|Round-table Discussions: "Baby Boomers Aging Society
in the World"
- Mr. Shuzou Tutsumi,
Professor of Graduate School of Human Science, Osaka University.
Prof. Tutsumi is the former Director General, Bureau of Welfare
for the Elderly of Ministry of Health, Labor and Welfare.
- Mr. Junichi Gouda, Director,
Housing Development Division, Housing Bureau, Ministry of Land,
Infrastructure and Transport. Mr. Gouda is responsible for policies
and programs for the infrastructure and housing for the elderly.
- Dr. Mike Rungie, CEO,
ACH Group in Australia.
- Mrs. Vivien Lai, Senior
Policy Advisor, Senior Manager, Policy Branch, Strategic Division,
Canada Health and Wellness, the Government of Alberta, Canada.
- The Hon. Edwin Walker,
Deputy Assistant Secretary for Policy and Programs, US Department
of Health and Human Services.
- Mr. Clayton S. Fong, President
and CEO. Mr. Fong was a member of Policy Committee of the 2005
White House Conference On Aging, held in Washington D.C. in December,
- Dr. Akihiro Igata, President, Nagoya University
of Arts and Science. Dr. Igata has been a leading member of the
Commission of Social Security Policies of Ministry of Health,
Labor and Welfare and has been serving in many other important
capacities on other Ministerial Commissions of Ministry of Health,
Labor and Welfare. He acted as the Moderator for the morning
Prof. Shuzou Tutsumi opened
his remark by quoting a famous remarks made by Isaac Asimove who
is said to have raised a question of " how long human-being can
live?". He then moved on to point out that it is the first time
not only for Japan but also for the rest of the world that are
being confronted with immeasurable experience in the history of
the humankind. Speaking of the life style of the elderly in the
old times in Japan, he introduced the way the elderly belonging
to different social classes in Japanese society spent their aging
period. He stated that Those who engaged in farming and fishing
labor forces continued to work after the age of 70 years old (in
Japan, the age of 70 years old is regarded the turning point in
their lives at which time the majority of those becoming at the
age of 70 years old are going to retire with the blessing of their
families, relatives and friends. However, In the era of feudalism(the
era of Samurai), those Samurais and rich merchants retired at the
age of 50 years old and spend their aging years with some degree
of powers still in their hands in the society but spent more time
with their grandchildren. This could have been one of their life
styles. Whereas, those who were farmers and fish and hunting men
continued to work which made more productive contributions to the
society in which they lived?
In his view, Baby Boomers who were born in the year from 1947-1949
were 56-60 years old in the year 2005, the population of which
was 6.780.000.persons that accounted for 5.3% of the total population
of the nation. Those who were born between 1948-1950, the population
of which is 10,260,000 persons which accounted for 80 % of the
total population of the nation in the year 2005.
He used the latest statistics of how changes are taking place
in aging society in terms of demographic condition in Japan based
on the latest information available, which is as follows:
(Productive working forces)
|Average Longevity (men)
|Average Longevity (women)
Policies and system implemented to take care of the elderly under
the law(s) in Japan. These are:
- The elderly who are until at the age of 74 with the universal
medical insurance system as a co-payment between employers and
- Those who are not being covered due to own business owner or
not being employed with companies which do not take up the universal
medical insurance is to be covered by another form of national
medical insurance system with the cost of the insurance premium
is to be born and to be paid by the incused.
- Those who are 75 years old and older will be covered by a specially
implemented medical insurance for the older aged person under
the medical insurance system with a reduced cost for the medical
- Japan's Care Insurance System has been introduced and implemented
since the year 2000 and revised it in the year 2005. Those whose
age are from 40 years old to 64 years old, they are required
to pay in the premium unit they reach at the age of 65 at which
time they become eligible to the recipient of care services after
they are assessed what level of care services are needed and
will be categorized into the level of care services required
accordingly. Those who are 65 years old or older are categorized
as the recipient of the care services with duly assessed procedures
that they must go through.
- When the elderly reach at the age of 65 years old, they will
be eligible to draw social security pension.
- Some type of housing assistances programs are made available
for the elderly who are 65 years old and older.
Commenting on some of the restructuring of some of social policies,
Prof. Tutsumi summarized these reform policies and programs which
are recently implemented and are going to be revised. These are:
Prof. Tutsumi views that Japan's Social Security Policies may be
changed in terms of its original vision and objectiveness which will
affect the services required for the larger population of the elderly
due to the entry of so-called Baby Boomers into the aging society.
As he pointed out, the government has already taken its steps to
apply the various factors in determining the standard and level of
care services for the elderly which may reduce the contents of the
services and will lead to the increase of fees they have to pay for
the services. He noted that the system will continue to be revised
as it was stipulated at the time of the law(s) was enacted to meet
the needs of the time.
