article Supporting working carers job continuation in Japan: prolonged care at home in the most aged society

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1 International Journal of Care and Caring vol 1 no Policy Press 2017 #IJCC Print ISSN Online ISSN X article Supporting working carers job continuation in Japan: prolonged care at home in the most aged society Shingou Ikeda, ikeda@jil.go.jp Japan Institute for Labour Policy and Training, Japan This article concerns new policy challenges relevant to companies in supporting working carers of older people to retain their jobs in Japan. Although long-term leave and flexible working measures have been reformed to address long-term in-home care, the results of new data analysis imply that the effectiveness of support measures differs according to the length of the period of care provided at home. Long-term leave and reducing working hours are effective if the period in which care is provided is relatively short, but when care at home lasts longer, flexibility in the working schedule is crucial. The results also signal the importance of addressing the health of working carers as a new challenge that arises regardless of the length of care at home. key words combining work and care family care leave flexible working carers health To cite this article: Ikeda, S. (2017) Supporting working carers job continuation in Japan: prolonged care at home in the most aged society, International Journal of Care and Caring, 1(1): 63 82, DOI: / X Introduction This article considers the challenges that employers and policymakers face in supporting working carers to retain their jobs and careers in Japan, the most aged country in the world. In Japan, the number of people who are over 65 years of age exceeds a quarter of the total population (Cabinet Office, 2016). Preventing working carers from quitting their jobs because of care responsibilities has become a significant social issue in Japan, in terms of both social welfare and business management. With the rapid increase in the number of older people needing care, and the decline in the number of younger people available to care for them, family care 1 has become a matter of serious concern, including with regard to male workers (JILPT, 2015), although this issue has traditionally mainly affected women s labour force participation (Sodei, 1989; Maeda, 1998). In 2016, Japan introduced legislative changes (put into effect in 2017, and described later) to expand support for working carers in the employment system. However, further problems are likely to affect working carers ability to remain in employment if their relatives need care at home for a long time, particularly in the context of restrictions on residential care services. 63

2 Shingou Ikeda In discussions of its welfare system, Japan is usually classified as a conservative, family-centred country (Kröger and Yeandle, 2013), even though it has established social support systems for long-term care to address the needs of its rapidly ageing society. To support retention among working carers, in 1995, the Child Care and Family Care Leave Act legislated for long-term care leave (Family Care Leave, which came into force in 1999) as one pillar of a support system that entitles employees providing care for a family member to take up to three months (93 days ) leave to make arrangements to combine their work and care. 2 Japan also introduced a Longterm Care Insurance System, in force since 2000, which has expanded public services 3 for older people with care needs. Within this system, people aged 40 years and older pay an insurance fee, which then entitles them to use publicly funded care services to meet long-term care needs, provided that these are certificated and based on a medical assessment. By 2016, Japan s care support system could be characterised as a mix of family care and public care services, with employers also assigned the task of supporting their employees who have family care responsibilities. Financial constraints on the government have meant that expanding public care services has not been easy, a situation likely to become more serious as the population continues to age. Although the supply of services is set to expand to address the growth in the number of older people needing care, it may not be adequate to keep pace with the increasing need for care. Despite its role in helping working carers retain their job or career, residential care services, such as nursing homes, may be more restricted in the near future, and families and companies will need to prepare for a situation in which care provided at home may last for years, during which the care recipient s health worsens and pressures on family carers increase. Based on these prospects, this article focuses on job retention among working carers who provide care to a family member living at home to reveal further challenges affecting workplace policies to prevent working carers from quitting their jobs after the 2016 amendment of the Child Care and Family Care Leave Act is enforced. Work and care in Japan Changing family and care roles The role of the family in the care of older people in a modern industrial society is not obvious, and in the modern nuclear family, it typically means childcare, as theorised by both functionalists (e. Parsons and Bales, 1956) and feminists, although many women also care for older or disabled husbands and parents (Sodei, 1989; Philips, 1995; Pavalko and Artis, 1997; Yeandle and Cass, 2013). Caring for an older relative has also become more common among men (especially husbands and sons) as a consequence of population ageing, smaller family size and a lower birth rate in Japan, the most aged society in the world (Tsudome and Saito, 2007). For the analysis and conclusions that follow, we begin by briefly reviewing previous studies on the traditional care role in the Japanese family, as well as changes to this. In Japan, providing care to older people was traditionally the role of the eldest son s wife, and was provided on a co-resident basis (Sodei, 1989). After the Second World War, however, nuclear families became more widespread, and although the proportion of adult children residing with parents or parents-in-law has remained high (compared with most Western countries), today, married women are less likely 64

