<![CDATA[From dementia to jobs, does Japan's ageing society hold the secret to growing old gracefully?]>

The story of Japan's ageing population is often repeated like a tired old tale.

"Ticking time bomb" and "demographic crisis" are the kind of phrases that usually feature as the country with the "world's oldest population" is held up as a cautionary example of what Asia's other developed economies can expect in their dotage.

The chief bogeyman is economic decay. As birth rates fall and life expectancies grow, experts warn that Japan's dwindling pool of taxpaying young workers will slowly be overwhelmed by the burden of financing the health care needs of the growing legions of elderly. And, so the story goes, where Japan leads, other big economies with falling birth rates " Hong Kong, Singapore, South Korea and mainland China among them " will follow.

That's how the pessimists see it. But there's another, more positive side to the Japanese experience. As its population matures, the country is making strides in caring for this growing segment of society, quietly leading its peers in areas such as welfare funding, dementia care and social initiatives for the retired.

Could it be that, much as in the 1980s other countries sought to emulate Japan's ground-breaking technology sector, they might one day be following its lead in how to grow old gracefully?

WHO ARE YOU CALLING A TIME BOMB?

That the country is in line for a fundamental shift isn't in question. With the population decline accelerating, the Japanese government estimates its population " currently around 127 million " will fall to just over 100 million by 2050. Last year, the fertility rate was just 1.42 " far below the 2.1 needed to maintain a steady population.

Japan's fertility rate has fallen to 1.42, far below the 2.1 needed to maintain a steady population. Photo: Reuters

Meanwhile, life expectancies are still growing, having soared from the low 50s in the post World War II period to today's figure of 87 for a woman and 81 for a man, according to the Ministry of Health, Labour and Welfare. The World Bank estimates that more than one in four Japanese is now older than 65, the standard retirement age.

But while it has become popular in the media to emphasise the negative aspects of these trends " type "Japan demographic time bomb" into Google and there are around 1.4 million results " some experts have started to note the positives, too. They point out that increased longevity is a sign of improved nutrition, medicines and living standards and note that as the population decreases, Japanese will have more living space (and therefore a higher quality of life) and make less of an environmental footprint. Then there is the consideration of how an ageing population is forcing Japan to re-evaluate what it means to be old and recognise that a person's worth to society needn't be tied to their age.

As part of this the country is reassessing its approach towards retirement. In June the government launched a plan to revise the law on elderly employment. If passed by the Diet next year, this would oblige companies to secure jobs for workers willing to go beyond the standard retirement age of 65 until they are 70.

OLD MAKES GOLD

Driving this in part is the government's need to widen the pool of workers, but it also reflects the desire of many elderly Japanese to continue working. A recent survey by the labour ministry found that more than 40 per cent of people in their early 60s hoped to work part time beyond the retirement age of 65.

Every year, 2.2 million people in Japan turn 65, and while some may be rehired by their companies on new contracts many others aren't. Of those who decide that spending their final years tinkering in the garden is not for them, many turn to the Silver Jinzai Centre. Set up in Tokyo in 1974 as an odd-job agency for retirees, the centre has grown into a full-fledged nationwide community resource, publishing newsletters and holding excursions for its 720,000 members and 1,304 locations.

Okinawa's first Jinzai Centre appeared in 1982. Since then a further 16 have opened across the prefecture. Through the centre, seniors get part-time jobs ranging from cutting grass to working as cashiers in supermarkets.

Jinzai (Japanese for human resource) workers earn an average of 40,000 yen to 50,000 yen (US$360 to US$460) a month, and their pay is capped at 120,000 yen (US$1,100), according to Moritou Kiyomasa, 63, managing director of the Naha City Silver Jinzai Centre.

"Japanese people basically like to work," he says. "These seniors already have full lives taking care of their families. But they have extra time and they want to make full use of it."

Kiyomasa says there are no age limits, but care is taken when assigning jobs that involve tasks such as driving.

"Even among seniors of the same age, there's a big difference in physical stamina. Some are 80 and very energetic, so age is not an indicator of their abilities," he says.

Noriyasu Sato, 72, is one of 845 active members of the Naha City Silver Jinzai Centre. Since February, he has been working at the Naha Haebaru Clean Centre, the larger of two waste management plants in Okinawa.

Sato leads a 12-man team in sifting through 1,910 tonnes of waste each year, prying open appliances to remove metallic lithium-ion batteries and prevent environmental contamination.

"Work is tough. It's so hot here," says Sato.

Noriyasu Sato, 72, works at a waste management plant in Okinawa. Photo: Jeremey Teo

His team works from 8am to 5pm for three or four days a week at the plant. They get an hour off for lunch and two half-hour breaks.

"I joined the Silver Jinzai programme four years ago and did gardening jobs in parks, and cleaned tombs and memorials. Look at me, I'm still healthy," says Sato, who still drives himself to work every day.

Some jinzai workers choose jobs completely removed from their pre-retirement lives.

