and over with a disability is eligible to use its services. The system covers 90 percent of the needs of most frail elderly. Nobody gets money directly, they just get the services they need, Campbell says.
"Sad to say, the U.S. isn't never going to have a system like this because the key is government and mandatory. We can't do that in health care unlike everybody else in the world," Campbell says.
But there are several aspects of the system that he thinks individuals in the U.S. could adopt.
Care management. Every participant in the Japanese system is assigned a care manager who advocates for the people he or she represents. They take care of administrative issues, and they make sure that the daycare or home care participants get is up to snuff.
Adult day care. Even people who get home care are transported by van to outside day care two to four times a week. While there, they get a bath, a large lunch, light rehabilitation and exercise, and participate in other activities.
Small-scale residential care. People who can't live at home often live in free-standing residences with nine residents each with his or her own bedroom, a big living room and kitchen combo and a staff of four or five.
Japan spends 20 percent more on long-term care than the U.S. government does. That calculation doesn't include what people spend privately in the U.S., Campbell points out.
Why is the cost so reasonable compared to the total amount spent in the U.S.? The Japanese regard care for the frail elderly in the same way as we look at day care for children -- a necessary convenience. "Ours is so expensive because it is thought of as a health care issue. The Japanese don't look at it that way," Campbell says.