The Care of the Elderly in Japan (review)

This is a fascinating book originating from the author's doctoral work, which cleverly marries a broader conceptual framework with detailed analysis of her case study. As the author claims, this is the first English publication of an anthropological study on Japanese institutional care for the elderly by a Chinese researcher. In terms of provision of care for the elderly, Japan indeed represents a good case study for other neighboring countries in East Asia due to its advanced stage of population aging, the changing structure and function of the family, and its well-established welfare systems. However, despite what the opening paragraphs imply, the aim of this book is not about what China can learn from Japanese institutional care and welfare policy (in fact, the comparison with and reflection on Chinese examples are kept to a minimum). The strength of the book lies in its rich description, illustration, and analysis of daily life in a Japanese long-term care institution.

The anthropological case study is based on six months of fieldwork in a comprehensive welfare institution named Kotobuki in a residential city of Tokyo. The institution comprises three types of residential facilities, differentiated according to the health status and income levels of their residents: Akashia is a residential home providing one private room per person, and low-income elders tend to enter Akashia on contract—they pay fees rather than being allocated by the welfare office; Sazanka provides shared rooms for those who are often "the weak of society"; and residents with severe physical and mental disabilities live in Aoba. The three different types of facilities serve as an important analytical tool. There are critical distinctions among the residents regarding their rights to reside in the home and their views toward receiving care. For example, some "fee-paying customers" voice their concern and take more action (for example, over the admission policy); and the author observed varying degrees of social interaction among residents and between residents and staff, and also varying levels of tolerance and appreciation toward fellow residents and the staff. As stated in the foreword, the author analyzes the full range of roles and relationships that affect those who live, visit, and work at Kotobuki, placing all in the context of the wider values, attitudes, and policies of contemporary Japanese society.

The book has eight chapters. The introduction begins with background information on aging in Japan, a conceptual framework including the use of the Quality of Life (QOL) debate and methodological approach. Chapter two provides general information on Kotobuki such as its history, location, the sociodemographic background of the residents, and the daily routine of the home. The following three chapters—three, four, and five—present an account of the residents, the staff, and the visitors, respectively. The narratives of five residents in chapter three echo some of my own findings regarding the life histories of the residents and how family relations and other factors shape their housing destinations.¹ In those chapters, different views are expressed by different actors involved in the institution toward institutional life, institutionalization, and social welfare. Three chapters are well structured and well written and the author successfully sheds light on institutional life and issues arising from institutionalization.

Chapter six deals with two kinds of conflicts and discusses how the limitations of the home, such as the lack of privacy, affected the quality of life of both mental and ordinary residents. The fieldwork was conducted in 1999 before the new social insurance on long-term care (LTCI) was introduced in Japan in 2000. All the data the author collected were therefore under the pre-LTCI regime. In this context, chapter seven appears to be added to update the situations highlighting some significant changes that have taken place in the home and accompanying views of selected staff members. This chapter, although informative, is not of the same quality as the previous chapters in terms of the level of analysis and the depth of data. The concluding chapter summarizes...