May 29, 2025
Today was the earliest start yet. We met in the hotel lobby at 7:50 am for a long journey to Magokoro Town, a private long-term care facility. Fortunately, a guide from the Kanagawa Prefecture office was there to guide us to our destination with three trains and a bus. We were required to remove our shoes and mask up upon entry for the safety of the residents. The Chairman of the Board of Directors of Magokoro Social Welfare Corporation, Masatoshi Masuda, presented on the philosophy of the facility, the business plan for the corporation, and introduced the “unique” technology used at their facilities. He shared that their mission is to create a local community for older adults, support them in their independence, and serve them with a smile. They are comprehensive in their support, offering daycare services and short-term stays, so caregivers and families can have a respite. They have several types of facilities and services, from the multifunctional/shared house that we visited, which mostly cared for daycare and short-term stay residents, to group homes for more long-term solutions, and home care services.
He touched on the caregiver shortage, how despite efforts started by the company and the central government over 10 years ago, they are lacking 400,000 workers in the long-term care industry. As a result, Japan is revising international labor policies, such as improving visa processes, to attract workers from Southeast Asia. However, they must learn the Japanese way of providing care and be able to converse in and understand Japanese. On the other hand, they are also investing in technology and have LASHIC monitoring systems for their residents – which consists of a room sensor, which is not a web camera, a bed sensor for detecting and predicting awakenings to prevent falls, a nurse call button at the bed, and an emergency button in appropriate areas. He claimed this technology allows one person to monitor 20 residents overnight to decrease the need for night shift workers.
The Social Welfare Corporation is not your typical corporation with investors and stakeholders expecting profits and dividends, instead, it was started with donations and is the only type of corporation that is allowed to establish long-term care facilities in Japan, and hence also enjoy subsidies and funding from the government as well. In America, the majority of long-term care facilities are owned by for-profit organizations, a good percentage by private equity, which have notoriously bankrupted and shut down these necessary facilities after acquiring them. Overall, the ethos of this Japanese long-term care company is inspiring and the legal framework for their setup allows for care and quality to be prioritized. Yet, the LASHIC technology is not that novel; American facilities use bed alarms, nurse alerts, and emergency buttons. The bed sensor does provide heartrate readings, but it was unclear what purpose the room sensor served. While it can be good to attract international labor to address the shortage, protection of these workers, from their rights to the immigration process, is important to prevent turnover and not create second-class citizens.
Afterwards, the manager of the Magokoro Town facility spoke about their end-of-life care and advanced care planning, something that has started to gain traction in Japan over the past 10-15 years after learning about its importance from the US. LTC facilities make sure to address advanced care planning with new residents at the beginning, having a conversation about goals and desires to maintain their dignity at the end of life. When the residents is getting closer to passing their review this plan, reaffirm their desire, and work as interprofessional teams to carry it out - whether it be to have the person go back home to pass away or enjoy what they want to do or eat in the last few days at the facility. He acknowledged that such events can be hard on staff, stressful especially for the younger staff and so they have staff meetings to debrief after someone has passed so staff have a space to share how they are dealing with the occurrence and older, experienced staff can share their practices and thoughts to help with the grief.
Finally, we took a tour of the facility, starting with an activity area where seated residents were following a staff member demonstrating exercises that can be done seated. The average age of residents for the multifunctional/shared facility was ~85, with residents as young as 55 and some residents visiting for over 20 years. He shared that daycare residents are picked up and brought to the facility, but some cannot wait and will show up even before they are open. They are dropped off in the afternoon as well, making it easier for families and caregivers. Residents usually let the facility know if they are coming that day, as capacity is 29, and they generally consider the schedule on a monthly basis, however, they are flexible and if someone need to stay-over or come for the day they make it work.
We visited rooms within the short-term stay area and the long-term stay section. Rooms had windows and balconies, they had a chest with a TV, a bed, and a sink/mirror area for simple cleaning up. The center of each section had a communal seating area where residents were in the process of receiving lunch. The manager showed us his lunch, as staff have the option of eating at the facility, the cost of which was nominal and cut from their pay, but signified to the residents that it was one community as everyone was “eating from the same rice bowl.” The food looked healthy and consisted of rice, soup, fish for lunch (but a different protein usually for dinner), vegetable side, and pickled veggies. Other ways that “community” was emphasized was how each section was given a town name, there was no nursing station in the middle of the floor plan, each town instead had a communal eating area and a shared kitchen for the residents. Overall, I thought there was much we could learn from long-term care in Japan and implement in the US. I’m interested in learning more, especially as we are visiting a public nursing home next week.
Alankrita Olson, MD, MPH
Preventive Medicine and Public Health Resident