3 Supporting working carers job continuation in Japan to live with their husband s parents (Sodei, 1989). Nevertheless, many families find it convenient to live with the wife s own parents (or her husband s parents) so that they can work outside the home when their children are small. Maeda (1998) showed that living with parents or parents-in-law had a positive effect on women s labour force participation when children were under six years old, but that when parents or parents-in-law were aged 75 or older, the impact on female labour force participation was negative, arguing that this effect was caused by their need for care (Maeda, 1998). This caused many Japanese researchers to focus on the relationship between women s labour force participation and their family care roles (Iwamoto, 2000; Maeda, 2000; Yamaguchi, 2004; Nishimoto, 2006), while researchers in Western countries (eg Brody et al, 1987; Stone et al, 1987; Evandrou, 1995; Ettner, 1996; Wakabayashi and Donato, 2005; Yeandle and Cass, 2013) were examining questions such as the need for shorter working hours, rearranged work schedules, time off without pay or quitting paid work entirely. It is particularly remarkable that about 10,000 to 20,000 male working carers in Japan also leave their jobs each year, according to the Employment Status Survey in The falling marriage rate and shrinking family size have increased the number of male carers who cannot rely on women in their family, either because they are unmarried or because they have to care for their wives (Tsudome and Saito, 2007). Tsudome and Saito (2007), in reporting this trend, note the confusion that some male carers experience when they find that they need to undertake all housework and family care, having done little of this before care needs arose. Employers in Japan perceive this situation as a crisis, 4 seeing the rising numbers of middle-aged or older male employees who have care responsibilities as a development that is damaging for business management (JILPT, 2015). Men of this age often constitute their core labour force and occupy full-time managerial positions, whereas (despite rising numbers of female managers) many of their middle-aged or older female employees are part-time workers (JILPT, 2015). Social support for combining work and care Although Japanese governments had historically considered co-residence by family members with older people, especially their adult children, as an important aspect of care provision for the so-called Japanese type of welfare society (Nihon-gata-fukushishakai), expanding social support for older people had become a notable social issue by the late 1980s. With the rapid ageing of Japanese society, care pressures were increasing on smaller families, and women were leaving their jobs to provide family care (Sodei, 1995). The government hoped to reduce this trend by legislating in 1995 for Family Care Leave, but despite this measure, according to the 2012 Employment Status Survey, 100,000 workers still leave their jobs because of family care each year ; the survey also reveals that just 3.2% of working carers use Family Care Leave. 5 By contrast, the number of working carers who take other kinds of leave, such as annual paid leave, is notable (Sodei, 1995; JILPT, 2006a; Nishimoto, 2012). Sodei (1995) shows that 34.1% of working carers who did not take Family Care Leave respond that they did not take it because annual paid leave was available. A JILPT study (2006a) shows that half of working carers report having taken leave to provide care, and that half of them have used annual paid leave for this. Nishimoto (2012) 65

4 Shingou Ikeda revealed that the needs for short-term leave, such as annual paid leave, are different from those of Family Care Leave. One study of the relationship between Family Care Leave and job retention among working carers showed that needing consecutive leave for family care had a negative impact on labour force participation, although this decreased when more public care services were available (JILPT, 2006b; Ikeda, 2010). Ikeda (2010) also found a negative impact on labour force participation when the person cared for had severe dementia, as well as higher turnover among full-time female employees with substantial work and family care responsibilities. These findings suggest that Family Care Leave is needed but that other kinds of support are also required. Not all working carers need to take a period of consecutive leave, and, for some, flexible working measures are more important as these allow full-time working carers (and especially women) to reduce their working hours by changing jobs to become part-time. To establish more appropriate support systems for working carers, in 2009, the Japanese government amended the Child Care and Family Care Leave Act to introduce Time off for Carers. This entitled working carers to take leave for up to five days each year, without pay, in order to provide care for an older or disabled family member, 6 for example, it could be used to take a family member to a hospital appointment. In 2016, amendments to the Child Care and Family Care Leave Act, the longterm Family Care Leave system and flexible working measures were implemented (see Table 1). This amended the Child Care and Family Care Leave Act, which (from 2017) will enable working carers to take their 93 days of Family Care Leave in three parts. It means that working carers will be able to divide the 93 days into three segments, although the total entitlement will remain 93 days. It also gives working carers the right to claim an exemption from working overtime for the duration of providing care, and creates increased opportunities for flexible working to facilitate providing care by requiring employers to offer carers the option of part-time work, flexitime or staggered working hours, for up to three years. Alternatively, employers Table 1: Outline of 2016 amendment of the Childcare and Family Care Leave Act (starting from 2017) Term of Availability Unit or Frequency of Usage Target Reason for Amendment Long -term Leave (Family Care Leave) Before Amendment Amended Regulation 93 days for 1 family member Once for 1 duration of caring 93 days for 1 family member 3 times for 1 family member Addressing emergency at acute phase of care for recipient. Addressing emergency at acute phase, changing life such as moving to nursing home at middle phase, and terminal care. Although there are not so many working carers who need long-term leave over 93 days, it becomes neccesary to take consecutive leave several times if the provision of care is prolonged for years. Short-term Leave (Time Off for Carers) Before Amendment Amended Regulation 5 days per year for 1 family member 5 days per year for 1 family member Daily basis Half-day basis Addressing daily caring such as assistance with going to hospital. Addressing daily care such as assistance with going to hospital. Although there is sometimes a need to take time off more than 5 times a year, it is not always necessary to take leave all day. Flexible working measures (part-timeworking, flexitime working, or staggered working hours) Before Amendment Amended Regulation 93 days for 1 family member including Family Care Leave Once for one duration of caring 3 years for 1 family member 2 times for 1 family member Addressing emergency at acute phase of care for recipient. Addressing daily caring such as bodily care and assistance with housework There are needs to change working hours even if care recipients uses in-home care services. Exemption from overtime working Before Amendment Amended Regulation Until the end of caring Addressing daily caring such as bodily care and assistance with housework There are working carers who can work full time if they do not work overtime, and there might be part time working carers who would suffer from overtime work. Notes: For an outline of the Child Care and Family Care Leave Act, see: koyoukintou/pamphlet/32.html. The reasoning for the amendment is shown in MHLW (2015). 66

