A Study on “Silver Housing” in Japan: the Roles of “Life Support Advisor

J. Home Econ. Jpn. Vol. 48 No. 3 235•`245 (1997;

Note

A Study on "Silver Housing" in Japan: The Roles of

`` Life Support Advisor" and "Life Support Services"

Yasuko KIKUZAWAand Rin NAKASHIMA*

Faculty of Education and * Graduate School, Hyogo University of Teacher Education, Hyogo 673-14, Japan

Keywords: silver housing, life support advisor, the elderly, housing.

Nonetheless, item (4) includes several interesting INTRODUCTION topics. SH are something new in the realm of "Sil ver Housing" (hereinafter written as SH), refers Japanese public housing, and the crux of problems to housing for the elderly that includes some level of can only be understood by grasping the realities of on-sight care. actual sites. Jointly sponsored by Ministry of Construction and With this view, authors have been conducting Ministry of Health and Welfare of Japan, planning and ongoing researching into the actual conditions at SH construction of SH projects began in 1987 in response projects, investigating LSAs and LSS situations by to the rapidly increasing numbers of elderly people administering questionnaires. living alone in Japan. The following report shows some of the fruitful In 1988 there were only 131 SH developments results gained by analyzing the aforementioned data throughout the country, but those numbers increased in order to contribute to the development of LSSs and rapidly each year thereafter, and by the end of 1993 LSAs in the near future. there were 4,369 SH sites. METHOD OF RESEARCH Although some variation exists, all SH projects share the following characteristics: Preliminary research of residents in SH in 3 regions (1) Initial joint, cooperative development by the (Kobe City, Nishinomiya City, and Karuizawa Town) Ministry of Construction and the Ministry of Health began in 1989, by means of the interview method both and Welfare. for residents and LSAs. (2) Barrier free designs adopted in the architecture After completing this preliminary research from of the buildings, as well as in its interior features. July to September 1994, more detailed interview with (3) Adoption of "emergency informing systems." residents and LSAs was carried out in 10 SHs in the Differing systems are employed, but many use bells Kansai area, as shown in Table 1. The items of equipped in the living quarters to be pressed by research were: motives for entering the SH; residents' residents for alerting of emergency. health conditions and life styles; and the contents of (4) Introduction of "Life Support System," which LSS for residents, and the treatment and working includes "Life Support Services" (LSS) and which is conditions of LSAs. Moreover, exclusive research of headed by a staff member called "Life Support LSAs was conducted to learn more about what they Advisor" (LSA). LSS is a system that assists elderly do to provide LSS, as well as their own working residents in their daily lives. It is coordinated by LSAs conditions and professional treatment from Septem- who provide various services, such as: "providing ber to December 1994. assistance in emergency situations," "regularly ask- Out of 40 SH businesses surveyed, data was ing after the health and safety of residents," collected for 25 (as shown in Table 1). Table 1 is the

`` consultations about daily affairs," and "temporary outline of the subjects from SHs surveyed for this housework assistance" etc. research. Items (1), (2) and (3) are relatively easy to CLASSIFICATION OF SH evaluate. However, the successful implementation of item (4) is more difficult to objectively assess. SHs as objects of this research can be classified

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(237) 29 J. Home Econ. Jpn. Vol. 48 No. 3 (1997) into 8 categories (as shown in Table 2), according to The professional treatment of LSAs scatters over a the type of housing (independent or combined with wide range too. In terms of salaries, annual incomes other purpose built housing) and the working range between 380 thousand yen and 4,900 thousand conditions of LSAs (exclusive or concurrent jobs, yen. For those in on-site live-in residential positions, on-site live-in residential or non-residential job municipal subsidies range from 0 to 744 thousand yen styles). per year, and in terms of duty hours, those who are The number of subjects in each category in this required to provide day-long shifts range from research is shown in Table 2. nothing to full-obligations. Motives for becoming an LSA and perceptions of THE PROFILES OF AN LSA AND THE ACTUAL their functions in providing LSS CONDITIONS OF LSS Table 3 shows the results of the answers concern- Profiles of an LSA ing the motives for choosing the job as an LSA. A The number of women predominates over the minority were hired publicly, usually as concurrent- number of men (women 21, men 5) among the total job care-takers. number of subjects (26), and the age of the subjects Table 4 shows the results of the answers concern- ranges from individuals in their twenties to people in ing their perceptions of their functions in providing their sixties. LSS. This table tells us the majority of LSAs regard, Concerning their previous occupations before `` action in an emergency case," and "asking after the becoming LSAs, 23.1% of the subjects were engaged health and safety of the resident," as the most in the medical or public health fields. Thirty point important items, compared with the other duties eight percent were engaged in the welfare field, and (consultations about daily affairs, temporary assist- the remainder were housewives with no outside ance with housework, and various information ser- occupations. vices). Forty-six point two percent of the subjects were Actual duties performed by LSAs and issues of the `` licensed nurses, welfare care-takers, etc., and were Life Support Service" concurrently engaged in other jobs. 1. Duties performed as a part of LSS Working conditions of LSAs Tables 5-9 show the results concerning the The working place is shown in Table 1. The existence of stipulated duties and the content of the majority of the subjects work 5.5 days per week, service for each item mentioned above. These tables followed by those who work 5 days per week. indicate the majority provide the various LSS whether The working-hour range spreads from 8:30 or 9:00 or not such stipulations exist, though minor excep- a.m. to 5:00 or 6:00 p.m. tions occur. As for working situations, the on-site live-in 2. Problems faced by LSAs in the conduct of their residential style dominates over non-residential posi- LSS duties tions (68 : 32), and the exclusive job style dominates Eighty-seven point six percent of the subjects concurrent employment situations (60 : 40). answered that they experience difficulties coping with

