The arrest of a former nursing home employee on suspicion of killing one of three residents who fell to their deaths there in 2014 has shed light on the labor shortage hitting the care sector and the harsh working environments at the facilities.
The suspect, 23-year-old Hayato Imai, was quoted as telling investigators that he "had work-related stress."
"It's an absolutely unforgiveable act," Health, Labor and Welfare Minister Yasuhisa Shiozaki told reporters on Feb. 16 after a regular Cabinet meeting. He said the ministry will work closely with local governments to prevent abuse at nursing homes.
Nearly 10 years have passed since the Act on the Prevention of Elder Abuse, Support for Caregivers of Elderly Persons and Other Related Matters came into force in April 2006. Over that period, however, the number of elder abuse cases has grown, and neither national nor local governments have come up with effective ways to prevent such incidents.
There were 16,039 elder abuse cases in fiscal 2014 confirmed by local bodies, up 27 percent from 12,623 in fiscal 2006, according to the welfare ministry. Abuse by nursing home and home care workers has increased markedly, almost doubling from 155 in fiscal 2012 to 300 in fiscal 2014.
A total of 328 nursing home workers stand accused of abusing elderly residents in fiscal 2014. Staff under 30 accounted for the largest group of alleged perpetrators, at 72. With regard to factors behind elder abuse, 184 cases (62.6 percent) involved issues related to their education, knowledge, and nursing techniques, among other issues. That is, the workers verbally or physically abused victims because they lacked understanding of people with dementia, with whom they had difficulties communicating. This suggests younger care workers without sufficient training were assigned to nursing homes and ended up abusing elderly patients.
Since fiscal 2007, the welfare ministry has subsidized half of the costs of training seminars organized by local governments for care workers to help them acquire proper knowledge and forestall any descent into abusive behavior. Some local bodies are taking their own measures to prevent workers from abusing nursing home residents. The Kanagawa Prefectural Government worked out a manual on elder abuse prevention following the enforcement of the legislation aimed at ending such abuse. The prefectural government holds at least one training seminar annually for workers at municipal governments under its jurisdiction.
"Both the central and local governments have implemented various countermeasures, but the number of abuse cases has been increasing. It's necessary to facilitate communications at nursing facilities and strengthen cooperation among workers" to prevent abuse, a senior official at the welfare ministry commented.
Former care workers, nursing facility operators and experts have pointed out manpower shortages and the harsh working environment at such facilities.
A 39-year-old man living in Sagamihara, Kanagawa Prefecture, who previously worked exclusively on the night shift at a nursing facility, admitted that he often got irritated at elderly residents. About half of residents at the facility suffered from dementia.
"Fewer workers are on the night shift than on the day shift, but they are flooded with more calls from residents. I was often irritated when residents ran amok or acted like a young child," he said.
At the facility, staff on night duty worked for 14 hours from 6 p.m. to 8 a.m., including a short sleep, for five days a week. Each worker looked after more than 10 residents, changing their diapers and watching over them.
"Workers deal with residents roughly because they are too busy, so residents get angry. Both sides are irritated, worsening the situation. I know that professionals must control the situation," he said. He quit the job after deciding his 250,000 yen monthly salary was not enough for the work he was doing.
According to the results of a survey released by the Japan Federation of Medical Workers' Unions on Feb. 16, care staffers work on two shifts -- day and night -- at nearly 90 percent of nursing homes. The night shift tops 16 hours at over 60 percent of these facilities.
About 1.24 million people used nursing services, including those provided at nursing homes for the elderly, in March 2015, according to the welfare ministry. Approximately 150,000 people, certified by local bodies as needing level-3 or a higher level of nursing care, are on a waiting list for spaces at special nursing homes.
However, business conditions for nursing home operators are severe. In 2015, 76 such organizations went under with liabilities of at least 10 million yen -- the largest number since the public nursing care insurance system was introduced in 2000. The businesses' financial situation has only worsened as of late, after remuneration for providing nursing care services was reduced in April 2015.
Care workers' average monthly salary came to around 220,000 yen in 2014, approximately 110,000 yen lower than the average wage in all industries.
The government has increased the care worker wage by about 12,000 yen a month by revising the nursing care remuneration system this fiscal year, but there remains a wide income gap with workers in other sectors. Furthermore, the turnover rate in the care sector remains high, at 16.5 percent in fiscal 2014.
Many in the industry lamented the serious labor shortages in the nursing care industry, and the difficulties to train nursing care professionals. "Small and medium-sized facilities are short of personnel, and workers can't participate in training sessions," said one industry insider.
Yasuhiro Yuki, professor of social welfare study at Chiba-based Shukutoku University, points to difficulties in securing high-quality staff.
"Since at least one worker must be assigned to every three nursing home residents certified as needing institutional care, facility operators don't have the leeway to pick the best workers from among numerous applicants," he said. "To secure enough people, operators must hire applicants regardless of whether they are qualified."