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| Japan wrestles with ageing problem | Japan wrestles with ageing problem |
| (20 minutes later) | |
| By Branwen Jeffreys Health correspondent, BBC News Matsu Yamazaki remains very activeEach day Matsu Yamazaki steps out of her small house in a Tokyo suburb to walk through busy streets to work at her family's grocery shop. | By Branwen Jeffreys Health correspondent, BBC News Matsu Yamazaki remains very activeEach day Matsu Yamazaki steps out of her small house in a Tokyo suburb to walk through busy streets to work at her family's grocery shop. |
| It would be unremarkable but for the fact she is 103 years old. | It would be unremarkable but for the fact she is 103 years old. |
| Mrs Yamazaki has survived an earthquake that devastated Toyko, the second world war and cancer in her seventies. | Mrs Yamazaki has survived an earthquake that devastated Toyko, the second world war and cancer in her seventies. |
| She cooks and cleans for herself, keeps her hands nimble through crafts and her mind agile through mathematic puzzles. | She cooks and cleans for herself, keeps her hands nimble through crafts and her mind agile through mathematic puzzles. |
| This is how we imagine old age in Japan, remarkably healthy and active. | This is how we imagine old age in Japan, remarkably healthy and active. |
| "Even if I go on living, I just don't want to lose my mind," she said. | "Even if I go on living, I just don't want to lose my mind," she said. |
| "I know lots of people who've lost their memory. They go out and wander around town and can't find their way home. " | "I know lots of people who've lost their memory. They go out and wander around town and can't find their way home. " |
| Pensioner numbers growing | Pensioner numbers growing |
| For Japan that is the problem - by 2055 the government is predicting pensioners will be around half the population. | For Japan that is the problem - by 2055 the government is predicting pensioners will be around half the population. |
| The numbers of the very oldest are growing steeply and that means rising costs. | The numbers of the very oldest are growing steeply and that means rising costs. |
| A look at around a care home in Japan | |
| Already caring for the elderly accounts for half of the health budget, and Japan has a huge financial deficit. | Already caring for the elderly accounts for half of the health budget, and Japan has a huge financial deficit. |
| So long term care insurance for the elderly was introduced in 2000 to help shift care out of hospitals. | So long term care insurance for the elderly was introduced in 2000 to help shift care out of hospitals. |
| The contributions are raised from the working population over the age of 40. | The contributions are raised from the working population over the age of 40. |
| Some changes were added in 2006, including incentives to promote more independent living at home. | Some changes were added in 2006, including incentives to promote more independent living at home. |
| Much more controversially a new health insurance scheme for the over-75s was introduced this year. | Much more controversially a new health insurance scheme for the over-75s was introduced this year. |
| Elderly patients told me they do not like being singled out and issued with special cards. | Elderly patients told me they do not like being singled out and issued with special cards. |
| It has already been nicknamed the 'hurry up and die' scheme, and has whipped up a political storm. | It has already been nicknamed the 'hurry up and die' scheme, and has whipped up a political storm. |
| Fee goes down | Fee goes down |
| In Hotano city an hour from Tokyo Dr Jun Saiwadaishi showed me around the wards and rehabilitation units of the hospital where he works. | In Hotano city an hour from Tokyo Dr Jun Saiwadaishi showed me around the wards and rehabilitation units of the hospital where he works. |
| Under recent changes the fee the hospital receives for a patient goes down after 100 days - as an incentive to shorten hospital admissions which are long by international standards. | Under recent changes the fee the hospital receives for a patient goes down after 100 days - as an incentive to shorten hospital admissions which are long by international standards. |
| If we just go ahead and cut budgets - Japan should be ashamed of that internationally Dr Jun Saiwadaishi | If we just go ahead and cut budgets - Japan should be ashamed of that internationally Dr Jun Saiwadaishi |
| Dr Saiwadaishi has launched a human rights legal case against the government because he is so angry. | Dr Saiwadaishi has launched a human rights legal case against the government because he is so angry. |
| "If we just go ahead and cut budgets - Japan should be ashamed of that internationally. | "If we just go ahead and cut budgets - Japan should be ashamed of that internationally. |
| "I think it is really dreadful - nothing like this has ever happened." | "I think it is really dreadful - nothing like this has ever happened." |
| A few days later in a publicly run care home in a wealthy part of Tokyo I saw the other side of old age in Japan. | A few days later in a publicly run care home in a wealthy part of Tokyo I saw the other side of old age in Japan. |
