As the baby boom ages into the elder explosion in the world's industrial nations, more and more innovative solutions will appear in the effort to provide seniors with the many sorts of care they deserve and to which they are entitled.
In Japan, the nation at the forefront of the elder explosion, 'Senior Co-operatives'--Koreikyo, a hybrid form of cooperation combining aspects of consumer and worker co-operatives of, by and for seniors, have grown rapidly to more than 100,000 members over the past decade. In the Koreikyo model, the active elderly (roughly 55 to 75 years old) provide care for the frail elderly (generally 75 and older) in the care receiver's own home through the co-operative's home-helper dispatch centers. Since 2000, this expense can be reimbursed by national long-term nursing care insurance (kaigo hoken) under defined conditions. People 65 and over are entitled to home-helper services and visiting nurse care, day care and brief stays at nursing facilities as needed, according to the judgment of a trained care plan manager.
The central focus of this long-term care insurance plan is to help seniors to live in their own homes as long as possible. This insurance provides them the varying degrees and types of care they require to continuing to live at home. One of the effects of the introduction of kaigo hoken has been a dramatic increase in demand for care services, especially home care attendants. And, as might be expected, home-visit care is the service people complain most about. The complaints are mostly about the quality of the services and attitudes of the care workers. The root causes of the problem are related to inadequate training of home-helpers.<
As a result Koreikyo is also becoming a major educational institution, developing training programs for professional long-term care specialists to provide care together with family members. In 2000 Koreikyo members started programs to train and certify themselves, opening these programs to the general public with the support of municipal governments, which are responsible for administering kaigo hoken. The training of home-helpers and the operation of home-helper dispatch stations have become major parts of Koreikyo activities.
As a co-operative, all Koreikyo members make a one-time purchase of a capital share in the co-op when they join (about $50 US, which is returned to members when they leave the co-op). They pay an annual $30 membership fee, which includes a newsletter subscription. Koreikyo is run democratically: members elect a board of directors and officers, and each functioning group within the local chapter sends a member to their board. What makes Koreikyo an unusual co-operative is the elegant way it combines features of consumer cooperatives, which are common in Japan, with worker co-operatives, which are not.
These two different kinds of co-operatives are combined by the simple method of a 'pay-as-you-go' ticket system. The different prices of the co-op's services are published, and generally kept slightly below market prices. Members buy books of tickets and as they use co-op services, they turn over the appropriate number of tickets to the co-op member providing the service. Service providers--themselves all co-op members as well--in turn redeem the tickets they've collected at the co-op office for their money. The Koreikyo retains a small amount from each transaction to pay local and national professional staff, and finance continuing expansion.
In addition to their home helper service, nursing home assistance, and transportation for dialysis and other kinds of therapy, Koreikyo provides a variety of other activities to its members, among them clothing re-tailoring and home environment repair and renovation services. Some chapters provide lunch and dinner cooking and home delivery, and day-care centers for seniors. Koreikyo even operates three assisted living centers.
In Japan it is important for seniors to stay active to maintain a sense of self-worth. Many seniors continue to work after formal retirement. Others do volunteer work or participate is social clubs. Consequently, many Koreikyo activities for members are not actual business services but social activities and community services such as touring and hobby groups (e.g., knitting, doll-making), reading and discussion circles, social service group volunteer opportunities, organizations to raise funds for Koreikyo and other charitable institutions, and newsletter publishing.
While working at the Kawasaki City Koreikyo in 2004, I met Tanaka Michiko, 76. One morning she came in "to just help" the Koreikyo linen changing crew change sheets at New Green Nursing Home. Ito Hana, chief of the crew, worried that Mrs. Tanaka was not yet fully recovered from her stomach surgery six weeks earlier and might be returning to work too soon for her own good. "She lost over 10 kilos," said Mrs. Ito, "but I couldn't keep her away." Mrs. Tanaka is the original Energizer Bunny, and just lights up any room she enters. All of the residents and staff just beamed when they saw her again, and she had something amusing to say to each person she met.
At age seventy-six, Mrs. Tanaka could find suitable work, take off time for surgery, recover at home with Koreikyo home helper services, and return to work more or less at her own admittedly rapid pace, all because she is a member of Koreikyo. Koreikyo's central mission is to find ways to help seniors remain in their own homes as long as they possibly can, and it approaches the problem from both ends: how to get frail seniors the help they need to stay independent, and how to help able seniors find worthwhile work that pays. Through Koreikyo, seniors stay active and add value to their lives through service to others. Members create community when they provide services and when they receive them, as Mrs. Tanaka and many others have already done.
Robert Marshall is Professor of Anthropology at Western Washington University.