5 Supporting working carers job continuation in Japan can introduce their own systems to provide financial allowances that enable working carers to purchase professional care services. The new divisible Family Care Leave assumes that if care lasts for years, carers will need to rearrange ways of providing care, particularly in its middle and terminal phases. In a typical caring situation in Japan, providing care begins in the home; however, it often becomes necessary, in the middle phase of care, to transfer the person cared for to a care facility, and in its terminal phase, to move them to a hospital. The recent legislative amendment recognises that at these times, carers need to take Family Care Leave to arrange suitable facilities or hospital places for their family members. The flexible work measures and exemption from overtime are designed to support daily care even when public home care services are available, recognising that these services address only part of the care recipient s needs and that families still play a role in providing care (MHLW, 2015). Exemption from overtime is especially important for maintaining a daily routine in which work and care can be combined successfully. This is important in Japan, where workers are generally expected to regularly work overtime, an arrangement that can disturb their ability to provide care even when the carer does not need part-time hours. The new scheme thus aims to address working carers needs over a period of several years; in contrast, the original Family Care Leave system (when first introduced) aimed to enable workers to make arrangements for combining work and care, such as consulting other family members about how to organise caring roles, making arrangements to use public care services and adapting the home to make it suitable for the needs of an older or disabled person. It was designed to help employees make arrangements for emerging care needs, typically at the point when they first arise, and did not address their support needs when daily care lasts for a long period. In short, Japan has recognised that it needs to enhance support systems to respond to changing care needs across the entire period of care, from beginning to end; conventional Family Care Leave addresses the first months of long-term care but is insufficient to fully meet subsequent care needs. There are further challenges in supporting combined work and care, however. The first concerns providing care for a longer period of time. The amended Act makes flexible working measures available to carers for up to three years, in line with the average duration of family care for an older or disabled person. Not all carers complete their caring role within three years, however, and care can sometimes last for 10 years or longer. How should long-term care be supported when care lasts for more than three years? Could the period in which support is available be further extended? Attention is also needed to another aspect of combining work and care. Although the Child Care and Family Care Leave Act focuses on time management between work and providing care through taking leave and reducing working hours, providing care for older people is not so time consuming as, for example, the care of young children (Ikeda, 2013; JILPT, 2013). While the care of older family members can sometimes be managed mainly by working as usual, unlike childcare, this does not mean that it is easy to combine caring for an older person with paid work. Ikeda (2013, 2014, 2016a) has shown this to be an important social issue in Japan, which is affecting work in a new way. If working carers continue to work as usual, their health is often compromised through accumulated fatigue, physical exhaustion and mental stress (Ikeda, 2016a). 67