- Due to reluctance mainly on the part of the employers of the
larger corporations and the government fiscal policies, the reform
took place in the year 2004 made, which introduced a concept
of so-called macro- economic factors that will dictate the level
of pension amount that the eligible persons can draw. It has
also implemented the level of income of those who are eligible
to draw their pensions. It will be reduced substantially from
the year 2004 through 2023. Another reforms took place on the
care services insurance system by reducing the availability of
care services for those elderly once whose level of care services
are assessed to be that they do not require a full services they
used to benefit before the reforms took place. It has also reduced
the construction of institutional facilities with the government
- In addition to these reforms which have reduced not only the
level but also the content of social policies and programs that
may create negative impacts on the elderly in their aging period.
According to the survey conducted in the year 2005 by Ministry
of Health, Labor and Welfare, it is interested to note the following
facts relating to how the elderly managed their life and how they
will be managing their aging period.
Prof. Tutsumi stated that how those elderly are spending their aging
period which is described as follows:
- Those who are at the age of 50 to 59 years old, they worked
for one company in their life times are 77.2%. Those elderly
who are at the age of 50 to 59 years old and are still a part
of working forces occupies 92.8%. Those who are at the age of
50 to 59 years old who wish to keep working occupies 82.1%. Those
who are at the age of 65 to 69 years old(men and women) are desirous
of leading their aging period on the pensions they draw, which
accounted for 69.5% and those who are at the age of 70 years
old or older accounted for 71%.
- Commenting on the health conditions of the elderly who are
at the age of 55 to 59 years old, 8.7% of them are having diabetes,
20, 0% having high blood pressures, high blood pressures with
cholesterol accounted for 9.8 %.
Prof. Tutsumi summarizes the most pressing issues associated with
their aging period which are cited as follows:
- For those men and women who are at the age of 50 to 59 years
old, it is broken into the following interests and activities.
58.3% is engaged in some type of interest and activities such
as their hobbies and educational activities, 21.0% are engaged
in some type of social activities, 7.7% are engaged with some
type of volunteer activities without compensations. How their
daily lives are being spent? For men, 52.1% are spending with
their neighbor and 67.9% for women. 70.7% of men are spending
their time with their friends and women are accounted for 81.6%.
Men are engaged with household affairs which accounted for 37.8%
and women are for 88.7%. The time they spent for extending care
services for members of their families are; 9.3% by men and 16.6%
by women. They are spending their times with their sons, daughters
and grand-children. Men are spending their time which accounted
for 20.9% and women are for 39.0%.
One of the case studies conducted which deals with so-called Baby
Boomers in terms of how reality with which they are being faced relating
to the management of their aging period from their point of views
which is described as follows. The hearings were conducted with 2.000
men whose ages were born in the year of 1947 to 1949.
- The issue of how to maintain the system of social security
policies and programs to be viable one, in particular, in the
system of medical insurance, pension system, care service for
the elderly due to the emerging socio-economic factors and the
decline of birth rate.
- How to remain in the communities in which those elderly lived
for a longer period of their time. This may necessitate them
to adapt their new life styles to meet the coming aging society.
- How to stay healthier and longer. Deployment of preventive
care measures may be one of the ways to meet this needs and to
enable this preventive measures is said to be effective from
getting chronically based diseases.
- How they can still perform something constructive for the society
and community and how they should manage to live their aging
period when they become frail with dementia.
* The average incomes of those men shows that those who earn
more than US$90.000.00 annularly are 3%. Those who earn from US$30.000.00
to 90.000.00 are 57%. Those who earn less than US$ 28.000.00 are
22%. As far as the amount of savings are concerned, those who save
less than US$ 48.000.00 are 39%. After their retirement, their
wives are desirous of getting divorce from their husbands. However,
those men are satisfied with their life and let their sons and
daughters to do what they want in their professional careers.
Prof. Tutsumi closed his opening remarks by citing that; (1)
The elderly are not quite prepared for and ready to establish their
firm plans as to how they should spend their aging period. This
may be true to Baby Boomers, (2) It is being urged that the elderly
must aware of how to spend their aging period with the sense of
being dependent. This will require the support and assistance from
the community in which they wish to live,(3) However, the elderly
are entitled to receive appropriate cares services regardless of
the government policies due to its fiscal difficulty and that the
elderly must be the one to be advocacy of this important social
security policies and programs to be in place properly.
As one of the architects of Japan's Care Services Insurance System
while he was serving in his capacity as the Director General of
the Bureau of Welfare for the Elderly, Ministry of Health, Labor
and Welfare, his concluding remarks cited is noteworthy. It is
likely that Prof. Tutsumi as one of the architects of Japan's Care
Service Insurance System may continue take his interests in how
the revised version will be carried out by regional governments
to which some degree of authorities for the implementation of certain
programs are delegated as they see it fit.
Mr. Jun-ichi Gouda,
Director of Housing Division, Bureau of Housing, Japan's Ministry
of Land, Infrastructure and Transport, focused the housing policies
and programs which are needed if the Elderly are to spend their aging
period at home as long as they could, which requires the appropriate
measures to be taken to meet the needs of the elderly. His remarks
and presentation are summarized below.
Mr. Gouda's opening remarks focused on:
Mr. Gouda provided an overview of Japan's society, which is rapidly
aging (see his power point presentation for details). Those born
between 1947 and 1949 "the Baby Boomers" are now turning 55 through
65 years old. They will become the family of the elderly in the year
2015, who will be entitled to draw the social security pension. 2005
was a peak year for total population due to high birth rates right
after the Second World War. In 2005, 20% of the population was 65+.