Toma Hidetoshi, 67, took the opportunity to work with young people.

A former statistician in an electronics company, Hidetoshi works as an administrator at a youth activity centre where facilities such as basketball and badminton courts and music rooms are offered free of charge.

"Nurturing children is very important and I feel this job also has an educational element to it," he says.

Hidetoshi believes that working with younger people and staying active help to keep him young.

"I don't feel like a senior citizen. I'm doing what I want to do and I enjoy what I'm doing," he says. "It's all about moving forward."

DEALING WITH DEMENTIA

Other developed economies are looking to Japan's experience not only in terms of retirement ages, but increasingly to learn from its social care model.

Japan's Long-term Care Insurance Act, introduced in 2000, is seen by many as one of the most comprehensive social care systems in the world.

At its heart is the aim of reducing the burden on families and promoting care in the community.

The seven-tier insurance system provides subsidies based on the level of care required by the individual, rather than on their income level or their family's perceived ability to provide informal care.

Japan's Long-term Care Insurance Act, introduced in 2000, is seen by many as one of the most comprehensive social care systems in the world. Photo: Reuters

Seniors and those above 39 who suffer from age-related diseases from dementia to rheumatoid arthritis qualify for the insurance, which is financed by mandatory payments by all citizens aged 40 or above. Seniors who require more intensive care qualify for higher subsidies.

While the system is geared towards care in the community organisations, the insurance can even be used to cover stays in residential care homes " another area where Japan is winning plaudits.

In Okinawa, with a population of just 1.4 million, there are 106 government-assisted care homes, each of which caps the number of residents with dementia to nine. The Ministry of Health, Labour and Welfare says this level provides the most homelike environment for residents, few of whom will ever return to their family homes.

In 2018, there were more than 300,000 people over 65 in Okinawa and the prefectural government estimates about 17 per cent of these have dementia symptoms, such as declining memory and language and problem-solving skills, that affect everyday activities. More government-assisted care homes are in the pipeline.

Thanks to the Long-term Care Insurance Act, the cost to a resident of staying in one of these care homes ranges from 110,000 yen to 180,000 yen (US$1,000-US$1,650). This covers about 10 to 30 per cent of the actual cost, with the government " financed by the mandatory payments citizens make under the care act " picking up the rest of the bill.

HOME LIFE

Perhaps not surprisingly, the homes are mostly a hit with those living in them.

When she was 101 years old, Tsuru Yogi moved into Churatoku, a care home in Okinawa City. She had dementia and needed a wheelchair to get around.

Centenarian Tsuru Yogi, 107, is helped as she mixes the batter for pancakes at the Churatoku facility. Photo: Jeremy Teo

Now 107, Yogi wheels herself by hand around the home, and makes a fuss whenever the staff try to help her. Her eldest son Jisshou Yogi, 88, visits her once a week.

The care homes group residents together according to need. Residents of Churatoku must be medically diagnosed with dementia and classified as Care Level 1 " the lowest insurance tier which requires a long-term care plan for their disability.

"Families are getting smaller, so it is hard to have sufficient caregivers. Some are reluctant, or are not prepared to take care of these [people] as well," says Churatoku's manager, Nozomu Sadoyama, 47.

Churatoku, which opened seven years ago, is currently at full occupancy with nine residents. Four or five caregivers take care of the residents in the day, while one or two cover the night.

Each resident has their own bedroom and is encouraged to decorate their space with photographs and familiar objects for a comfortable living environment.

Daily activities, such as making pancakes for an afternoon snack, keep residents active, as do field trips every couple of months to keep them "in touch with the outside world," according to Sadoyama.

Another home, Hiyamikachi in Naha City, encourages residents to accompany staff on weekly grocery shopping trips.

Seiko Uechi, 83, is one of nine residents at the Hiyamikachi dementia group home. Photo: Jeremy Teo

"They are often excited to meet new people, and this can help to slow down the rate of dementia as well," says Hiyamikachi director Nakaima Tomoko, 60.

Resident Akiko Nagamine, 91, says: "I like it when I go outside, and go into book stores. When I start flipping through a book, I will be glued to it and refuse to join the rest."

Still, the staff are careful not to let residents roam without supervision. Among the basic precautions are double locks on every exit in the home. The residents are also issued silver "SOS rings", jewellery that identifies them to the Naha police in case they get lost.

On the last Saturday of every even month, a dementia cafe operates, with residents, staff and volunteers acting as baristas or service staff.

The pop-up cafe costs 100 yen (US$1) for the public to enter. It gives residents the opportunity to interact with more people, while the public gets to learn about dementia.

Nurse Sari Nose, 28, from the Omoromachi Medical Centre visits seniors at the Hiyamikachi home to make sure they are well. Photo: Jeremy Teo

While such care homes have won many admirers, things are not all plain sailing. Labour shortages are a pressing concern. Recruitment and retention of staff can be hard due to low levels of pay.