6 Shingou Ikeda While the Japanese government and researchers have focused on how working carers reconcile their working hours and time spent providing care, 7 less attention has been paid to how working carers health is affected if they do not take leave or change their working hours. In 2015, the Japan Institute for Labour Policy and Training (JILPT) showed that working carers who provide care on their days off, early in the morning or late at night feel substantial fatigue from doing so. Although the length of time spent caring each day also influences fatigue, this is not the main issue. Workers who provide care for less than three hours a day also feel fatigue, suggesting that those who do not take leave or change their working hours may be at risk of deteriorating health (JILPT, 2015). Problems of long-term care at home: hypothesis and method of analysis Hypotheses The analysis presented here suggests that there will be new challenges in providing support for working carers to retain their jobs, even after the implementation of the newly amended Child Care and Family Care Leave Act. The following hypotheses will be tested: 1. Family Care Leave and reducing working hours, such as part-time working or exemption from overtime working, have an influence on job continuation if the length of care at home is relatively short. 2. Flexibility in a working schedule, instead of taking Family Care Leave or having shorter working hours, is effective in allowing carers to continue their jobs if care at home is prolonged. 3. Carers health problems are a further factor in their job leaving, independent of their working hours. Ikeda s (2010) data analysis showed that the need for consecutive leave has a negative impact on carers job continuation, and that the length of working hours was also an important factor in remaining in the same job. The 2016 amendment of the Child Care and Family Care Leave Act takes account of these results. However, it seems likely that the causal factors that lead to quitting one s job to provide care will differ according to whether care is needed for longer than three years or for only a short period of time. Managing one s own work schedule to fulfil both care and work responsibilities may be more suitable than reduced working hours when combining work and care is likely to last for several years or longer. Reducing working hours, for example, to part-time work (a popular way of balancing work with family life, especially for women) has well-established disadvantages for the worker with respect to income and career progression (Matsubara, 2012). To protect workers from these disadvantages, it is best to keep the period of reduced hours as short as possible. In the care of older people, however, it is hard to predict how long care will be needed or when it will end. Carers with older family members sometimes need to take leave, arrive at work late or leave work early, although not usually every day. Some find that they can combine work with the care of an older family member without reducing their 68

7 Supporting working carers job continuation in Japan working hours as their relative can be left at home alone for a few hours, unlike small children, who cannot be left unsupervised (JILPT, 2015). Ikeda (2016b) points out that discretionary working that enables workers to control how much they work each day; how they develop their working schedule or what time they start and end their daily work is effective in enabling carers to stay in the same job. This kind of discretionary working applies only to some specific workers in Japan, however, such as professionals, managers and workers who are engaged in business planning. It is possible for workers in general to arrange their working schedule, even if they cannot change their daily working hours. Working carers are likely to benefit if they can move their work to another day in order to fulfil their care responsibilities, even if overtime work is necessary. Moreover, although earlier case studies (Naoi and Miyamae, 1995) showed that long-term care can cause workers to resign from their jobs because of deteriorating health caused by providing care, and Japan s Long-term Care Insurance System was established to reduce the burden of family care, studies by Shimizutani and Noguchi (2005) and by Fujisaki (2002) showed that the community care services provided through this system had only a modest effect on reducing the pressures of family care. In sum, working carers poorer health influences job resignations, and has an effect independent of managing working hours through Family Care Leave or a flexible working measure. Research has also shown negative impacts on carers health, especially when the cared-for family member has dementia. Ikeda (2016a) shows that physical fatigue has a negative impact on work performance, and that while fatigue may not be the immediate cause of workers leaving paid work, injury or illness caused by the pressure of providing care can lead them to resign from their jobs. To further explore this phenomenon, we need to focus on care in the home as this is especially important for working carers jobs and career retention, although the total duration of care (including time when the care recipient is in a care facility) is often what is discussed. It is quite common for care recipients to move from home to residential care if they need care over several years and their health condition worsens. Placing an older relative in a residential facility can relieve the carer of difficult or demanding care and enable them to avoid quitting work, and so the enhancement of residential care services may be important in enabling working carers to remain in their jobs. The supply of residential care is limited because of government budgetary constraints on public expenditure; however, if, as the older population grows, the availability of residential or hospital care falls short of meeting care needs, it will be necessary to consider how working carers can avoid leaving their jobs when care at home lasts for years. Method of analysis To test the hypotheses outlined earlier, we analyse data covering the whole period in which care is required. This is important as the full range of job retention problems can only be grasped if care provision is studied from its start to its end, especially as providing care normally becomes more demanding as time passes. The data used are from the Survey on Family Carer s Employment Status and Job Leaving conducted by JILPT; they are appropriate as the survey traces the process of providing care from the initial occurrence of care needs until the end. 69