Table 2. Classification of SH

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`` action in an emergency case." Their sentiments are statements include the following examples: "there are reflected in statements like: "there are a lot of false some residents who don't desire to be visited," "the alarms," "they don't find out how to cope with it," inner situation of the residents cannot be grasped `` they feel mental burdens that they should watch from the outer observation of their housing units," etc. residents throughout the day." "Other responses Fifty-four point two percent of the subjects pointed included: "the job of LSA is one of uniform routines out problems concerning the item, "consultation and is difficult to match with the personal rhythms of about daily affairs." For example, their complaints one's own daily life," and "it is difficult to cope with centered on: "human relations in SH," "detailed due to too much alarm information," etc. explanations about diseases and medical treatments As for the issue of, "asking after the health and safety of the resident," only 25% of the subjects Table 6. Confirmation of safety (plural answer) answered that they feel difficulty coping. Their

Table 3. Motives of becoming LSA (plural answer)

No. of effective answer: 24.

Table 7. Consultation of daily living affairs (plural answer)

Table 5. Action in case of an emergency (plural answer)

No. of effective answer: 23. No. of effective answer: 24.

Table 4. Perception of priority of life support service by LSA

Numbers in parenthese mean %.

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Table 8. Temporary housework support (plural THE PROFIES OF RESIDENTS answer) AND THE ACTUAL CONDITIONS OF LSS FROM RESIDENTS' PERSPECTIVES

Profiles of residents The number of single elderly respondents dominates the number of elderly couples (134 : 73), reflecting the supply rate of housing for the singles and couples in 10 SHs in the Kansai area. The profiles of subjects interviewed for this research are shown in Table 1. Female respondents dominated over males (107 : 27), and the average age of subjects was 74.1 in Nishinomiya and 73.1 in Ashiya, relatively older than other areas' schemes because of the earlier opening dates of SH sites. However, the averaged figures above do not extend to the age of 75 (the minimum age of the latter period of the elderly).

No. of effective answer: 24. According to self-declarations about their health conditions, 72.1% of subjects had some chronic disease, and 65.8% of them noted "subjective symp- Table 9. Information supply service (plural answer) toms" (self-diagnosed). Fifty-eight point one percent reported consulting the doctor more than one time per month. The kinds of chronic diseases mentioned above were: hyperpiesia (41.8 %), heart diseases (25%), rheumatism (24.4%), diseases relating to the digestive organs (22.4%), neuralgia (14.8%), hypertension (13.3 % ), urinary diseases (10.7 % ), and vascular diseases (6.1%). Moreover, the kinds of "subjective symptoms" they reported were: arthralgia of the limbs (44.1%), lumbago (43.0 % ), stiffness or pain of the shoulders (24.6 %), temporary paralysis of the limbs (22.3 %), physical dullness (14%), cold constitution of the limbs No. of effective answer: 24. (13.4%), temporary paralysis of the shoulders or arms (8.9%), hearing loss (8.9%), and cold constitution of the waist (7.3%). of them," or "troublesome affairs in the Children's In general, many residents with a weak constitution Association related to Residents' Council." were recognized in SH, even if they seem to live Only 25% of the subjects referred to problems independently, and the few residents assisted by concerning the item "temporary housework assist- privately employed home-helpers were found only in ance," by commenting that, "assistance work cannot the relatively older SH projects. be followed by only one LSA," or "cooking for Reasons for entering SH facilities and the charm- residents is always the source of trouble," etc. ing points of SH life Sixty-two point five percent of the subjects were Listed in the order of frequency of responses, engaged in the LSA job without the experience of chosen by resident who selected to live in SH in the pre-training, although 71.4 % of them desire to do so, last stages of their lives, from 1 through 6 are such resulting in troublesome situations that still require reasons concerning their previous abodes they had problems to be solved. This situation suggests the experinced as: "higher rent (27.6 %)," "old buildings necessity of experiencing pre-training before engag- (26.5 %)," "inadequate equipment (22.4 %)," "bad ing in the work of an LSA. environment (15.4%)," "requested or forced removal