In 2017, a survey by the Ministry of Health, Labour and Welfare found the average annual income of caregivers in Okinawa was 2.47 million yen (US$22,600), compared to the prefecture's average of 3.66 million yen (US$33,450).

Still, in a land where elderly concerns touch an ever growing proportion of the population, many people are happy to volunteer their services.

Hidetake Ginoza, 67, began volunteer work at the home in 2018 after his 93-year-old mother-in-law died in Hiyamikachi.

"She was happy here. I wanted to give back and continue taking care of her family here," says Ginoza, who visits the home twice a month.

Full-time caregiver Aimi Kochi, 29, who started work in Hiyamikachi in June, says the work is tough but worth it. "I want to support the residents," she says. "To make a difference to their lives."

Caregiver Aimi Kochi, 29, chats with Hiyamikachi's youngest resident Sugako Arakawa, 69, who moved into the home three years ago. Photo: Jeremy Teo

Masaki Uchima, 66. Photo: Jeremy Teo

Former sailor Masaki Uchima returned to his hometown in 1987, took a bank loan with his two elder brothers to purchase a plot of land in Nakijin village, northern Okinawa, and began growing mangoes.

His idea was inspired by a trip to Los Palamós in Spain, where he lived for four years and learned Spanish. The Uchima brothers now co-own 106 mango trees with the government.

In the summer, Uchima and his wife, Kiyoko, 67, harvest about 25 cartons of mangoes daily.

July and August are the "hardest time of the year", says Uchima. "It is so hot. We have to work all day to harvest."

The mangoes are not sold at the market. Besides online orders, the fruits are offered as gifts in the furusato nozei, or 'hometown tax donation' programme in which Japanese taxpayers can opt to pay their income taxes towards a particular area. Introduced in 2008 to close the gap in tax revenue between urban and rural areas, municipalities offer taxpayers various gifts to attract tax-deductible donations.

"The best part of living in the countryside is the stars. Here and now, I'm doing things for myself," he says.

Takako Ganaha, 63. Photo: Jeremy Teo

Takako Ganaha has worked at the fast food chain Hotto Motto for 31 years and for the past seven she has been stationed at an outlet in Tsuji, a former red light district.

Her husband, 62, works in construction and she is candid about their finances. "You can marry rich or you can marry poor. Unfortunately, I didn't marry rich. So we both need to keep working," she says.

The couple had a daughter in 1983, a year after getting married, and worked to pay for her education.

"I've had a hard life but my daughter has had a hard life too. She's now in Tokyo working in IT," she says.

And Ganaha misses her. "Only a lucky few have lots of grandchildren and have people around them all the time. Many old people are lonely like me."

She believes hobbies can help prevent depression. "It's important to have a hobby. I know people who have committed suicide after retirement," she says. "As you get older, it's important to do more things for yourself."

Emiko Kinjo, 70. Photo: Benedict Kee

As the owner of Eminomise in Ogimi Village, Emiko Kinjo has been preparing traditional Okinawan fare for 31 years. Hailed as a secret to longevity, Kinjo's chouju- zen menu, or longevity set, features vegetables grown on her nearby farm.

Priced at 2,500 yen (US$22), the 15-item set includes ebi tempura with fennel batter, stir-fried papaya and spare ribs boiled with shikuwasa citrus and awamori, an Okinawan whisky.

In the 1980s, the former school canteen operator became concerned about US influence on Okinawan cuisine. "I was worried about the culture disappearing and I wanted to preserve the food culture."

To start the restaurant, Kinjo used 5 million yen (US$46,000) from her savings.

"Though it's hard running the restaurant, I want to do something by myself and something for the health of others."

She says restaurants did not exist in the village when she was young, so the seniors are used to fending for themselves. "They work on the farms, they are always busy and they have something to do."

Eishin Takayasu, 78. Photo: Jeremy Teo

Eishin Takayasu returned from Tokyo three years ago, after working in a shipping company for half a century, in a bid to instil a love for the countryside in the next generation.

Born into a family of nine children, Takayasu has just one grandchild, Gintaro Suzuki, 6.

"I have a son and two daughters, and they live in Tokyo," he says. "My grandson is here visiting for two weeks, as he does every year."

The grandfather and grandson like to visit the Okinawa Prefectural Library, where Gintaro picks out books for himself.

Stretching his arms wide, the boy says: "I'm going to read this much!"

Four of Takayasu's siblings died recently, and he hopes his Tokyo-born grandson will appreciate Okinawa, where the extended family is based.

"My other siblings are all here," says Takayasu. "I just want to show him our lifestyle."

Jovi Ho, Neo Rong Wei and Jeremy Teo are students of the Wee Kim Wee School of Communication and Information at Singapore's Nanyang Technological University and were in Okinawa for a journalism module called Going Overseas for Advanced Reporting

This article originally appeared on the South China Morning Post (SCMP).

Copyright (c) 2019. South China Morning Post Publishers Ltd. All rights reserved.