¶ … Hawaiian elder care professionals improve patient eldercare services to Japanese nationals, taking into consideration Japanese cultural norms and expectations Caregiving for elderly parents in Japan

Japan has witnessed a significant growth in its elder population. In the year 1950, 4.9% of the Japanese population was aged 65 years and above. This figure increased to 14.8% (1995). By 2025, it is estimated to grow to 25.8% (Yamamoto & Wallhagen, 1997). Japan's 'very old' population group (aged 85 and above) is swiftly increasing in number. It has been projected that by 2025, the nation's 'very old' population will account for 4.3% of its total population -- a five-fold rise in three decades. Furthermore, it was projected that as many as 2.62 million Japanese would be suffering from senile dementia by the year 2015; the 1990 estimate for senile dementia was about one million individuals (11WSA 1996).

Change in the percentage of Japan's aged population has also brought with it a corresponding change in Japanese social norms pertaining to family issues. Historically, elder care in Japan was regarded as the predetermined duty of the successive generation in patrilineal extended families. Owing to this tradition, even in the year 1992, as many as 33.4% of aged, bedridden Japanese who weren't sent to institutions were taken care of by their children's spouses (Yamamoto & Wallhagen, 1997). The above moral tradition was financially strengthened by means of primogeniture, wherein main family assets went to the male heir upon his father's demise. But following the Second World War, a newly-passed legislation on inheritance abolished the primogeniture tradition. Hence, despite the time-honored moral imperative continuing to strongly influence involved individuals, the actual operation of this familial duty is now changing gradually. For instance, Japanese households with three generations of the family reduced from to 12.5% (1995) from 19.2% (1970). The above modification to family configuration will likely significantly change Japanese views on family caregiving to aged persons.

Another key element relating to Japanese parental caregiving is women's role in the traditional Japanese family. Elderly and patient care was traditionally a role expected to be performed by the women in the household (Yamamoto & Wallhagen, 1997). As per the traditional Japanese cultural rule, the wife of the heir (first son) is required to care hands-on for his aged parents. This includes changing their diapers, feeding them, etc., until the aged person(s) gets hospitalized due to a medical condition. However, of late, this age-old role expectation might be a cause of conflict for Japan's growing number of working women. In the year 1975, roughly twelve million Japanese women held jobs, whereas by 1993, this figure had increased to twenty million (Yamamoto & Wallhagen, 1997).

With more widespread acknowledgement, in Japan, of the problem of a growing share of aged individuals requiring assistance with their everyday activities, a number of formal services were launched. In the year 1990, a "Gold Plan" (an exclusive ten-year plan) for improving support for aged individuals and family members was executed. This Plan entailed the launching of daycare facilities, homecare support facilities, and development of facilities for long-term patient care. The Japanese Health and Welfare ministry planned to bring about a roughly-tenfold increase in these services from 1990 to 2000 (Yamamoto & Wallhagen, 1997). However, family support for people with demented, aged parents continues to be limited. If possible, these services must be extended to demented, elderly individuals and families. In fact, behavioral issues displayed by aged individuals diagnosed with dementia usually exclude this group from services like "short-stay" and day care arrangements. Also, the services offered are far less than what is required in Japan. Consequently, aged persons and their familial caregivers who require assistance are made to wait long (Yamamoto & Wallhagen, 1997).

In spite of their success, the long-term and health care structures of Japan experience sustainability problems similar to those faced by their U.S. counterparts, including increasing demand and mounting expenditure. The government of Japan is weighing up and pursuing numerous options, like: preventive services; increasing premiums, fees, or taxes; and promoting community-based healthcare services (Belli, 2013). The year 2011 saw the implementation of reform focused on the holistic model of community care. Slightly similar to a responsible care institution, such a model would guarantee access to hospital, medical, or long-term patient care, preventive services, legal services or life support, and residential care services within elderly people's communities (Belli, 2013). Attention to service consolidation and prevention will, with any luck, reduce the use of costlier services, as it would ensure the population remains fitter.