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(13.6%)" and "small spaces (10.3%)." the elderly (28.7%)," "It is under public management This result reflects the bad residential conditions (25.7%)," "The equipment is fully prepared (25 %)," they experienced before entering SH projects. This and "It is prepared for emergency situations (22.4 point is clearly demonstrated in the following %)." On the other hand, only 11 percent of subjects statistics: 57% of subjects had lived in privately felt the LSA feature was an attractive point when they owned wooden rental apartments, and 56% of had just entered the SH. subjects had lived in small residences with less than The frequency of contact with LSAs 16 m2. As a whole, although 23% of subjects had daily In describing the charming points of SH life, contact with LSAs, 49.7% of them rarely talked with residents indicated that: "It is designed for living by LSAs.

Table 10. Actual situations of "action in case of an emergency" per SH

Table 11. Actual situations of "confirmation of safety" per SH

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Table 12. Actual situations of "consultation of daily living affairs"

Table 13. Actual situations of "temporary housework support" per SH

The frequency of contact with LSAs was scattered mechanisms. The other is through human power, and over a wide statistical range among the SHs surveyed. each SH adopts either one method as shown in Table Regarding the type of contact involved, 59 % of 11. A firm answer to the question of, "Which is the subjects exchanged only greetings, and 20.8 % of preferable way ? ," was not grasped from this re- them rarely met with LSAs. search, leaving the conclusion for future surveys. Actual conditions of LSS Table 12 shows consultation issues as "health Tables 10-14 show the details of services, including conditions" and "housing and equipment" are stipu- the actual conditions, duties stipulated, duties per- lated and carried out in almost all SHs. However, formed, residents' perceptions of LSAs, and the need Table 12 also suggests that the stipulation and for and utilization rates of such services. Responses performance of other job items differ widely between suggest that residents' perceptions are unexpectedly individual SH facilities. These differences reflect the low in almost all SH projects. existence or non-existence of specific stipulations in Concerning the confirmations of residents' safety, job manuals, as well as the nature of the organization as shown in Table 11, there are two general ways in dispatching the LSA and LSS, namely public or private which this is done. One way is through equipment sector management by local authorities.

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Table 14. Actual situations of "information supply service" per SH

Regarding temporary housework assistance, Table by a personal sense of responsibility on the part of 13 suggests that the perception rate was relatively individual LSAs, and such a tendency was especially high for SHs stipulating such support services. evident among LSAs who have concurrent work as Whether or not temporary housework support service LSAs and in other social welfare jobs. It should be is an indispensable job of the LSA, however, is not the pointed out that a reason for the above-mentioned issue being to be re-considered, because such a situation, is the fact that the role of LSA is vaguely service, primarily, falls into the realm of and should defined as a kind of home-helper or volunteer, with be considered by the field of social welfare. the characteristics of a friendly neighbor. There is also ambiguity about duty-stipulation and about the ISSUES AND CONSIDERATIONS ABOUT LSS necessary professional quality required of LSAs An outline of the research concerning the LSS support for residents. These dilemmas can be duties of LSAs was described above, suggesting the attributed to the fact that the administrations of 11 variety of services supplied, as well as the differences SHs among the total (25) entrusted the dispatch of in working conditions and levels of professional LSAs to the private sector. It is time to clarify the consciousness of LSAs, etc. significance and role of LSA jobs, to compile basic Now, the authors will attempt to reiterate the main manuals for LSA positions, and to establish training points and problems by reflecting on the information systems for LSAs. gained from our case studies. (2) Regarding actions in cases of emergency, which (1) In the course of conducting research, it was is one of the most important support services, many recognized that great variations in contents of service on-site live-in LSAs noted the accumulation of mental exist among 25 administration constituents of SH. stress that comes from services that require them to The ambiguity of the stipulations about kinds, look after residents all day and all night, without contents, scopes, methods, limits of activities, etc. was shifts. especially evident. These ambiguities were the clear Such situations pose urgent problems that require causes of mental stress on LSAs, who feel a strong improvement. LSAs should work under one-shift responsibility in their job. Both the quantity and working conditions. Adoption of the shift system- quality of services rendered were strongly influenced especially in cases of LSA absences and vacations, at

