Human Resources in Long-Term Care Services - Japan s Case - MASAHIRO MORI NY Representative for MHLW, Japan
In 2060, the total population will drop below 90 million while the aging population ratio will exceed 40%. Population (million) 140 Productive age (15 64 years old) population ratio 120 Actual figure (National Census) 127.0mln (*1) Figures estimated in 2012 (Population estimated of Japan) 116.6 mln 100 80 60 40 20 0 Population of 15-64 years Population of 14 years old and below Aging population (65 years old and above) ratio 1950 1960 1970 1980 1990 2000 2010 20142015 2025 2035 2045 2055 61.3% *1 26.0% *1 1.42 (2014) 36.8 mln 67.7 mln 12.0 mln Population of 65 years old and above Total fertility rate 86.7mln 34.6mln 44.1 mln 7.9 mln Productive age population ratio 50.9% Aging population ratio 39.9% Sources: Ministry of Internal Affairs and Communications National Census and Population Statistics, National Institute of Population and Social Security Research Future Population Projections for Japan (January 2012 estimate): Moderate-range Projects for Births and Deaths (Each year s population is as of October 1) Ministry of Health, Labour and Welfare Population Survey Report (*1) Source: Ministry of Internal Affairs and Communications, FY2014 Population Estimates (The 2010 Population Census shows Japan has a population of 128,060,000, a productive-age population ratio of 63.8%, and a population aging rate of 23.0%.) 1 Total fertility rate 1.35
In 2025, all baby boomers reach the age of 75. Age 1990 (Actual figure) 2014 (Actual figure) 2025 2060 Total population: 123.61 million Total population: 127.08 million Total population: 120.66 million Total population: 86.74 million 75 65 People 75 years old and above: 597 (5%) People 65-74 years old: 892 (7%) People 75 years old and above: 1,592 (13%) Baby boomers (born in 1947-49) People 65-74 years old: 1,708 (13%) People 75 years old and above: 2,179 (18%) People 65-74 years old: 1,479 (12%) People 75 years old and above: 2,336 (27%) People 65-74 years old: 1,128 (13%) People 20-64 years old: 7,590 (61%) People 20-64 years old: 7,184 (56%) People 20-64 years old: 6,559 (54%) People 20-64 years old: 4,105 (47%) 20 Second-generation baby boomers (born in 1971-74) People 19 years old and below: 3,249 (26%) People 19 years old and below: 2,224 (17%) People 19 years old and below: 1,849 (15%) People 19 years old and below: 1,104 (13%) 0 50 100 150 200 250 50 100 150 200 0 50 100 150 200 250 10,000 10,000 10,000 10,000 (Source) Ministry of Internal Affairs and Communications National Census and Population Statistics, National Institute of Population and Social Security Research Future Population Projections for Japan (January 2012 estimate): Moderate Projections for Births and Deaths (Each year s population is as of October 1) 0 250 0 50 100 150 200 250 2
The number of employees for long-term care services has tripled since long term care insurance system was implemented. (thousand) employee 2.000 1.500 1.000 500 0 549 2,180 訪問系 In- home service 通所系 Day care service 入所系 facility service 小規模多機能型居宅介 Multi functional service 護など 3.480 2,580 635 180 (32.8%) 237 4.8(8.7%) 59 3,030 724 277 72 849 342 88 321 339 375 419 (58.5%) 3,870 964 368 104 492 4,110 1,086 413 125 548 4,350 4,410 1,141 397 141 603 1,196 391 (32.7%) 4,550 371 155 166 (13.0%) 640 678 (53.5%) 4,690 423 190 4,870 432 210 5,080 458 230 724 753 782 5,330 485 264 5,640 502 286 836 869 5,860 507 (28.7%) 306 (17.3%) 895 (50.7%) 10(0.8%) 18 27 32 40 45 50 56(3.2%) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 1,233 1,363 1,427 1,509 People requiring care (thousand) 1,630 1,708 1,765 6.000 5.000 4.000 3.000 2.000 1.000 0 Source: MHLW 3
The job to application ratio in long term care service sector is higher than all other industry average. Job to application ratio 4 (times) 3,5 3 2,5 2 Industry average Long term care service 1,5 1 0,5 0 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 *) FY2010: the ratio is calculated without Iwate, Miyagi and Fukushima Prefecture due to Tohoku Earthquake and Tsunami *) Source: Statistics for Employment Stabilization by Ministry of Health, Labour and Welfare, Workforce Research by Ministry of Internal and Communications 4
Labor force is expected to decrease by 7.9M in 15years. Assuming that the labor force rate increases with appropriate economic growth, the decrease would be 1.8M. Labor Force Simulation (2020 & 2030, Male & female total) 63.5 million 60.5 million (-3.1 million) 63.8 million (+ 0.3 million) 55.6 million (-7.9 million) 61.7 million (- 1.8 million) Increase by 3.4 million Increase by 6.1 million 60 yrs or above 12.3 11.4 +1.4 million 12.8 11.3 +2.8 million 14.1 30 59 yrs old 40.7 39.3 40.8 +1.5 million 35.4 +2.4 million 37.8 15 29 yrs old 10.4 9.8 10.2 8.9 9.8 +0.4 million +0.9 million ((Actual) 実績値 ) (Scenario) 経済成長と労働参加が Stagnant (Scenario) 経済成長と労働参加が Appropriate 経済成長と労働参加が (Scenario) Stagnant (Scenario) 経済成長と労働参加が Appropriate economic 適切に進まないケース growth and economic 適切に進むケース growth and 適切に進まないケース economic growth and economic 適切に進むケース growth and 2014 年 labor force participation labor force participation labor force participation labor force participation 2020 年 2030 年 2020 2020 2030 Scra Source; MHLW and JILPT 5