By 2015, this percentage will increase to 26% and 36% by 2050. In
2005, 9% of the population was 75+; this will increase to 21.5% by
- An overview of the Japanese Aged Society
- Housing Conditions of the Japanese Elderly
- An Outline of Housing Policies for Japanese Elderly
- Future Directions for Housing Policies for Japanese Baby Boomers
It should be noted that individuals now between the ages of 30 to 35
years old are called "the Second Generation of Baby Boomers".
Although Japan is currently the oldest of the developed nations - older
than Italy and Spain - it is likely that Korea and Singapore will rapidly
becoming aging nations.
In terms of employment, 70% of the men 60 and over are still engaged
in some professional activities and if the elderly men hoping to work at
the early 65 years old are combined, approximately 85% are categorized
as workforce - a relatively high rate in the world.
The average elderly has a cash-flow of $180,000.00 and assets in market
value of $250,000.00. The question is how to maintain this financial condition
during old age.
In Japan, children (either a son or daughter) traditionally will live
with their parents when the parents become old and require some type of
care assistances. Traditionally, the eldest son and his wife are held responsible
for taking care of his parents. 45% of the elderly lived with their son
and his wife until 1983. By 2003, the percentage of elderly living with
their son and his wife was reduced to 15%. This decrease may be due to
the following life style changes; (1) exodus of the younger generation
to major metropolitan cities and larger cities where co-habitation with
their parents was difficult; (2) change in housing and architectural design
resulting in popularity of smaller houses with modernized amenities; (3)
lifestyle differences among older and younger generations, with younger
generations more receptive to independent lives unencumbered by family,
especially "in-law" relationships; and (4) implementation of Japan's Long-term
Care Services Insurance System which provided more options for both parents
and their children to live separately.
In view of these life style changes both for parents and their children,
the Ministry of Housing, Infrastructure and Transport shifted its housing
policies to focus more on helping the elderly remain independent and in
their homes. Home and community based infrastructure programs are now become
the policies of the Bureau of Housing.
Mr. Gouda discussed how the elderly are managing the kind of problems
and difficulties with which they are confronted. The ratio of home ownership
of the elderly is about 85%, compared to the overall ratio of 60% for home
ownership in Japan of any age. Approximately 10% of the elderly rent houses
or apartments (private market housings and apartments). It is also necessary
to scrutinize how they are managing the housing cost.
The following concerns are being raised about housing for the elderly;
(1) their homes are aging and out-dated and about 16% of them require renovations;
(2) there is a shortage of ample sun-light and comfortable and healthy
conditions; (3) bathrooms, toilets and kitchens are not made to comfortable
condition for the elderly; (4) many steps in homes and apartments affect
the mobility of the elderly.
According to available statistics comparing housing conditions around
the world, the majority of the elderly in the United States prefer to stay
in their own homes as they age. In Korea, 12% of the elderly prefer to
live with their children and in Sweden 30% of the elderly would prefer
to move into housing units for the elderly. In Germany, 13% of the elderly
prefer nursing homes whereas in Japan, 14% of the elderly prefer to move
into some type of hospital.
One of the main reasons Japanese elderly prefer to move into hospitals
is that medical treatment and attention are available under the universal
medical insurance system but this system is now under consideration for
revision. This proposed change in the system may change their style of
living as they age.
The next subject is whether or not houses or apartments in Japan are
appropriate for the elderly to remain in as they begin to loose cognitive
functional ability and stability. The Ministry has been promoting programs
to renovate and modernize out-dated and older homes to meet the needs of
the elderly. The introduction and implementation of various financial assistance
programs to modernize these homes is being vigorously promoted but the
fact remains that only 3% renovated their homes as of 2003 and rented homes
and apartments accounted for only 1.5%.
In order to promote and enhance this program, the Ministry embarked on
a new policy in 2006. The Ministry is promoting a comprehensive, total
infrastructure design approach, which includes encouraging the private
sector to play a more leading role, working together with both the Central
and regional level governments. This policy is called "the Basic Program
for Housing (2006-2015)". The program includes 13 policy targets, of which
3 targets are related to an anti-aging measures described in the power
point presentation. Basic concepts of these measures include:
Renovation of public housing is now mandatory and "Day Service" units must
be established in it. The Ministry has been promoting and implementing the
policy of "Life-Support Advisors" assigned to enhance the security of the
elderly in "Silver Housing". Public housing is made on loan to providers
of care services, so-called Group-Home for the elderly.
- Encouraging "Barrier Free" housings. Financial assistance programs
are available for both new and renovated housing, including subsidies,
a special line of credit with a reasonable interest rate and tax benefits.
All public housing units will be made barrier free.
- Making programs more effective by situating institutional care services
facilities and medical clinics near one another to strengthen coordination
of housing and social welfare programs. This coordinated policy and strategic
direction will address the increasing mobility of the Japanese workforce,
helping to ensure that the elderly will be not left alone and there will
be ways to address their loneliness and to cope with emergencies, if
they should arise.
