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Alleged elderly murder-suicide shows flaws in Japan nursing care insurance system

The place where the 88-year-old mother was found. Flowers were found placed at the site the day following the incident, on Dec. 17, 2019. (Mainichi/Shunsuke Ichimiya)

FUKUOKA -- At the end of 2019, in this western Japan city's Nishi Ward, an elderly woman and her elderly daughter were found dead. From the circumstances, it is believed that the mother killed her daughter, who was confined to her bed, then killed herself.

The two women lived in a group rental home for seniors, which provided some nursing care and a 24-hour on-call nurse. Those around the pair had heard from the mother that she was concerned about her daughter's deteriorating health and their financial situation.

According to the Fukuoka Prefectural Police's Nishi Police Station and other sources, on the morning of Dec. 16, 2019, the mother was found bleeding from her neck and other parts of her body in a park adjacent to the home where she was living with her daughter. There was a kitchen knife and a suicide note nearby. In the room where the two women lived, the daughter was found dead, bleeding from her neck.

The daughter had been afflicted with Parkinson's disease, and had been certified as requiring level-5, or the most intense level, of nursing care. Her mother had pushed her wheelchair, changed her diapers and her clothes, and taken care of her everyday needs, but her symptoms had worsened lately, requiring her to get a gastrostomy tube for nutrition.

The mother had not been completely isolated, however. The home where the two were living had a nursing care facility attached to it, and the daughter was receiving treatment. A nurse was on call 24 hours a day to respond to emergencies. There was a cafeteria, where the mother and daughter had been seen eating together in the past.

The number of such group homes with services for seniors has been surging nationwide, and all 59 of the rooms at the home where the mother and daughter were living were filled. It was, however, extremely rare for a parent nearing 90 to be caring for her child. The mother seemed to be worried, in addition to the pair's nursing care arrangement, about their finances.

The mother and daughter's main source of income was their pensions, but when adding together the cost of rent, food and nursing care assistance, they needed about 300,000 yen per month to get by. In addition, they needed money for medical expenses and diapers. The mother is said to have begun asking the nursing care staff at the home about one month prior to the alleged murder-suicide, "What should I do to continue nursing care?" and "Do I have enough money?" This was around the same time the daughter's health had begun to deteriorate.

Was the incident preventable? It is unknown how the pair came to live at the group home, but there is a possibility that they had chosen accommodations that did not fit their income or the burden of nursing care they faced.

Care managers consider the income of a client certified as requiring nursing care to plan out the contents of nursing care services they will receive and where they will live. Publicly run special elderly nursing homes not only provide nursing care services around the clock and care for those who die, they receive a wide range of subsidies from the central government and municipal governments and are generally cheaper than the kind of group care homes at which the mother and daughter were staying. Shuhei Ito, a Kagoshima University professor specializing in social security law, says, however, "Special elderly nursing homes are often full to capacity and not taking new residents, so there are cases in which people are forced to choose group homes for seniors instead."

Comprehensive support centers are set up at all municipal governments, where residents can seek advice about nursing care for seniors and other concerns, but the mother had not consulted one of these centers, according to the Fukuoka Municipal Government. Professor Ito says that had a center been involved, it may have been possible for the pair to go on welfare, or for them to enter a publicly run special elderly nursing home. "It is necessary for a care manager (who understands the clients' financial situation) to put the client in touch with a center or other administrative authority," Ito says.

According to a National Livelihood Survey conducted by the Ministry of Health, Labor and Welfare, cases in which the live-in person primarily providing nursing care is at least 80 years old increased from 6% in 2001 to 16% in 2016. Yasutomo Arai, an associate professor at Bukkyo University in Kyoto who specializes in the social welfare of seniors, argues that there is a need to fully review the case. "One can only fulfill the challenges, both financially and physically, of providing nursing care before they are 80. At age 88, it must have been tough, unable to see what was to come. And to think that the woman's daughter was certified as level-5, which is usually a level at which entry to a special elderly nursing home is necessary. If this case took place because those involved were strained beyond their limits by nursing care, then it shows the shortcomings of the current nursing care insurance system," he says.

(Japanese original by Yoshihito Asano, Shunsuke Ichimiya and Makoto Kakizaki, Kyushu News Department)

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