8 Shingou Ikeda The outline of the survey is as follows. The scope of the survey includes those who engaged in long-term family care, who finished providing their care between April 1999 and July 2010, and who were aged when the care recipient ceased to need care. An Internet questionnaire survey was administered to respondents registered at an online survey company. The actual survey took place in July and August To correct sampling bias, the ratio of respondents employment status by sex and age, and job categories by sex at the end of care, were approximated to the result of the Employment Status Survey in 2012 (see Appendices 1 and 2). Concretely, the questionnaires were distributed to as many respondents as possible (without deciding the numbers for distribution in advance) from groups segmented by sex, age, employment status and job categories, until the numbers of respondents in each group reached the planned sample size. The following analyses focus on carers who provided care after 2000, when the Long-term Care Insurance System started. The descriptive statistics of the variables used in the following analysis are shown in Appendix 3. We continued to distribute questionnaires until the 2,000 respondents required by the design of the methodology had been obtained (JILPT, 2016). While, of course, a general sample survey would ideally be used, according to the 2012 Employment Status Survey (a nationwide Japanese government general survey undertaken by the Ministry of Internal Affairs and Communications), carers constitute only 4.2% of all employees. It was not possible, given the constraints of time and budget, to adequately correct the size of the sample of working carers to analyse the details of combining work and care in an ordinal general survey, so an Internet questionnaire survey was used as the best available alternative. In presenting the study results in this article, first, data on the length of total care and care at home are presented to show that the total duration of care is longer than the length of care at home because people tend to use residential care services, such as nursing homes, if care lasts for a long period. Such cases arise, for example, when care recipients have needs arising from a stroke or dementia, which are among the typical causal diseases of long-term care. Secondly, the tendency to leave one s job by length of care at home, is shown. Although leaving a job for reasons of family care is traditionally an issue for women s work, there are also male workers who leave their jobs to provide care, as the data confirms. In this article, we focus on continuing in the same job from the start of care to its end, setting this in the context of the Child Care and Family Care Leave Act, which aims to support workers to stay at the same job, consistent with the practice of long-term employment in Japan. In the internal Japanese labour market, and in Japanese employment practice, it is difficult for middle-aged workers to maintain their income if they change their jobs given the seniority wage rule. It is therefore crucial for workers to retain their employment with the same employer in order to maintain their benefits while they are engaged in family care. Guided by evidence, we focus on care at home that lasts more than three years to examine new challenges in enhancing support systems, asking Is it effective to provide the same support system for care at home that lasts less than three years as for care that lasts longer than this? A multivariate analysis was conducted to reveal the factors that affect remaining in work. In the first step, the total employment sample was analysed; two analyses were subsequently conducted to compare these factors by length of care at home. 70

9 Supporting working carers job continuation in Japan For the analysis, we used logistic regression analysis in which the explained variable is job continuation in the same company from the first occurrence of care needs to the end. The explanatory variables relevant to the hypotheses mentioned earlier are the need for long-term leave for caring, actual daily working hours, flexibility of own working schedule 8 and experiences of injury or disease linked to providing care. The need for long-term leave for caring, 9 based on previous analysis of Ikeda (2010), shows the necessity of Family Care Leave to avoid leaving one s job. We can say that carers need Family Care Leave to continue in their same jobs if the explanatory variable shows a significant negative impact on job continuation. The length of actual daily working hours is categorised as over eight hours, over six and under eight hours and six hours or less. Over eight hours means working overtime as legal working hours end after eight hours. The typical length of part-time work is six hours or less. Over eight hours is used as the benchmark in the estimation. If over six and under eight hours or six hours or less show a significant positive effect, we can say that the exemption from overtime work is supported, and if six hours or less shows a significant positive effect, we can say that part-time working is effective. The flexibility of one s own working schedule, and experiences of injury or disease linked to providing care, are dummy variables (Yes = 1, No = 0). Data are available on the attributes of the carers (sex, age when care first began and at its end, and educational background), the care recipient s condition and characteristics when the care need first arose (family relationship, causal disease, other family members who provide care and voluntary wish to provide care), working status (which refers to either regular or non-regular employees such as fixed-term employees), and job categories at the first occurrence of care needs. Age, sex, and educational background are basic attributes affecting job turnover. For age, job turnover decreases if workers are ageing, but there is a mandatory retirement system for older workers in Japan. Age at first occurrence of care is used to see the influence of young workers job turnover, and age at the end of care is used to identify those of retirement age. Working status and job categories also affect job turnover. The care recipient s condition and the presence of other family carers affect the burden of care. Relationships with the care recipient and the presence of other family members are related to gender, but care roles are found among male as well as female workers, consistent with reductions in family and household size, as previously explained. The duration of care at home is also considered as an explanatory variable in the analysis of the total sample, to verify its negative effect on job continuation. We also compared the effects of care at home which lasted less than three years, with care at home for longer than three years, which is the length of caring the Child Care and Family Care Leave Act assumes. Determinant factors affecting the job resignation of working carers In the analysis, the duration of care at home was first compared with the total length of the care period (that is, care at home and care in a facility, hereafter referred to as total care ). Figure 1 shows the lengths of total care (its duration from the initial occurrence of care needs to their end) and of care at home (the period during which the care recipient was living at home). As is well known, long-term care can last for over 10 years, as Figure 1 shows. The maximum length of care at home, however, is between four and five years, and its mean duration is 18.0 months, compared with 71