- Sustaining the wellbeing of low-income elderly through availability
of appropriate housing, including public housing programs. For example,
priority for public housing is given to low income elderly. "Reverse-
Mortgages" will enable the low-income elderly to move into better housing.
The Ministry has delegated the authority for housing promotion for the
elderly to prefecture governments and other regional governmental entities
who will determine which private sector construction and housing companies
are bona-fide licensees to provide quality rental housing for the elderly.
Financial subsidies from the central and regional governments will help ensure
reasonable rents. And Registration and access to records on housing easily
accessed by the elderly and System for guaranteeing rent arrears was established
in 2001. Implementing this system will reduce the reluctance by landlords
who fear that the rent will not be paid, or will be delayed.
The Ministry is also implementing a unique policy and program on housing
mortgage for home ownership. The following programs are in place:
- The Japan Housing Financing Agency (Agency) is providing a line of credit
at the lower rate for homes that incorporate barrier free architectural
design and layout. (Some tax reduction is applicable and property tax reduction
is also applicable).
- Reverse Mortgages are available to the elderly who undertake renovation;
the full payment of the loan for this renovation will be closed at the
- Local government entities receive a "Financial Grant at Large" from the
Government, allowing for more flexibility in developing priority programs
appropriate to any given region.
Currently there are 2,200,000 units of public housing across the country.
Rental housings units for the elderly are increasing greatly in numbers in
recent years. Since 1990, new housing units (either congregate units or single
family detached housing units) are designed to be barrier free every year.
Units (10,000) built before the new policies were implemented are being renovated
as barrier free. Silver Housing and multiple types of housing combined with
Day Care Centers are being promoted (See photos).
Quality rental housing for the elderly with cognitive impairments is expected
to grow as the population of the aged continues to expand. 23,000 units are
being built (See photo in power point presentation of group home built by
a non-profit social and welfare organization in Uozu, Toyama Prefecture).
Currently, there are 100,000.housing units for the elderly built by private
sector companies. The Ministry has been promoting this type of housing for
the elderly, the handicapped and foreigners in cooperation with private profit
and non profit organizations and other entities.
In closing, Mr. Gouda discussed the importance of developing innovative
and practical policies and programs to cope with the newly emerging issues
of an aging society. It is not a question of how long one can live but how
to spend one's years with a sense of dignity and joy. The government must
create and enhance the infrastructural environment for the elderly. Housing
must be modernized to meet the needs of the elderly and to allow them to
remain in their homes as long as possible, with easy access to needed care
services. The elderly should be given options to choose where they live.
It is also important and vital that they have the opportunity to lead their
lives as normally as possible by being involved in their communities in which
they live with their devotion and interest in what they deem to be the most
valuable way of lives they can spend in their aging period.
Additional information regarding reverse mortgages:
The Ministry began implementation of one type of the reverse mortgage program
in October, 2006. It is designed to "facilitate the rental of large houses
owned by the elderly to households with children and others who may require
a larger house." The aim is to ensure that the elderly have incomes in order
to relocate to new housing and that they generate living expenses from rental
fees of their homes
The Ministry makes it safe for the owner of the house to rent out their
houses with a guarantee clause in the agreement for the continued payment
of the renting fees which is assured by the public fund. The central government
will ensure payment of rental fees and will guarantee against risk factors
non-payment or delayed payment of the rental fees by the tenant of the houses.
Another system of the reverse mortgage is that elderly people can pay only
for interest on the principal of the money borrowed. When the borrowers dies,
the total amount of the borrowed amount must be paid in full either in cash
or from the proceeds of sale of the house, condo or apartment. This is designed
so low-income elderly can renovate his or her house for barrier free architectural
layout and so on.
The amount of the line of credit with the public fund depends on the type
of renovation, to include a barrier free layout and the reconstruction of
condos and apartments. The maximum credit is $40,000.00. The maximum for
reconstruction of rental condos or apartments is $80,000.00.
The interest rate for the borrowed money from Japan Housing Financing Agency
is 3.30 % (April 2007) at a fixed rate. This rate decreases by 0.20% if rental
renovations include "anti- earthquake architectural structural methods".
Terms and conditions for establishing a line of the credit from the Leasing
Corporation is guaranteed by a newly created corporation - an arm of the
central government. A market value of assets is used to establish the line
of credit. For more detailed information, please see the following power
point materials provided.
Mr. Yusuke Kataoka, US Foundation for International Economic Policy, provided
translation and editing of Mr. Jun-ichi Gouda's remarks, together with additional
information and materials. These remarks were edited for the Administration
on Aging's website.
Click here for Mr. Gouda's presentation
materials in PDF.
Hon. Edwin L. Walker, Deputy
Assistant Secretary for Policy and Programs, US Department of Health and Human
Services(AoA) has delivered his opening remarks and presentation entitled "Entry
of the Baby Boomer Generation into an Aging Society: Challenges & Opportunities
of an Aging U.S." The summery of his remarks and presentation is as follow:
Mr. Walker stated that the core of social security policies and programs
of which Medicare and Medicaid are the major pillar of social security policies
and programs in the United States based on Older Americans The declaration
of objective under Older Americans Act covers many broader areas of program
services which are designed to enhance the wellbeing of the elderly. It includes
the matter of employment, economic security, civic engagement, long-term
care, protection of rights, housing, active aging, health, community living,
and institutional care. These programs are designed to enable older individuals
to maintain their dignity and to live independently in their own homes and
communities for as long as possible.