1.2. Japanese vs. American elderly care

Professionals in the field typically look to Japan as an example of a nation that effectively handles its swiftly

Its long-term and health care systems, though in no way absolutely perfect, provide aged Japanese with holistic, economical care. As the U.S. endeavors to implement healthcare reforms for controlling expenses and shifting focus to preventive and managed care, Japan has a few recommendations to put forward (Belli, 2013). While a nation's healthcare structure is not solely responsible for shaping its population's health, it can contribute to altering the population's outlook towards health via the services on offer. Rather than following an exclusively acute health model, American healthcare is gradually migrating towards chronic disease management, prevention and long-term patient care. Aside from reducing costs, this type of shift can aid individuals in living healthier longer.
Some life expectancy disparities between Japan and the U.S. may be accounted for using health indicators. The U.S. obesity rate features on the list of the world's highest (35.7%), whereas Japan's obesity rate is one among the lowest (3.1%) (Belli, 2013). Obesity raises risks for several chronic ailments like diabetes, heart disease and hypertension. Further, America's diabetes incidence is more than that of Japan. Smoking constitutes another factor (Belli, 2013). While Japan's current smoking rate is higher than that of the U.S., traditionally, it was the reverse. On account of the prior high smoking rate in the U.S., life expectancy of Americans is now approximately a couple of years less (Belli, 2013). Apart from health influences, cultural values impact the aging population as well. Japan's working population is one among the longest globally, thus older adults are able to support themselves for longer. Further, their strong social and family networks suggest that families deliver much of elder care. However, this trend is changing with Japanese society's modernization.

While Japan and the U.S. experience similar challenges with regard to an increasing aging population group, the two nations have adopted different approaches to meet this population's needs. Historically, the American healthcare structure emphasized acute care, and dealt with diseases as they surfaced, instead of concentrating on disease prevention or management. The rise in incidence of chronic diseases necessitates long-term social and medical services for more individuals, especially older adults, to help them manage their conditions. A large number of chronic ailments can be prevented via healthy lifestyle behaviors (e.g., regular exercise and healthy eating) (Belli, 2013). While U.S. healthcare insurance is still not available to all, nearly a half-century ago, the nation's government recognized elderly people's unique needs and launched its Medicare initiative. Currently, Medicare covers nearly all adults aged 65+, and some supplement the services not covered by Medicare through private insurance (Belli, 2013). Furthermore, almost 17% are entitled to Medicaid coverage. But Medicare is not all-inclusive, or even free, and this creates care gaps when patients are unable to find appropriate services or are unable to afford them.

Moreover, while Medicare covers nearly every aged American adult, its focus is acute care. The means-tested Medicaid initiative for people with low incomes belonging to all age groups covers long-term as well as acute care. A number of aged individuals also supplement Medicare with private insurance. Medicaid and Medicare are highly costly ventures, and cost over 900 billion dollars in the year 2010. The initiatives demand cost-sharing by all except the poorest beneficiaries, and their out-of-pocket expenditures are mounting (Belli, 2013). Aside from mounting healthcare spending, long-term and health care structures for the elderly are complicated and fragmented. Patients probably have no clue regarding the services that are available, services for which they are entitled, and who disburses their hospital bills. Inadequate communication typically ensues between patients' service providers, but this may be mitigated through case managers' aid. Also, family caregivers might not have adequate support. In case of elderly individuals suffering from chronic ailments and disabilities, this complex framework hampers their ability of receiving prompt and appropriate care.

Obamacare offers a few solutions like enhancing care coordination by adopting the EMR (electronic medical record) system, providing healthcare professionals with financial incentives for delivering the right care the very first time, and covering elderly persons' preventive services (Belli, 2013). However, unlike American citizens, every citizen of Japan enjoys healthcare coverage. They are covered under a compulsory employment-based or "community-based" scheme -- the latter entails insuring of citizens and residents not covered under the former system, by municipalities. Exceptions to the above systems are individuals aged above 75 years, covered under the prefecture-funded system, and poverty-ridden individuals, whose healthcare…