10 Shingou Ikeda 39.5 months for total care. In short, the duration of care at home (the type of care that presents a particular and serious problem for those combining work and family care) is considerably shorter than the total care period. Figure 2 shows that the total length of care is longest for those caring for a person whose causal disease is a stroke, disability or dementia. Care at home is no longer in these cases than for people with other kinds of causal disease, however, although time spent in residential care is much longer, implying that residential care is necessary when care extends over many years. Figure 3 shows the proportion of working carers who continued to work in the same company, from when the care need first began to its end, by the duration of care at home. Three years seems to be a critical point for combining work and care. There is little discernible difference between those whose care lasted under one year and between two and three years ; however, job retention is lower when care lasts between three and four years, and is lower still for between four and five years. There is also a notable gender gap in job continuation. Female workers have lower job continuity than male workers, for all durations of care. While women are known to undertake a heavier burden of care, men too have recently come to experience care responsibilities; in our data 19.2% of female carers are sole carers, while the figure for male carers is 11.2% (the tables and figures to support this claim are not included here). It seems possible that gender may become less relevant to job leaving as increasing numbers of male workers become sole carers. The results of the multivariate analysis of the data collected are shown in Table 2. We can first point out the control variables. In the results for the entire sample, age, being a sole carer, and type of employment were all significant, consistent with previous research. The reason that sex is not significant is because the concept of sole carer contains a gender bias. Duration of care at home is also significant, that is, the probability of job continuation decreases when care at home lasts more than three years, consistent with Figure 3. Based on the results, the data for those whose care lasted under three years and over three years was then compared. Age, sole carers and type of employment were also significant in the results for under three years, but not for over three years. Further, in the results for those caring for under three years, we found a positive significant effect on job continuation if the care recipient s causal disease was dementia, compared to stroke. Ikeda (2010) showed that dementia has a negative impact on job continuity if the condition is advanced. Figure 1: The rate of the total length of care and in-home care periods Total care period (N = 1,889) In-home care period (N = 1,968) % Under 1 year Between 1 and 2 years 13.2 Between 2 and 3 years 9.4 (Mean = 39.5 months) Between 3 and 4 years 8.3 Between 4 and 5 years Between 5 and 10 years Over 10 years (Mean = 18.0 months) Source: JILPT (2016). 72

11 Supporting working carers job continuation in Japan Figure 2: The rate of total length of care, in-home care and residential care by causal disease of care recipient 0% 20% 40% 60% 80% 100% Total** Under 1 year Between 1 and 3 years Over 3 years Mean Dementia (N = 205) 13.7% 28.3% 58.0% (53.0) Disability (Physical/mental) (N = 50) 18.0% 28.0% 54.0% (45.7) Stroke (N = 147) 17.7% 32.0% 50.3% (54.2) Senile Decay (N = 109) 28.4% 22.0% 49.5% (41.4) Fracture, Tumble (N = 111) 36.0% 23.4% 40.5% (38.3) Cancer (N = 205) 59.0% 29.8% 11.2% (17.1) Other (N = 288) 28.8% 33.3% 37.8% (37.9) In Home** Dementia (N = 225) 48.4% 28.4% 23.1% (21.9) Disability (Physical/mental) (N = 52) 55.8% 15.4% 28.8% (19.0) Stroke (N = 157) 58.0% 21.7% 20.4% (19.8) Senile Decay (N = 113) 52.2% 21.2% 26.5% (22.0) Fracture, Tumble (N = 123) 58.5% 19.5% 220% (18.1) Cancer (N = 206) 79.1% 17.0% 3.9% (9.1) Others (N = 299) 51.5% 28.1% 20.4% (18.6) Residential* Dementia (N = 131) 30.5% 34.4% 35.1% (21.2) Disability (Physical/mental) (N = 20) 35.0% 40.0% 25.0% (16.6) Stroke (N = 70) 24.3% 42.9% 32.9% (21.4) Senile Decay (N = 34) 55.9% 32.4% 11.8% (9.3) Fracture, Tumble (N = 49) 42.9% 30.6% 26.5% (12.8) Cancer (N = 21) 61.9% 23.8% 14.3% (4.6) (11.4) Notes: ** chi-square < 1%; * chi-square < 5%. Source: JILPT (2016). Figure 3: The rate of job continuation by in-home care period among male and female employees at the occurrence of care needs Total (N = 1161)** Length of in-home care Under 1 year (N = 665)* 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 82.8% 87.3% 79.9% 87.1% Total Male Female Between 1 and 2 years (N = 163) Between 2 and 3 years (N = 110) Between 3 and 4 years (N = 64) Between 4 and 5 years (N = 159)* 67.3% 61.4% 81.6% 82.9% 80.6% 84.5% 91.2% 81.6% 76.6% 75.0% 77.5% 77.6% Notes: ** chi-square < 1%; * chi-square < 5% (between male and female). Source: JILPT (2016). 73