In order to provide such programs effectively, National Aging Services
Network has been playing an important role by developing collaborative alliances
among the government and its agencies both at Federal and local level together
with supporting organizations and entities in private sectors. Administration
On Aging is playing the role of a commanding position not only as policy
makers but also as a coordinating body to shape the various policies and
programs into practical implementation by which the elderly are able to take
advantages of services made available for them. As Mr. Walker stated, AoA
is the Federal Leader of the Aging Network, working closely with the various
governmental agencies at state and local level as well as providers of services
in private sectors. The materials he provided in the form of power point
at the session at the symposium will illustrate how Aging Network functions.
Commenting on the increase of the population of the elderly as the result
of the entry of Baby Boomer generation into the family of the aged, Mr. Walker
cited about the predicted trend of increase of older adults(age of 65+ with
disability) since the year of 1996 to 2049. He spoke of who might need long-term
services and supports. It is predicted that the rate of progression requiring
long-term services and supports is expected to rise sharply as the elderly
reaches at the age of 80 to 89 years old.
On commenting on the shift that the government of United States of America
has been promoting under the leadership of the President George Bush, Mr.Walker
emphasized the importance of some of the major policies and programs designed
to design to rebalance the system. Mr. Walker listed (1) President's New
Freedom Initiative, (2) An Executive Order-Community-based Alternatives for
Individuals with Disabilities, (3) Federal Agencies- -Real Choice Systems
Change, (4) Congressional Action- -Deficit Reduction Act. Under these initiatives
are aimed at the enhanced involvement of the elderly with community in which
they live; encouraging the elderly to try to stay away from being housed
at nursing homes. More comprehensive direction by federal agencies to evaluate
and recommend ways to expand community-based services for individuals with
disabilities. Provide grants for improving system of transportation and make
it more optional for the elderly for choice for their independence. The establishment
of LTC Clearinghouse designed to have easier access to information by the
elderly for their needs. And, so-called "Money Follows the Person" program.
Mr. Walker introduced some of unique and constructive measures which are
aimed at the enhancement of social and welfare policies for the elderly.
He summarized these programs as follows:
On the foregoing cited measures and programs, Mr. Walker elaborated further
on each measures and programs. He emphasized how it is important to make the
utmost efforts to improve and enhance the collaborative alliances among governmental
entities at the level of the Federal, states and local governments, working
the various organizations and entities in private sectors and of course those
of the elderly and their families to cope with the ways of how successfully
the elderly can lead their aging age.
- Consumer Focused Mission
- Bottom Up, Locally Driven
- Nationwide Aging Network
- Social Model of Care
- Ability to Reach People Early
- Before Spend Down to Medicaid
- Prevent Nursing Home Placement
- Demonstrated leadership in Systems
- Reforms and State and Local Levels
Mr. Walker cited about (4) points which are regarded as successful elements
of establishing long-term care services methods including preventive measures
for the elderly from not progressing further their cognitive stability and
capacity. These (4) points are:
- Vision and coordination across; institutional, and home and community-based
- Aggressive screening tactics and alternative services; to divert individuals
from entering nursing homes.
- Efficient person-based financing; in least restrictive setting and to
integrates and supports unpaid care.
- Promote flexibility and creativity; in meeting individuals' needs.
From the foregoing elements which are the core of policies and programs
to make long-term care services to be effective and successful, Mr. Walker
maintained that these policies and programs must be coordinated among the
parties concerned; Federal and states governments and its agencies, professional
organizations and community's supporting groups are the key component for
the enhancement of collaborative alliance which will contribute to the effective
development of services for the elderly. As Mr. Walker raised the issues
of how Baby Boomers will lead their aging period, he pointed out that change
in their life style must be landscaped, preparation of financial plans must
be carefully in place which include the solid plans to be developed to cover
the cost for long-term care services and the necessity of awareness of choosing
their life style when the elderly are in need of long-term care services.
Mr. Walker's presentation enabled how AoA is shaping its policies to develop
specific programs to provide the various services and options for the elderly
to choose to meet their requirements of services. He has also enumerated
how the governments both at the federal and states level works together with
other parties which are fundamentally supported by the vision and sprit of
the Older Americans Acts. In-nutshell, he is suggesting that the issue of
aging in which many complexes and un-predictable difficulties that may emerge
due to the entry of Baby Boomers generation into the family of the aging
society, thus, it is so important to develop a team of consolidating all
necessary resources to maximize the supporting infrastructure in coping with
the issue of the newly emerging aging society. To make it successful, the
governments both at the federal and states level must listen to the elderly
and their families how they are being faced with many difficulties and problems.
It must be the policy of the government which can be described as "Grass-roots
movement policies" which will makes it effective to cope with the issue of
the newly emerging aging society.
