Care Crisis Exposed When Elderly Care Breaks Down

The crisis facing care facilities

This year marks a turning point as all members of the so-called baby boomer generation turn 75 or older, entering the late elderly stage.

On April 25, nonfiction writer Hironori Jinno published Shocking Report: The Great Collapse of Nursing Care – Even Money Can’t Bring Peace of Mind! (Takarajimasha Shinsho). Jinno himself discussed the critical crisis facing Japan’s nursing care system amid the super-aging society.

— What exactly does the great collapse of nursing care refer to?

“Nursing care is an issue that many people cannot avoid. The government promotes the goal of national solidarity—everyone supporting each other—but in reality, the burden on families continues to grow without limit. Due to staff shortages, depopulation, and lack of funding, many elderly people cannot receive necessary services. Reports say that in 2024 alone, 95 nursing care providers went bankrupt.

As this negative cycle progresses, facility users lose places to go, and families providing home care reach their limits. It is no exaggeration to say the system is already collapsing. The book includes many real cases and court rulings to offer hints and insights for anyone who may face caregiving for themselves or family in the future.”

— Many shocking cases triggered by elderly caring for the elderly are introduced in the book.

“Last year, in Osaka City, a wife was arrested on suspicion of murder after strangling her elderly husband with chronic illness in a residential paid nursing home. The wife committed the act after agonizing over not wanting to let her husband suffer any longer. Is this a rare case? Elderly caring for elderly is truly serious and always carries the risk of mutual collapse. Two years ago, in Hokkaido, a 94-year-old husband killed his wife with dementia, and in Tokyo, a daughter in her 70s killed her 102-year-old mother. Even cases that don’t make the news, similar tragedies are happening all over.

These painful incidents cannot be dismissed simply as tragedies — there are systemic issues behind them. For example, even if someone is in a facility, the actual care is left to the family, showing the system’s limits. There are also cases where families continue home care out of necessity because they cannot find a facility, leading to isolation and many other backgrounds.”

Problems due to the closed spaces

―― The book also covers real court cases related to caregiving troubles.

“Many of the lawsuits introduced in the book started because families distrusted the facility’s handling. For example, an elderly person staying short-term at a special nursing home fell and broke a bone at night, then developed pneumonia and passed away. The family claimed fall prevention measures were insufficient’ and ‘emergency response was delayed, but the facility argued they had taken adequate measures. The court partially held the facility responsible and ordered a settlement payment.

In another case, a family accused the facility of poor infection control after the mother possibly contracted pseudomembranous colitis due to sloppy handling of excrement. The facility denied it, but the court again recognized the facility’s responsibility and a settlement was reached. There were also lawsuits over delays in medical cooperation and inadequate monitoring after elderly residents died from COVID-19.”

―― Was there any way to prevent such accidents?

“These cases show how difficult it is for families to see what really happens daily in caregiving facilities. They are like closed worlds. When abuse or troubles occur, families want to seek help outside, but often lack the physical and emotional strength, leading to many cases where they suffer in silence. Lawsuits are rare exceptions.”

―― Problems related to caregiving and money  continue as well.

“Long-term care insurance involves about 11 trillion yen, making it a huge market. Some providers seek illicit profits. Because regulations lag, some abuse services like guarantor or asset management, even illegally withdrawing elderly people’s inheritances.”

Severe shortage of caregiving staff becomes evident

— What are the biggest problems threatening the collapse of the long-term care insurance system?

“The biggest issues are the lack of funding and personnel. The Ministry of Health, Labour and Welfare estimates that by 2040, there will be a shortage of about 570,000 care workers. Although efforts to improve working conditions are underway, wage cuts and the physically demanding nature of the job make it hard for young people to stay. Regional disparities are widening, and for those with lighter care needs, service benefits are being cut back, shifting the burden onto families. This goes against the idea of socializing care.”

— Hearing about so many serious problems is disheartening.

“Reading this book, you might only see the tragic and dark sides. But understanding these realities is the starting point for seriously thinking about what kind of care and society we want.

The book shares voices from caregivers working on the front lines who continue their jobs driven by a passion to support their clients. Yet, there are many who feel betrayed — those forced into consecutive night shifts without rest, or who discovered wrongdoing by management. The book aims to portray all aspects of care honestly, not just criticize.

It’s because of these hardworking people that the current system barely holds. I hope it serves as a basis for each person to think about how we should reform care.”