12 Shingou Ikeda By contrast, it may be possible for carers to continue in their work if progression of dementia is slower. In the results for care lasting over three years, senile decay had a negative impact. It might be hard to foresee when caring ends in such cases. Job category also shows a significant effect, with service workers tending to continue in the same jobs, compared to blue-collar workers. A service worker s working style is more flexible than that of a blue-collar worker, and we can assume that this is reflected in the results for service workers. To examine the hypotheses mentioned earlier, we focus on the results of the entire sample with reference to the needs for long-term leave, daily working hours, experiences of injury and health problems caused by providing care, all of which have statistically significant effects on job continuation. These imply that Family Care Leave, part-time work and exemption from overtime work are elements of the Child Care and Family Care Leave Act that are effective in supporting job continuity. That is to say, the negative effect of working carers expressed need for long-term leave (time away from work to provide care) implies that Family Care Leave is necessary Table 2: Determinant factors of job continuation from the occurrence of care needs to the end (logistic regression analysis) Explained variables (Yes = 1, No = 0) Job continuation from the occurrence of care needs to the end Length of In -home Care Entire sample Under 3 years Over 3 years B SE Exp(B) B SE Exp(B) B SE Exp(B) Sex Male=1, Female= Carers' Age at Occurrence of Care Needs ** * Carers' Age at End of Care ** * Educational Background High school (BM) Junior College University or Graduate School Causal Disease of Recipient Stroke (BM) Dementia * Disability (physical, mental) Senile Decay * Fracture, Tumble Cancer Others Care Recipient (Parents in Law = 1, Others = 0) Sole Carers (Yes = 1, No = 0) ** ** Type of Employment (Regular = 1, Non-regular = 0) ** ** Job Categories Blue Collar (BM) Professional, Manager Clerical Sales Services * Need for Long -term Leave (Yes = 1, No = 0) * ** Length of Daily Working Hours Over 8 Hours (BM) 6 Hours or Less * ** Over 6 and Less Than 8 Hours Flexibility of Own Working Schedule (Yes = 1, No = 0) ** ** Experiences of Injury or Disease from Providing Care ** ** * Length of In -home Care Under 1 Year Between 1 and 3 Years Over 3 Years * * Chi-Square ** ** * DF N Notes: Need for long term leave: need for consecutive leave over one week to provide care. Scope of analysis: employees at the occurrence of care needs. BM = benchmark. ** p <.01; * p <.05. Source: JILPT (2016). 74

13 Supporting working carers job continuation in Japan to prevent workers from leaving their jobs. The positive effects of working under six hours, compared to those of working over eight hours, imply that part-time working and exemption from overtime work are important. In addition, we find that negative impacts on carer s health are a new issue not addressed in this legislation. We also find that the factors which are determinant for job continuation differ by duration of care at home. The needs of long-term care have a positive, significant effect on job continuation when care at home lasts for less than three years, but not if it continues for more than three years. Daily working hours when care begins also have an impact on job continuation when care at home lasts for less than three years. However, the flexibility of the working schedule has a positive effect on job continuation if care at home lasts for more than three years. Experiencing an injury or health problem caused by providing care has an impact irrespective of the duration of care at home. These results confirm the preceding hypotheses. Conclusions This article has discussed the challenges of providing support for combining work and care for older people in Japan. The need to support working carers will become a more serious problem as the number of older people increases in the future. The Japanese government has legislated Family Care Leave and flexible working measures to enable workers who are providing long-term care to avoid resigning from their jobs. The article discussed the effects of these support systems and investigated future challenges. The results of the data analysis can be summarised as follows: 1. Long-term leave for caring and shorter daily working hours both have a positive effect on job continuation when care at home lasts for less than three years. 2. If the length of care at home is longer than three years, the flexibility of the working schedule, rather than Family Care Leave and daily working hours, has a positive effect. 3. Experiencing an injury or health problem caused by providing care has a negative impact on job continuation, irrespective of the duration of care at home. We can conclude, first, that Family Care Leave is a vital support system for working carers who seek to continue their jobs, alongside the part-time work and exemption from overtime options that are provided for in the Child Care and Family Care Leave Act. Family Care Leave has been enacted to facilitate combining work and care, typically at the beginning of care provision, when the carer needs to learn about the procedures involved in using public care services, or to consult other family members about sharing care responsibilities; the reduction of daily working hours is also necessary to retain employment. It is appropriate for the needs of working carers that the 2016 amendment to the Child Care and Family Care Leave Act added an exemption from overtime work and expanded the period in which the working carer can claim flexible working for up to three years. However, our results indicate that support for carers with prolonged care tasks at home need to be reconsidered because enhancing Family Care Leave and reducing daily working hours are not sufficient to help working carers retain their careers. While it is also crucial to work flexibly if care at home lasts for a prolonged period, the focus needs to shift to flexibility in the working schedule by managing employees progress 75