For more detailed information, please visit the website of AoA: http://www.aoa.gov.
Click here for Mr. Walker's presentation
materials in PDF.
Mr. Clayton F. Fong, President & CEO,
National Asian Pacific Center On Aging. The member of the Policy Committee
of the 2005 Whitehouse Conference On Aging. The immediate past Chairman of
Asian Pacific Americans Institute for Congressional Studies and serving as
the leading member of the U.S. Governmental Commissions such as Medicare system
reform and its related fields.
Mr. Clayton S. Fong has been known to be the most active and effective
leader not only in Asian Pacific Islanders community but also the communities
at large in the United States in which he has been playing the important
roles in promoting and enhancing the wellbeing of the elderly from not only
from the position of being an effective advocacy but also the voice of the
grass-roots movements which has impacted on the shaping of policies and programs
of the government of the United States concerning the various policies and
programs to meet the needs of the elderly and their supporting entities.
His extensive careers in the Federal governments serving in the capacity
of the inner circle of the Administration under the Bush Administrations
enabled him to contribute to the wellbeing of Asian Pacific Islanders Americans.
He was the member of the US delegates to the World Assembly on Aging and
also involved in many ways in the empowerment and enhancement of social security
policies in the United States.
He made his presentation focusing on how each nation should cope with the
issue of the newly emerging aging society. His presentation was presented
with the sense of concise, accurate and simple in addressing to the issues
with which we are facing and will be confronted with in the era of Baby Boomer's
Click here for Mr. Fong's presentation
materials in PDF.
Dr. Mike Rungie, CEO, ACH
Group in Australia. The presentation by Dr. Rungie is titled "Shifting Attitudes
in Australian Aged Care". Dr. Rungie pointed out that the shift is being taking
place in the attitude of the elderly in their aging period. He cited about
(3) major points which are now seen in their line of thinking of how to spend
their aging period. He stated that older peoples are more receptive to find
their own solutions to deal wit their life style. They are more conscious and
independent in terms of choosing what kind of services they wish to be provided,
the attitude of which are quite different compared to their seniors. He stated
that the older people will be more selective and demanding in terms of services
they will be looking for.
He cited about the positive and negative aspects of how the attitudes
of the older peoples will have the impacts on their life style in their
On the positive and negative sides:
- Older peoples are more receptive and independent to choose their
own way of life.
- Older peoples are likely to spend their aging period in the communities
they live but will be more selective and demanding for the type of
services when they are in need of it.
- More older peoples are anxious to spend their aging period with
their families and are determined to maintain their physical condition
through re-habilitation exercises if need.
- Level of services in terms of quality might be improved better or
- Some of providers of care services are now deploying more cost-oriented
service to be made available which is provided for "respite services" with
the support of volunteers.
- More interactions among the older peoples will be increased with
the role that so-called "Connectors" play which will enable the frail
elderly to have more access to interact with other older peoples.
- An issue of abuse vis-?-vis the reduce of quality of service will
be another issues that may emerge.
As CEO of the providers of care services for the elderly, Dr. Rungie
stress the importance of how the quality of care services by care givers
should be improved. He used the term of "Customer Impact Statements." He
listed in his power pointer presentation the following points:
- Considers what life is really like
- Engages staff in the dilemma(care is great- life is not)
- Engages all in developing better practice
- Uses 5 Life dimensions:
・ Right relationship
・ Relevant, individualized, strengthened-based approaches
・ Valued social roles
・ Enhancing capacities
・ Personal safeguards
Dr. Rungie referred to the shift being emerged relating to Dementia
and Mental Health. He said that 60-80% residents in nursing homes have
Dementia. Whereas, it is less percentage for those who are staying at
homes. He predicts that the percentage of having Dementia may change
if the deployment of the measures are taken which include; Awareness,
Research, Training, Early Interventions, Community Packages targeting
Dementia, Respite Services targeting Dementia which may result in Transition
Cares 50% Dementia, 30% Mental health.
He has pointed out that shift in properties and value of older will
be coming. These shifts are:
- Departure from traditional notions of old age and family obligations
- Desire for independence, control and autonomy
- Patterns of housing tenure, lifestyle and family relationships are
- Flexibility and fluidity
- Living alone and loving it
- Consumption and lifestyle take precedence
- Home as conduit to lifestyle choices
- Location and friends prime importance-international communities
Having the extensive experiences as the top management of providers
of care services for many years in South Australia, Dr. Runcie's viewpoint
of how shift will be taking place in his country may shed some lights
on the new style of elderly in the Baby Boomer's Aging Society. It is,
however, that the heritage, history, culture, family tradition of given
societies may still be some of the major factors as to how shift is going
to be universal in the both the developed and developing countries. However,
it is true that the issue of aging is no longer the issue of one nation
but also that of the whole world. For more detailed information, please
see the following power point presentation materials.
Click here for Mr. Rungie's presentation
materials in PDF.