| Volunteers from the neighbourhood had come in to sing folk songs with the residents, most of whom have dementia. | Volunteers from the neighbourhood had come in to sing folk songs with the residents, most of whom have dementia. |
| The words are too hard to recall for many, but almost all added a faint voice to the song. | The words are too hard to recall for many, but almost all added a faint voice to the song. |
| Unprecedented pressures | Unprecedented pressures |
| Just under a third of Japanese people over the age of 85 have Alzheimer's or some other kind of dementia, a very similar rate to the UK. | Just under a third of Japanese people over the age of 85 have Alzheimer's or some other kind of dementia, a very similar rate to the UK. |
| So the increase in the very oldest has created unprecedented pressures. | So the increase in the very oldest has created unprecedented pressures. |
| Under the long term care insurance elderly people here contribute 10% towards their care and demand for places has increased. | Under the long term care insurance elderly people here contribute 10% towards their care and demand for places has increased. |
| Matsui Kawazaki on her wedding day | |
| There has been an increase in the number of nursing homes but not enough. | There has been an increase in the number of nursing homes but not enough. |
| At just this one home there are hundreds of people on the waiting list. | At just this one home there are hundreds of people on the waiting list. |
| One floor of the home is unused because of staff shortages. | One floor of the home is unused because of staff shortages. |
| Local companies can offer better pay for easier work. | Local companies can offer better pay for easier work. |
| The manager Masae Tanaka told me he has to turn away families desperate for a night of respite care. | The manager Masae Tanaka told me he has to turn away families desperate for a night of respite care. |
| "The families tell me they can't cope looking after them at home, they're exhausted and plead with me to take their elderly in. | "The families tell me they can't cope looking after them at home, they're exhausted and plead with me to take their elderly in. |
| "They'll go under as well with the strain of it all. In Japan this is called a double collapse." | "They'll go under as well with the strain of it all. In Japan this is called a double collapse." |
| Political challenge | Political challenge |
| Like some of the doctors I met he is pessimistic about the ability of the system to cope as the population continues to age. | Like some of the doctors I met he is pessimistic about the ability of the system to cope as the population continues to age. |
| As the NHS turns 60, the BBC is giving the service a health check. Over the next week BBC News will be providing reports, features and analysis on TV, on radio and online. | As the NHS turns 60, the BBC is giving the service a health check. Over the next week BBC News will be providing reports, features and analysis on TV, on radio and online. |
| But many experts support the government's efforts to find solutions which are financially sustainable in the long term. | But many experts support the government's efforts to find solutions which are financially sustainable in the long term. |
| Trying to introduce measures which ask people to pay an increased contribution is politically tough. | Trying to introduce measures which ask people to pay an increased contribution is politically tough. |
| One of Japan's leading health economists, Professor Naoki Ikegami argues their long term insurance has been a success by widening access to social care. | One of Japan's leading health economists, Professor Naoki Ikegami argues their long term insurance has been a success by widening access to social care. |
| He still believes there are hard choices ahead: "politicians don't like making unpopular decisions and raising taxes or cutting benefits is unpopular but they have to make either of these decisions. " | He still believes there are hard choices ahead: "politicians don't like making unpopular decisions and raising taxes or cutting benefits is unpopular but they have to make either of these decisions. " |
| The growing proportion of the elderly are a significant political influence in Japan. | The growing proportion of the elderly are a significant political influence in Japan. |
| No party can afford to ignore their votes. | No party can afford to ignore their votes. |
| That may mean that younger generations face more radical reforms as it is easier to adjust entitlement with several decades warning. | That may mean that younger generations face more radical reforms as it is easier to adjust entitlement with several decades warning. |
| The dilemmas faced by Japan now lie ahead for all the major economies whose populations are also ageing. | The dilemmas faced by Japan now lie ahead for all the major economies whose populations are also ageing. |
| A rapid growth in the very oldest can create a heavy burden for families, and a financial headache for governments. In Japan, as in parts of the UK, the debate is how the burden should be shared. | A rapid growth in the very oldest can create a heavy burden for families, and a financial headache for governments. In Japan, as in parts of the UK, the debate is how the burden should be shared. |