Hi, JapanLife.
My wife and I (Americans) have recently moved to Japan for work. We’re in Tokyo.
My wife’s mother, who is a Japanese citizen, is in a skilled nursing facility in the US. She last lived in Japan in the early 1980s, and she’d now like to return.
We spoke with our ward’s local elder services office and were told that she must be evaluated for placement in a Japanese skilled nursing facility. We asked if this could be accomplished via telehealth or if we could submit her medical records. They explained that the evaluation must occur in-person, here in Japan. Also, there would likely be a months-long wait to admit her to a facility. Until this could happen, she would live at our home.
Given her medical issues, this is impossible. We are unable to provide the kind of skilled medical care that she requires on a daily basis. This is not a matter of unwillingness: I have a US nursing license, and I would not be able to render appropriate care outside of a specialized facility. When we told this to the elder services office, they repeated that she must be in-country for evaluation and that there would likely be a months-long wait to admit her to a facility. It feels to us like there’s a clear impasse between process and possibility.
We attempted to get a “second opinion” on the situation by visiting another elder services office. They were unwilling to speak with us because we did not live in their assigned area. They told us to return to the prior office. We’ve spoken with a few of our friends here about what to do. They’re at a loss. They believe that neither a bengoshi nor a scrivener would be of any help. So, I come to you. Any ideas?
4 comments
So she requires specialized care? Is she going to survive the flight? You’ll need to be more specific because my first thought was hire a live in nurse for a month but sounds like that’s not an option. The wife and I have been slowly investigating this since her parents are in their 80s.
But if she requires specialized care, like say dialysis, we paid out of pocket for my dad when he visited and iirc at a very nice and modern clinic it was about 15,000 jpy per visit. You could always find a private clinic and arrange a month of regular visits and out of pocket the expenses until you get her diagnosed. It’s not easy but it’s doable.
Alternatively contact the closest japanese embassy to her they might be able to help.
**Edit** : Another thing that just popped into my mind, since she’s a Japanese citizen reach out to the city her koseki is registered in. They might be more helpful.
I agree with the other comment in regards to contacting the Japanese embassy in the US. Embassies usually have better information at what to do to repatriate a citizen in need of help. Try that.
Can only say that locally–and not for skilled care–there was a months-long wait for my wife’s mother to find a space. Unfortunately, the situation for skilled care is likely the same.
But what may be useful: my wife’s mother spent that waiting period in a hospital.
Care such as what you describe might fall into the 介護保険 sphere of things. I think everyone here over a certain age pays premiums for that over and above the normal/regular NHI/国民保険. (I do.) As a j-citizen it may make less of a difference (or not) whether she’s been paying that, but one concern would be getting her started on those two things. AFAIK payment history would not be a factor, once signed up and having started making the monthly payments, you are then covered (pre-existing stuff does not count).
Getting her set up and enmeshed with the medical insurance system here would be important, and it’s probably the only thing that any care home would be familiar dealing with. I think someone paying their own way, as it were, would be pretty novel, which would be another challenge to face.
The problem is that the system in place does not account for the possibility that somebody would come from outside the country to require immediately this level of care. On top of that, the care sector is underfunded and overworked. The civil servants who do the assessment are probably also. And they don’t do zoom. So I would warm up to the idea that this is going to be a long fight with no perfect solution.
If neither the embassy nor the Japanese home town people have better information for you (and I’m guessing the latter’s response will not be much better than the one you got now), you need to look for medical care she would need if the proper care she is having now cannot be provided right away. So she needs to go from the airport to City Hall and then to a doctor who can have her admitted to a hospital if needed. This will be made more difficult by the fact that she probably isn’t enrolled in the health insurance here. You may be asked to pay for some of the care up front.
The system here is more geared towards care some of the time, i.e. an army of vans collects people in the mornings and takes them to a place providing professional care. And at night they get driven back home. It is a possibility that this may be a stepping stone to full time care or indeed *the* solution. I’ve seen it in my wife’s family. Two cases: dementia and full loss of mobility, sleeping at home every night with other members of the family standing guard on a rotating schedule. So prepare yourself also for the possibility that she may not qualify for full time placement at all. You may not have to bathe her at home, but you may need to look for toilet solutions etc. before you put her on a plane. Put that on a checklist for plans B thru Z.
This is going to be frustrating. Don’t show it. Keep a stress ball in your pocket. Don’t complain to other Japanese people about how dumb this system is. You’re probably right but we prefer to suffer in silence here. Find a good sturdy wall to punch or some foreigners to vent with on a regular basis.