(243) 35 J. Home Econ. Jpn. Vol. 48 No. 3 (1997) night, or in emergency situations-would entrust the emergency" and "asking after the health and safety job to other organizations or assistant staff members, of residents," as the remarkable features of SH life, thereby deepening the mutual understanding between expecting implicitly that LSAs perform multiple roles LSA and residents. of home-helper, volunteer, and friendly neighbor. (3) The findings clarify the fact that the treatment The LSA system is a new venture being tried for and working conditions of LSAs varied widely, and the the first time especially as a public sector itself in majority of them received low, inadequate salaries. Japan. There is much groping in the dark for answers Moreover, in the case of on-site live-in LSAs, it was to the daily execution of many activities that their family members who mostly assisted, without constitute the job. However, as already mentioned pay, in providing LSS on a 24-h basis. The recent above, it is important to keep in mind the point that example of the small number of applicants for the SH projects are only type of housing alternative that public recruitment of LSAs reveals the realities of the elderly choose as homes in the last years of their relatively low wages and ambiguous working condi- lives. tions for LSAs. Fromthis, point of view, the ideal role of the LSA (4) From this research it was clarified that the should be clearly defined-namely to support the life existence of LSAs, the role of LSAs, and the contents of elderly residents by devoting themselves to the of LSAs' services were not well understood by SH role of a coordinator. Humanness, after all, is one of residents, and contact between LSAs and residents the most important and desirable goals in the fields of were rarely made, with a few exceptions. social welfare or social services, etc. As background to these inadequacies regarding As a result, adjustments should be made to focus recognition of LSAs and LSS, it should be pointed out the job to include consultations and information that according to the information gained from the services about daily affairs, in addition to emergency interview surveys of residents, SH administrators did responses and health and safety confirmation. not adequately explain the LSA system, giving special In order to realize such transformation, training is priority only to, "action in an emergency case," and to necessary to acquire the technical information and " asking after the safety of the residents' health qualities considered indispensable in the role of LSA. conditions." Consequently, the establishment of a nation-wide Positive incentives to make full use of the LSA authorization system concerning LSAs is the key to system are now required, as the latent demands of the the future development of SH in Japan. elderly for "life support services" are to be numerous, Finally, the authors express our gratitude to all if only such a system can be utilized. those who cooperated in this research: the residents Moreover, the fact that residents of SH selected and LSAs of SHs, staff of the Housing and Planning such facilities as their homes in the last years of life, sections of Osaka Prefecture and Kobe City, and the preferring them to nursing homes or hospitals even COM Planning Institute. when taken ill, suggests the necessity of closer REFERENCES cooperation with social welfare, home-stay local services, etc., in addition to the need for clarification A Symposium of the Kanto Branch of the Urban Housing about the role of the LSA. Society (1995) (in Japanese), Toshi Jutaku Gakkaishi (Magazine Urban Housing Soc. Jpn.), 9, 3-15 CONCLUSION Bureau of Housing of the Ministry of Construction (ed.) This research has clarified the present situations of (1994) The Handbook of Community Housing (in Ja- residents of "Silver Housing" in Japan. Unfortunately, panese), Nihon Jutaku Kyokai (Japan Housing As- sociation), Tokyo they are spending their lives in SH facilities, Ogawa, M. (1992) Study for the Floor Plan in the "Silver uninformed about the provisions of their contracts Housing" (in Japanese), in The Synopses of Japan concerning the roles of "Life Support Advisors" and Architects Association, 127-128 `` Life Support Services." Moreover, the explanation Tamaki, S. (ed.) (1994) Community and Housing, Keiso- about these matters offered by SH administrators is shobo, Tokyo likely only to emphasize, "action in cases of

36 (244) A Study on "Silver Housing" in Japan: The Roles of "Life Support Advisor" and "Life Support Services"

シルバーハウジングに関する研究 - LSA の役割と生活援助サービス

菊澤康子, 中島倫*

(兵庫教育大学学校教育学部, *兵庫教育大学大学院) 平成 8 年 10 月 2 日受理

生活援助員システム(LSA)はシルバーハウジングでの高齢者の日常生活を公的に援助するという目的のために, 1987年より計画策定が開始され, 1989年より管理開始されたわが国ではじめて採用されたシステムである.筆者は標記に関して関西地域の10カ所のシルバーハウジングに関する予備調査を行い, ひきつづき1993年から1994年にかけて, 全国の40カ所のシルバーハウジングに関する本調査を実施し, 次の知見を得た.(1)LSAのサービスはシルバーハウジングごとに大幅に違いがある .またLSAの処遇(給料など)にも大幅な違いがある. (2)住み込み方式のLSAの場合は24時間対応という精神的ストレスが大きい.(3)シルバーハウジング居住者のLSAに対する認知度は関係自治体の説明不足もあり, 必ずしも高くはない.

キーワード:シルバーハウジング, 生活援助, 高齢者, 住居。

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