Mrs. Vivien Lai, Senior Policy
Advisor, Senior Manager, Policy Branch, Strategic Division, Alberta Health
and Wellness. The presentation by Mrs.Vivien Lai was made by focusing mainly
on Alberta's Continuing Care System and Challenges and Directions that
the government of Alberta has been implementing and is embarking on new
strategic directions to meet the issue of newly emerging aging society
as Baby Boomers generation become the family of aging society.
Sun Life Social & Welfare Organization and US Foundation for International
Economic Policy have been promoting the mutual productive relationship
for the last several years. The representatives of those organizations
visited the office of Alberta Health and Wellness to exchange views and
opinions concerning the policies and programs that both Japan and Alberta
have been implementing with a special focus on how the best quality care
system could be made available to cope with the newly emerging aging
society from which all of us benefited to learn how each country is seriously
coping with the issues of what it may be facing all of us in the new
era of the aging.
Mrs. Vivien Lai opened her remarks by using her power point materials
to outline some of key policies and programs that the government of Alberta
has been implemented and is now promoting to meet the newly emerging
issues of the aging society. Firstly, she started to summarize the historical
review of how the government of Alberta has been concentrating on for
the implementation of the policies and programs which are the major steps
that the government has taken. These are:
- Long-Term Care Review: Final Report of the Policy Advisory Committee
- Auditor General's Report on seniors' Care (2005).
- MLA Task Forces on Continuing Care Health Service and Accommodation
(1) Long-Term Care Review 1999:
・ In 1990, the Minister of AHW appointed a Long-Term Care Review Committee
to assess the changes that are required from the continuing care system to
address the future needs of the baby boomers. By talking to more than 5000
Baby Boomers and concluded that the "status quo is not an option" from which
it has discovered that Baby Boomers are desirous of seeing a new system to
be in place from the current one.
・ The Committee develops a new policy concept for delivery of services called " unbundling
of services", designed to reduce unnecessary or un-required services on the
part of the residents at nursing homes whereby a sort of confinement conditions
that may be imposed at nursing homes could be reduced.
(2) AG Report: In 2005, the Auditor General of Alberta conducted an audit
of Alberta senior's programs and services. The audit report recommended that
AHW place higher priority in developing and updating standards, improving
quality and ensuring compliance.
(3) MLA Task Force: In response to the Auditor General report, a MLA Task
Force was appointed by the Minister of AHW. The report recommended new continuing
care standards emphasizing client-centered care, enhanced care planning and
case management, improved protocols for service delivery, and requirement
of core competencies for unregulated workers. The standards also require
that all continuing care providers must have quality improvement programs
to strive at excellence in the delivery of services. It also recommended
the development of a compliance framework and monitoring mechanisms.
Mrs. Lai elaborated how Continuing Care in Alberta has been in place.
She cited about the role that Regional Health Authorities are playing,
and held responsible for the delivery of services across the province
of Alberta. The government policy has been that un-necessary care services
are to be not applicable through a thorough the methods of identifying
and assessing that the one is genuinely required the needed care services:
and to encourage for the individuals to be looked after in the community
which is called "Needs baaed System". (For the further details, please
see the power point presentation materials provided).
In the wake of the coming of Baby Boomers generation who will be the
largest population of the aging society in the near future, the government
of Alberta listed the core of policies and programs which are:
- Increase of Volume of Service Needs
- Changing Expectations of baby Boomers
- Emphasis on Quality
- Issue of Sustainability
- Public Accountability
- Workforce Issues
- Technological Advances
Commenting on the importance of the above points, she stated that baby
boomers are more educated; expect choice and having higher expectations
of health system. They are not shy to tell that if they are unhappy with
the services they receive. Consumer relationship will be a very important
aspect in the future management of long-term care.
The writer has maintained that the vision or philosophy laid out by
the government must be translated into strategies and directions out
of which a specific programs must be developed to meet the needs of the
individuals, in particular, in the era of aging society where baby boomers
are going to be the dominant population of the newly emerging aging society.
In this sense, the steps that the government of Alberta has taken are
On the matte of Increase of Volume, Mrs.Lai cited about the direction
- Primary health care
- New approaches to acute care
- Prevention of admission to hospital and LTC facilities: Choice programs
She told that Alberta has allocated $100 million through an agreement
with the Alberta Medical Association to implement primary health care
throughout Alberta, designed to provide the needed care and some medical
attention in stead of providing un-necessary and excess services. Speaking
of Choice Program, she emphasized importance of this programs which include
the various activities and services such as community center and day
care services with nursing therapy and other activities which is aimed
at reducing the use of long-term care beds and acute hospital beds. She
stated that as the results of these programs, the flowing results are
- Inpatient days have decreased by 70%
- Emergency room visits have decreased by 63%
- Ambulance trips have decreased by 51%
She talked about the subject of Changing Expectation of Baby Boomers.
She listed the following points as the key component of the programs;(provide
choice and quality of life options to clients):
- Aging in place options
- Campus concept for elderly care
- Resident-focused care
- Involvement of family members
Mrs. Lai talked about the services at home which are being offered
by providers of care services. She did introduce the availability of" aging
in place "campus in which private condominiums, supportive housing and
long-term care beds are all located in one single complex. She has also
mentioned that a Rental Affordable Supportive Living program to provide
financial assistance to assist housing operators to build affordable
supportive housing spaces in rural settings for the elderly. From 2005
to 2006, a total of $101 million in targeted one-time capital funding
was allocated towards the construction of 1,872 units.
