The Elder Abuse Prevention and Caregiver Support Law in Japan

By Ms. Yumiko Watanabe(Director, Pension and Welfare Department, JETRO New York)

1. Background

The Elder Abuse Prevention and Caregiver Support Law went into effect in April 2006 in Japan. The Law defined types of elder abuse and set forth a reporting system for both domestic and institutional elder abuse cases. It also laid down responsibilities of the national and local governments for elder abuse prevention and caregiver support.
This Law was the product of a four-year effort by national and local governments, parliamentary members and the academic community.

The first National Survey on Elder Abuse

In 2003, the Ministry of Health, Labour and Welfare launched the first nationwide survey on domestic elder abuse cases. There had been previous research on elder abuse in domestic and institutional settings, but this was the first nationwide survey of domestic elder abuse.

The survey gathered data on elder abuse cases held by care management agencies and home nursing care service providers. The survey indicated the following about domestic elder abuse:

1. The average age of abused elders is 81.6 years old.
   Approximately 75 % of abused elders are female and 60% are suffering from dementia.【Figure1】
2. The main domestic abusers are sons (30%), daughters-in-law (20%) and spouses (20%). About 60% of abusers are caregivers.【Figure2】
3. The main types of abuse are emotional abuse (63%), neglect (52%) and physical abuse (50%). Other than these, financial exploitation and sexual abuse have also been reported.【Figure3】
4. Almost half of abused elders are conscious that they have been abused, whereas half of the abusers were not aware that they had abused elders.【Figure4】
5. The main reasons for abuse are:
   - relationship strain between the abused elders and the family abuser (50%);
   -caregivers’ stress (37%); and
   -lack of proper knowledge about dementia care (37%).

• 【Figure1】Abused Elders by Age Group (N=1,991)
  
• 【Figure2】Main Domestic Abusers (N=1,991)
  
• 【Figure3】Main Types of Abuse(answered by care managers in charge)
  (multiple response/N=1,991)
  
• 【Figure4】Consciousness of Abuse (N=1,991)
  

These results prompted government officials and parliamentary members to propose measures to prevent elder abuse and support caregivers.

The study group among parliamentary members

In early 2002, the Study Group on Elder Abuse Prevention was established in the ruling Liberal Democratic Party. The Study Group held several hearings with the MHLW, and people representing the academic community and key local projects. In addition to the LDP, the Komei Party and the Democratic Party launched similar study groups. This suprapartisan movement eventually led to the 2005 legislation.

The Academic Community movement

The Japanese Academy for the Prevention of Elder Abuse (JAPEA) was founded in 2003. JAPEA strongly advocated the law and presented draft legislation to policymakers. Other than JAPEA, the Japanese Bar Association and the Japanese Academy of Adult Guardianship Laws also promoted the legislation.

The Reform of Long-term Care Insurance System

Along with the above movements, MHLW revised the Long-term Care Insurance Law after five years of being implemented. The revised law established the new community care system and created “Comprehensive Community Care Centers.” These centers have various management functions ranging from preventative care to difficult cases such as dementia care and elder abuse. The revised law appropriated part of the long-term care insurance finances for the operation of these centers, and thus established the financial basis for the elder abuse prevention and caregiver support system.

2. The Outline of the Elder Abuse Prevention and Caregiver Support Law

The main purpose of this law is “early detection and early management”. This law:

1. Defines and categorizes elder abuse for the first time in legislative history;
2. Clarifies the responsibilities of the national and local governments, designating the municipal government as the central agency in charge of elder abuse prevention;
3. Establishes the mandatory reporting system for both domestic and institutional abuse cases; and
4. Emphasizes the importance of caregiver support.

Definition of elder abuse

The law identifies the following five categories of elder abuse:

1. Physical abuse
2. Neglect
3. Emotional abuse
4. Sexual abuse
5. Financial exploitation

The reporting system

・Domestic abuse cases
The law stipulates that anyone who discovers an abused elder in danger of his/her life or health in a domestic setting must report the incident to the municipal government. Although mandatory reporting is limited to life-threatening or health-threatening cases, the law also states that anyone who finds an abused elder in a domestic setting shall make every effort to report the incident to the municipal government. Upon receiving the report, the municipal government shall investigate the facts and take measures to protect the abused elder. If necessary, the municipal government can shelter the elder from the abuser and move the abused elder to a nursing home or an alternative facility under the Law for the Welfare for the Elderly. The municipal government is allowed to enter the house where the abused elder seems to be in danger of life or health.

・Institutional abuse cases
The law specifies that the personnel of nursing care facilities and home care providers must immediately report incidents of elder abuse by employers and employees to the municipal government. Upon receiving the report, the municipal government will investigate the facts and/or report the case to the prefectural government. Under the present system, both the prefectural and municipal governments have the authority to supervise long-term care providers. The 2006 long-term care reform reinforced the authority of these local governments, thus empowering them to take strong measures against fraud or abuse by long-term care providers. The local governments can revoke the license of a provider, if necessary, in accordance with procedures under the Long-term Care Insurance Law.

・The Responsibilities of the government
As stated, the municipal government is basically in charge of early detection and early management. The Comprehensive Community Care Center plays an important role in this context. The municipal government also has responsibility to support caregivers through various measures such as consultation, guidance and respite care services. The national government is responsible for providing assistance to the local governments and promoting research on elder abuse and caregiver support. The prefectural government is in charge of assisting the municipal government and providing proper training programs for employers and employees of long-term care providers.

・The Appropriation
The Elder Abuse Prevention and Caregiver Support Law itself does not appropriate any budget. However, as stated above, this law has established the basis for early detection of elder abuse cases and has linked it to various measures under the Long-term Care Insurance Law and the Law for the Welfare of the Elderly. The operational costs of the core agency, namely, the Comprehensive Community Care Centers, are financed by the long-term care insurance system.

3. The Future Agendas

The supplementary provisions of the Elder Abuse Prevention and Caregiver Support Law require that this law be reviewed and revised, if necessary, after three years of its implementation. It is also stated that the abuse prevention system for adults under the age of 65 shall be reviewed and necessary measures provided in accordance with the results of the review.

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