14 Shingou Ikeda in addressing care needs, even if they need to work overtime, rather than focusing on the length of working hours needed to fulfil both work and care responsibilities. It would be helpful if working carers were entitled to decide for themselves how they will carry out their work schedule. In the case of relatively short-term care (less than three years), it might be possible to balance work with providing care without a flexible working schedule if carers can shorten their working hours. However, working for shorter hours for many years will be a disadvantage in maintaining and developing their careers. It is important that employees contribute to their work duties as much as possible, even if they provide care to a family member living at home. In this case, the flexibility of the working schedule is likely to be more beneficial than part-time work, as is an exemption from overtime work for workers who are engaged in providing care over long periods. It is important to change the way we support working carers to accommodate the length of time during which care is provided at home. Furthermore, we must note another issue that the Child Care and Family Care Leave Act does not consider. The present discussion on work life balance in Japan mainly focuses on time management between work and private life, which requires arranging one s working hours to allow for a private life. One of the origins of this is the discussion on working mothers caring for an infant who cannot be left alone in the home. The Act designs regulations from this perspective. While it is also necessary to take leave and arrange working hours to combine work with the care of older people, time management needs are less restrictive than when caring for a child as some older care recipients can be left alone at home for several hours. However, some working carers suffer from the burden of providing care at night, or provide care during their holidays, and many workers do not take leave or rearrange their working hours. Consequently, some working carers resign from their jobs as a result of injury or health problems caused by providing care. In sum, although it seems likely that the recent enhancement to the regulations will be effective in improving support for working carers and help them to remain in their careers, some challenges remain to be addressed because of restrictions in the supply of public residential care services. It is important to bear in mind that care of an older person or disabled adult is inherently different from childcare. In care of older people, it is often hard to predict how long the recipient s health condition will last and when they will finish receiving care, whereas predicting how children will grow and what will happen in their lives is much easier. It is better to construct support systems that enable carers to work as normally as possible to address longlasting care at home. Flexibility of working schedules is likely to be the key concept, rather than length of leave and working hours. We must also consider the possibility that carers who come to work usually face difficulties because of worsening health conditions that are caused or exacerbated by providing care. This is not usually an issue when balancing work with childcare. Future research should investigate further challenges given these considerations. Finally, a limitation of this article should be noted. We cannot assume reverse causality between these explanatory and explained factors, as analyses in this article do not reveal direct causal relations. Further evidence from analysing panel data sets collected by general sampling is needed as retrospective data collected using an Internet questionnaire survey were used in this study. 76

15 Supporting working carers job continuation in Japan This article is based on JILPT (2016) conducted in Japan as an original survey by Japan Institute for Labour Policy and Training with its own fund. Notes 1. In general usage, family care may include childcare, but the policies of the Japanese government and employers distinguish childcare and family care, using the latter to refer to care provided to elderly or disabled family members; this is the meaning of family care in this article. 2. The aims of the Family Care Leave system are indicated in the Ministry of Labour Women s Bureau (1994), which explains that three months is the ordinal length of the acute phase of stroke, which is a typical causal disease of long-term care. Although the Family Care Leave system does not focus on the care of older people, but includes family members with disabilities, this article mainly considers the care of older people as combining work and care becomes a social issue in light of population ageing. 3. In the Japanese Long-term Care Insurance System, care services are provided by non-profit or for-profit private organisations, although they are financed by the public insurance fund. 4. A survey on combining work and care conducted by the Tokyo Metropolitan Government in 2014 shows that about a half of middle- or small-sized enterprises recognise employees family care as a crucial management matter. 5. The Employment Status Survey is a nationwide government survey in Japan conducted by the Ministry of Internal Affairs and Communications. 6. The working group s discussion of the amendment in 2009 is published by the Ministry of Health, Labour and Welfare Equal Employment, Children and Families Bureau (MHLW, 2008). 7. Similar discussions can be seen in European countries (Phillips, 1995; OECD, 2011). 8. Flexibility of working schedule refers to whether workers can decide their own working schedule. 9. The need for long-term leave for caring is defined as the need for consecutive leave of over one week to provide care, as workers can use time off for care when they face the need for leave of less than one week. The questionnaire item is: How much consecutive leave did you need for providing care? Please answer the term you think necessary, regardless of your actual leave taking. References Brody, E.M., Kleban, M.H., Johnsen, P.T., Hoffman, C. and Schoonover, C.B. (1987) Work status and parent care: a comparison of four groups of women, The Gerontologist, 27(2): Cabinet Office (2016) White paper on aged society, Tokyo: Nikkei Printing Inc (in Japanese). Ettner, S.L. (1996) The opportunity costs of elder care, The Journal of Human Resources, 31(1): Evandrou, M. (1995) Employment and care, paid and unpaid work: the socioeconomic position of informal carers in Britain, in J. Phillips (ed) Working carers: International perspectives on working and caring for older people, Hants: Ashgate Publishing, pp Fujisaki, H. (2002) Introduction of care insurance system and family care, in I. Kaneko (ed) Aging and childless society, Kyoto: Minerva Publishing, pp