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  • The Care of Older People: England and Japan, A Comparative Studyby Mayumi Hayashi
  • Iza Kavedžija
Mayumi Hayashi. The Care of Older People: England and Japan, A Comparative Study. Studies for the Society for the Social History of Medicine. London: Pickering & Chatto, 2013. xiii + 291 pp. Ill. $99.00 (978-1-84893-417-7).

In the context of rapidly aging populations, this comparative study of care for older members of Japanese and English societies is a timely contribution to the study of the policy and practice of residential care. The book offers a historical overview of policies and provision in both settings, focusing on continuities and changes, as well as challenges on the national, regional, and local levels. It is clearly structured, with three paired sets of chapters: the first two chapters outline, respectively, the English and Japanese national contexts; the second two take a regional perspective, with Norfolk and Gifu Prefecture selected as examples; while the third pair explores case studies in particular institutional settings in Norfolk and Gifu, focusing on the delivery of care and, to an extent, providing insight into the perspectives of the residents and staff by including their own voices.

The comparative approach highlights similarities and differences between the systems in the two countries, and cultural specificities embodied in policy and legislation. For example, while the postwar legislation in the United Kingdom emphasized the responsibility of the state and the universality of care provision, the more restrictive Japanese provision focused on the neediest and those without family support, reflecting cultural values of family responsibility. The shift of focus of responsibility for the welfare of older people, away from the family and toward the state, occurred much later, with the socialization of care with the introduction of long-term care insurance. It could be argued that the shift was only partial and a reverse trend can already be observed, as Japanese officials and local governments attempt to shift some responsibility back to the families, communities and volunteers. That said, the overarching analysis of trends in policy and practice is not the main aim of this book, a point to which I will return below.

The author emphatically argues for a multilayered approach, one that encompasses data from the national, regional, and local levels, and thus moves beyond policy toward implementation and everyday provision. The case studies provided [End Page 147]in chapters 5 and 6, focusing on particular localities and residential settings, reveal the shortcomings of an analysis of the macro level alone, particularly one that focuses exclusively on statutory provision and excludes other forms of support, such as in the health and social care sectors. For instance, the author indicates that the contrast between Japanese family-oriented values and the assumed breakdown of family support in England may be overstated. In fact, at times older people in Japan faced considerable abuse or lack of support in their families, and the proportion of older people in residential care may have been underestimated if the large numbers of “socially hospitalized” were not included, while in England “poor quality evidence of family care and assumptions about the breakdown of the nuclear family may have led to an underestimation of how much the family actually contributes to caring for older people” (p. 182). Sometimes these misconceptions have far-reaching consequences, as these faulty analyses may support or perpetuate certain serious shortcomings in the provision of care.

While the book offers a meticulous and a systematic account of many of the features of both systems, including an overview of policies and their translation on the local level through detailed case studies, it does not pursue detailed critical evaluation of the policies, trends in legislation, or practices. A more explicit comparative analysis is offered in the conclusion, yet as the author is very careful in drawing her conclusions, it raises more questions than it attempts to answer. Rather than offering a novel policy analysis or a critical reading with a theoretical or ideological agenda, the book provides a detailed and nuanced description of historical changes, supported with a large amount of material. While this may be a drawback for readers interested in critical policy analysis, the author’s...

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