The number of employees in health and welfare sector will be equivalent to that of retail and whole sale sector in 2030. 30% of nurses, 40% of certified care workers, and 60% of nursery teachers do not work despite having professional licenses. (Million) 12 10 8 6 11,0 7,5 10,0 10,6 10,3 8,6 9,9 9,6 9,6 4 2 0 5,1 4,8 4,2 Mining/Construction Manufacturing Retail/whole sale Medical/Welfare 2014 2020 2030 Source; MHLW 6
More than 1 million workers increase is required by 2025. Nurses; 1.6M in 2014 1.96 2.06M in 2025 Care Worker; 1.71M in 2013 2.31M in 2020 2.53M + α in 2025 7
8 Care worker wages are lower than the average of all industries. By Industry By Occupation Average age Total Male Female Years of employme nt Monthly salary Male compositi on Average age Years of employme nt Monthly salary Female compositi on Average age Year of employme nt Monthly salary (year) (JPY/000) (%) (year) (JPY/000) (%) (year) (JPY/000) Industry total 42.3 12.1 333.3 66.6 43.1 13.5 370.3 33.4 40.7 9.4 259.6 Medical/welfare 40.9 8.3 301.5 28.1 40.6 8.6 379.4 71.9 41.0 8.2 271.0 Social insurance/social welfare/nursing care 41.7 7.6 246.5 29.6 40.6 7.8 277.6 70.4 42.2 7.5 233.4 Service 44.6 9.4 282.1 70.0 45.9 10.1 305.3 30.0 41.7 7.5 227.9 Doctor 40.0 5.1 848.4 73.8 41.1 5.3 910.6 26.2 37.0 4.4 673.2 Nurse 38.2 7.8 329.2 9.3 35.2 6.7 335.3 90.7 38.5 7.9 328.6 Assistant nurse 48.3 10.9 277.4 9.1 41.5 10.0 292.0 90.9 49.0 10.9 275.9 Physical therapist/occupational 31.5 5.3 284.0 53.7 31.9 5.2 292.1 46.2 31.1 5.3 274.7 therapist Nursery staff 35.0 7.6 219.2 5.3 30.9 5.8 238.2 94.7 35.2 7.7 218.2 Care manager 47.0 8.7 261.6 27.5 42.2 7.8 281.7 72.5 48.9 9.1 254.0 Home helper 45.3 6.6 225.1 22.2 37.5 4.3 237.7 77.8 47.6 7.2 221.5 Welfare service worker 39.7 6.0 223.5 34.4 37.3 5.9 238.8 65.6 41.0 6.1 215.5 Source: MHLW
9 New hiring rate and turn over rate are relatively higher than the average. (%) 30 25 27,4 Comparison of New Hiring Rate 25,2 25,8 22,6 21,0 23,3 21,7 20,6 20 15 15,9 14,2 15,5 14,3 14,2 14,8 16,3 17,3 10 Industry ave. Care workers 2007 2008 2009 2010 2011 2012 2013 2014 (%) 30 Comparison of Turnover Rate Inustry average Care worker 25 21,6 20 18,7 17,0 17,8 16,1 17,0 16,6 16,5 15 10 15,4 14,6 16,4 14,5 14,4 14,8 15,6 15,5 2007 2008 2009 2010 2011 2012 2013 2014 Source; MHLW andcare Worker Foundation
Marriage/Child rearing, Workplace policies, and Relationship with other workers are the main reasons for leaving their jobs. 40% 31,7% 30% 25,0% 24,7% 23,5% 22,0% 20% 18,9% 19,7% 14,3% 13,2% 13,1% 12,2% 10,9% 10% 5,3% 4,2% 3,7% 2,0% 0,9% 0% Others Estabished own business Personal issue with other family member Restructuring, layoff, liquidation Obtained certificate/qualification Relocation of family member wanted to experience diffferent job Lack of career development Elderly care Could not develop expterise fully Backache Dissatisfied with work hours/holiday/work shift Health problem (excl. backache), reached retiring age Low salary Relationship with other workers dissatisfied with workplace policies Marriage, Childbirth, Childrear Source; Social Welfare Promotion and National Examination Center 10
11 Target goal is Mt. Fuji shape which has broader entrance as well as higher and more clear career ladder. Highly Professional Future career path is not visionary Basic Level Limited entry Function between professional and no professional is mixed up High turnover Limited entry Not labor force with licenses
12 Wage increase is supported through long-term care insurance system. Wage Increase (reimbursement price premium ($270)) No refund educational loan Registry System for licensed care workers leaving the industry Maternity Leave and Child Care Services
13 Improving expertise of care workers will bring productivity increase Care workers with training are allowed to conduct sputum suction. Nurses with training are allowed to conduct specified medical treatment such as Decubitus removal, Drain removal, Quantity adjustment of insulin injection Visualize capability and expertise of care workers Career Grade System for long term care services was introduced. Higher Productivity will result in Higher wages
14 Optimizing the allocation of human resources is required Non-professional workers such as retired, community volunteer will be utilized for shopping/walking support, cooking and cleaning. Service revision for people with lower care needs. (More preventive, More independent, More improvement)