On the subject of Emphasis on Quality, she cited that the objective
is to establish the direction- provide restricted funding to implement
standards and improve quality. These are:
- Implementation of the new Continuing Care Health Services and Accommodation
- Improve staffing
- Enhance Care Management
- Medication Management
- Enhance clinical expertise
- End of life care
- Develop compliance framework
For these programs, Minister of Health and Wellness has allocated $42
million in targeted funding to increase quality in long-term care. The
funding includes; implementation of enhanced standards, improvement of
staffing, case management, medication assistance, clinical expertise
and end of life.
Mrs. Lai talked about the issue of Sustainability which is designed
to provide the opportunity of explore alternative funding approaches:
- Unique funding approaches
- Client responsibility
- Assessment of unmet needs
She stated that the Direction is aimed at exploring alternative funding
approaches and aimed for the establishing the sense of " Equilibrium" in
social policies for both well-to-do and less well-to-do, for which the
system must be structured in such a way to be sustainable and viable
in long term. She introduced some other programs to enable the less-well-to
do elderly to have the access to affordable housing and other programs.
She stated that one of the important priorities of the government is
to ensure Albertans that Public Accountability which is directed to measure
performance of the system. She listed these important points as follow:
- Health Plans
- Auditor General's Report
- Health Quality Council of Alberta
- Standardized assessment tools
Commenting on Workforce Issue, Mrs.Lai has described it to mean that
this direction is to address workforce issues and focus on recruitment
and retention strategies. She stated that when Baby Boomers are going
to enter into the aging society, the issue of workforce is going to be
the most pressing issues--availability of qualified human resources.
She also referred to the issue of Technological Advances and cited the
flowing measures for more positive and effective utilizations:
- Health Link
- Self Management Care Monitoring System
- Wireless Technology
- Alberta Electronic Health Report
Health link is available for 24 hours a day, 7 days a week nurse advice
and health information service has been implemented in Alberta province
wide. On Self Management Care Monitoring System has contributed to reduce
not only the cost but also reduced the confinement of the elderly in
nursing homes. Technological Advances are also contributing to the management
of the health records and assessment of the conditions of the elderly
as well as the efficiency of the operation of care services both at home
and facilities. Alberta being such a large province in terms of its sizes
and the closer communication methods with the elderly who live in the
remote area will benefit from technological advances such as wireless
communication to be in touch with the elderly to monitor their daily
Mrs. Vivien Lai has concluded her remarks by quoting two quotes the
book " Shifting years" . It reads" Change does not strike like a bolt
of lightning out of lightning out of the blue. If you know where to look,
you can see it coming for mile"., We have known for a long time that
baby boomers will be aging, and needing services．We need to plan for
"If you always do what you have always done, you will always get what
you have always gotten".
Baby Boomers told us that they do not like to the current way we provide
services. We need to design a new system for them.
I would like to thank you our Japanese hosts again for organizing this
very important symposium and I look forward to discussing strategies
to address the needs of baby boomers with experts from different countries.
Mrs. Vivien Lai, the writer (in collaboration with Dr.Teruhisa Mokuno)
is fortunate enough to have developed the close relationship with Alberta
Health and Wellness and on our visit there, we have had the opportunity
of sharing many ideas and opinions concerning the issue of policies and
programs both Canada and Japan have been facing with the issue of the
newly emerging aging society. Although the system of the both countries
is different at least technically, it is a binding sprit with which the
issue of aging must be re-defined and re-designed which requires for
more international collaboration as expressed by the Hon. Josefina G.
Carbonell, Assistant Secretary for Aging, US Department of Health and
Human Services emphasized by quoting the remarks made by the Secretary
of State, Condoleeza stated at the recent US Department of State's Summit
on Global Aging in which she stress "the importance of integrate the
issues of aging into our foreign policy."
Click here for Mrs. Lai's presentation
materials in PDF.
The Round-table discussions provided the delegates from their respective
country but also the participants who are experts on the issue of aging
in the public and private sectors with the opportunities of having in-depth
analysis and views as expressed by the delegates of how each country is
coping with the issues of multiple natures in order to prepare for the
coming of the new aging society due to the entry of Baby Boomers generation
into the aging society. Discussions were conducted among the delegates
and one of the highlights of the questions rose which was directed to the
former Director General of the Bureau of Welfare for the Elderly, Japan's
Ministry of Health, Labor and Welfare. The questions raised was; "How do
you develop the system of Japan's Long-term Care Insurance System if you
were now in charge?" Because of the assertion that the former Director
General made in his presentation which stressed the importance of social
security policies should not become the victim of external factors or political
pressures by citing that with the wisdom and balanced sense of concerted
efforts, the system could be maintained and kept viable.
Dr. Igata commented that the session was a very fruitful and constructive.
He stated that he wished that more time would be allowed to the delegates
to discuss further on many other issues and thanked for the delegates and
the participants for their presentation and discussions. The session adjourned.
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