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A Country for Old People

Japan is facing a unique demographic challenge. Not only does it have, along with a number of other developed countries, one of the lowest birth rates in the world. For reasons that remain intriguing to researchers in the field, Japanese people live longer than any other nation on earth, bar the tiny principality of Monaco (population 39,000).

These two factors combined already make for an ageing population, with ever fewer young people in work to finance the services, infrastructure and care of a growing cohort of seniors who live, on average, to the age of 87.6 for women and 81.5 for men.

Where Japan's demographic dilemma is becoming increasingly problematic is in the fact that it also has one of the lowest rates of immigration in the industrialised world. Only 2.3% of Japan's 125 million people are resident foreigners and the government estimates that hundreds of thousands of immigrants will be needed over the next two decades to fill essential jobs, many of them in the care sector.

The topic of ageing, and what it will mean for Japan's future, is all around. It is affecting every aspect of Japanese life - from social policy and economic development to urban planning and technological innovation. Once again, following Japan's leadership in innovation and economic dynamism in the 1980s, the country finds itself at the forefront of a new era, where 'gerontification' is forcing a complete rethink of how society is run.

One of the main challenges is how to enable older people to enjoy their later years as comfortably, sociably and independently as possible. To this end, the Health Ministry launched eight 'living labs' in 2020 - real life environments in which robots dedicated to nursing care can be tested.

The promotion of technology in elderly care makes fiscal sense. Japan's long-term care provisions are among the most generous in the world, with between 70 and 100 percent of costs covered by health insurance. Across the board, Japanese people pay far less in taxes and premiums than the cost of their health care.

Over the past two decades there has been a concerted effort to allow people to live - and die - at home rather than stay in hospitals till the end. Robotics is only one of several ideas being trialled. Unavoidably, though, the country will need to look at its immigration policies as well as the shortfall of care workers becomes unmanageable.

Since 1990, social security spending in Japan has tripled, largely financed by government debt. Its debt to GDP ratio, at 263%, is the highest in the world, yet tax rises or cuts in social spending are rarely floated as a solution. Instead there is talk of raising the retirement age above 65 and getting more women into work.

The proportion of over 65s, however, keeps rising and is expected to hit 38 percent by 2050. In the absence of a simple solution, innovative approaches to elderly care and new tech solutions are being tried to keep the old healthy and active for longer.

Japan's demographic decline - from its peak of 128 million in 2010 to 125 million today - is in evidence everywhere but most starkly so in small towns and the countryside. More than half of municipalities are now classified as 'depopulated', meaning that their population has dropped by 30 percent or more since 1980. In many of these ageing communities, new ways of living are being explored to give elderly people as much independence and access to goods and services as possible. Schools, long closed due to a lack of children, are being turned into health centres and gymnasiums for older people, with exercise equipment adapted to be freely usable by people with limited mobility.

Yet while the repurposing of public buildings can be relatively straight forward for local councils, the growing problem of abandoned houses faces numerous legal hurdles. In many smaller towns, but in Japan's major cities as well, tens of thousands of homes are standing empty, with municipalities neither able to fill them with new residents not have them demolished.

For those who are unable to live on their own anymore, nursing homes beckon. This is where much of the innovation is being trialled. 'The Hug', a robot developed by Fuji Corporation, can lift elderly patients from their wheelchairs into their beds; Telenoid is a robot with an expressionless face through which remote care workers can talk to patients; Panasonic, meanwhile, has developed a hi-tech bed which splits into two, allowing care workers to roll patients onto one half which then converts into a wheelchair. Smart beds equipped with sensors allow a skeleton staff at care homes to check on whether hundreds of patients are asleep.

In a country where the youth is fully immersed in digital technology and social media, tech companies have realised a new market in providing apps for older people as well. Rakuten, Japan's biggest e-commerce company, launched Rakuten Senior in 2019. It rewards users who walk with points which can be used toward purchases.

Some companies, like Daiwa House, a large housing firm, has come up with the idea of 'Livness Town Projects', select communities which are adapted to make them more user-friendly for older people. For Daiwa House, helping the elderly is seen as a form of corporate social responsibility. Daiwa hopes to sell its expertise abroad to recoup costs.

Despite all this investment and attention paid to the lives of elderly people, thousands of old people still die alone every year - 4,200 over 65s in Tokyo alone in 2020. Property owners can now insure rental units against the risk of older people dying alone in their apartments and not being discovered for weeks or months. The insurance policy will pay for lost rental income and for clearing out and cleaning.

For now, Japan faces a particularly acute demographic prospect which it is managing through innovation and changes in social policy. Much of the rich world will soon face similar problems to which Japan's experience may provide invaluable insights and technology.
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