15 Professional Long Term Care Career Grades Level Features 7 Top Professional as representative of each sector Professional Level 6 Highly professional, originality of care services 5 4 Excises leadership in a team 3 Independently providing services without direction. 2 Providing services with direction. 1 Finished Basic Training
Welfare service vision with response to demand of new era was released in Sep 2016. Family issue is more complicated and more cross sectoral System is working sector by sector child welfare long term care welfare for disabled welfare for low income family Shrinking demographic will cause shortage of human resources and infrastructure in welfare services 16
Comprehensive consultation system Multi generational and functional service center Comprehensive educational system for multi functional services Introduction of Innovation as well as improvement of service flow efficiency 17
Create community where individuals supports everyone mutually. There is no distinction between supporter and supported in such community. This concept will lead us to Inclusive society. 18
19 Case 1 Case 2
Case 3 20
We are planning to create a common curriculum between licenses License A License B License C A B C Common Curriculum 3 years 2 years Complicated case Efficient allocation Mobility increase New career ladder Example of Licenses Health Care Nurse OT PT ST ORT Radiology Technologist Clinical Laboratory Technologist Welfare Certified Social Worker Certified Care Worker PSW Nursery Teacher 21
22 Number of Immigration by EPA(as of 2016/1/1) Number of Immigration Accepted Candidates Working Contract terminated & left Japan Total Qualification Obtained Working (number of immigration) Contract terminated & left Japan Indonesia 966 528 224 214 135 79 Philippines 885 502 242 141 115 26 Vietnam 255 253 2 - - - Total 2106 1283 468 355 250 105 Source: JICWELS
Long term care robot development promotion project Needs and Seed Matching Project Idea Providing information on proposal from on site workers Practical Trial Supporting Project Development Monitoring Research Project for Development of Service Method Marketing Deployment of effective utilization of the robot Campaign on outcome of trail use 23
Okayama city was designated as Special Zone for Home Care Service Model Development Robots and various devices to support home care PARO(Seal type therapeutic robot) Sensor Mattress Power Assist Gloves PARO react human s touch and voice, which improves cognitive symptoms JPY3,000/month (excl. tax) Target user: People requiring care (level 1-5) Kabo-can (Communication Robot) Sensor mattress monitors caretaker s daily life via tablet/mobile phone JPY1,780/month (excl. tax) Target user: People requiring care (level 1-5) Rakunie (Lamber Support Wear) Support grasping movement by air pressure JPY1,700/month (excl. tax) Target user: People requiring care (level 1-5), People requiring support (level 1-2) One hand walking assist Improve cognitive symptoms through communication with Kabo-can JPY150 /month (excl. tax) Target user: People requiring care (level 1-5), people requiring support (level 1-2) Help care giver s physical burden JPY600 /month (excl. tax) Target user: People requiring care (level 1-5), people requiring support (level 1-2) and care givers Help the half-paralyzed to stand and walk JPY350 /month (excl. tax) Target user: People requiring care (level 1-2), people requiring support (level 1-2) Source: Okayama City Government 24
Walking Assist Walking Assist Robot RT.1 Walking Assist ACSIVE Toileting Aids Auto-wrapping defecation treatment system This power walking robot assists you with curve or slope. GPS tracking function supports home care. JPY1,500/month (excl. tax) Medication Aids Robot Medication Aids Robot It doesn't require the use of electricity nor motor, but is powered by a cam spring mechanism. JPY1,000/month (excl. tax) Medication Aids Home medication aids Take medicine! Auto-wrapping defecation treatment using thermocompression reduces care giver s burden. JPY800/month (excl. tax) Everyday Life Support Tatami customized for care takers Barrier-free Slope Voice and screen display reminds you of taking the medication. JPY1,500/month (excl. tax) Source: Okayama City Government Digital light and voice reminds of you medication time and details. JPY800/month (excl. tax) Barrier-free tatami helps wheelchair users to move at home or nursing home. 24 JPY850/month (excl. tax)
DBD has dropped dramatically after 6 month use of PARO DBD 23.2 点 points month 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14-5 -10-15 -20-25 Source; Okayama city 26
Ms. A case Age 90, Female Care need 5 (highest) Dementia Independency Ⅳ (Second highest) Abusive to care workers Strong demand to be spoiled by her son Outstanding improvement was seen in 13 month use of PARO DBM 20 16 NM scale 17 21 Zarit 40 13 Source: Okayama City Government 27