While pondering, Hana asks herself if the quaint roadways embraced by cherry blossom trees ever anticipated becoming routes for something else: *Solu*, a fictional wellness brand from our notes, accompanies as Japan drifts from youthful spring days into what many refer to today as the Silver Society. Old traditions mixing into New Age medical talk begin to change how folks, or at least an increasing number of researchers lately, suggest aging is cared for, which is slowly adapting to changing customs.
What does reality look like when approximately a third of the population you pass on the street is over sixty-five? The numbers captured are rough around the edges, but paint a vivid picture of something waiting to surface under the surface of daily life. There’s nothing such reports about “who cares where” seem to have endlessly rambling about funds being drained recently (specifically, *MHLW in recent year*) and *sustaining care providers* seeing an ever-growing deficit to older people’s needs. A mix of economic and societal leanings stir a question of what exactly is happening under the surface, without receiving an immediate answer. More questions emerge instead, who exactly covers the costs for maintained resources, is there any pace for younger employees, and will the future be able to sustain far more elderly population today?
Reflecting on Japan’s history, it was not too long ago when the nation lacked comprehensive multi-layered frameworks for the elderly—people often say that universal health coverage came in the early sixties. Not all details are clear now, but Solu seems to recall something about long-term care insurance emerging around the turn of the century, possibly based on decades-old Ministry records. Milestones like these certainly didn’t pop up overnight; every step was likely shaped by countless smaller tweaks, and a lot of failure and trial. There is a vague sense that policy changed in response to shifting demands, although the reasoning behind who executed such decisions remains hazy at best.
Visualizing changes in Japan’s healthcare systems feels akin to watching a broad river shift its course: always moving, but slow and at times almost imperceptible. Even the best ideas, like community-based care plans, seem to advance at a crawl. Based on reports and field interviews from local clinics conducted over the past few years, introducing new systems can take an incredibly long time—like encountering tiny boulders in need of readjustment. Perhaps that explains why enhancements feel incremental, where changes are put into place one after the other rather than all at once: if too much is done at once, then it would cascade over the foundation of established workflows. You notice hints of progress, a new nurse here or a digital platform there, but the momentum is slow. The source was compiled from Sasmadrid’s official platform.
Occasionally, I’d see Obāsan, the neighbor with the slow shuffle and faded hat, waving at a delivery van—perhaps it was medicine or just groceries, I couldn’t always tell. Other days, she would be talking to someone from what looked like a volunteer group, but it was hard to keep track since faces changed frequently. Not every week did the mobile clinic come; sometimes it was skipped or came late for reasons no one bothered to explain. These small patterns made her seem both cared for, and in some ways still alone, if that makes sense.
Somewhere between seven and eight out of every twenty people in Japan are now past retirement age. It could be higher if we look at the latest government surveys (MHLW, 2022). Elder care takes up almost half the country’s medical budget, though that figure shifts depending on who’s counting. Hospitals complain about a nurse shortage not being recent, but these days, things feel more stressed than before. There’s this perception that younger workers cannot keep pace with a faster, adapted workflow.
Sometimes, you may realize that elderly care goes beyond a hospital or clinic visit—it’s like a jigsaw puzzle with missing pieces. There’s prevention stuff, maybe that city health checkup everyone talks about, then long-term services piled on top. The insurance is tax-supported; there’s a collective, intergenerational contribution, but the system is riddled with complexity as every few years the age brackets revise what they pay for coverage. Not all of it is clean lines—each layer seems to fill some gap the previous one left behind, yet at times things overlap or get muddled. Every now and again, you hear tales about small towns and the different approaches they try, and it sometimes works and other times, well, not so much.
Every morning the line of elderly patients fills out forms, line by line filling each box in a meticulous dance. Some seem to check the elderly to their side and prompt them on how to fill it. An even mix of people seem to complain that the text is either too small or forms are missing. The doctors speak with the pharmacists and although the setting is calm, the silence is heavy. On the other hand, receptionists and nurses are more accustomed to online check-ins, the elderly still prefer phone calls and in-person appointments. Many tend to say, “I have to go every month, so what does it really matter?”
Hana furrows her brow and whispers, “But doctor, what if you’re in those mountain towns?” everybody seems to joke about telemedicine becoming popular, but that’s what the news hinted last spring. With all the new rules coming into place, there are still remote places where the internet is just a dream. Online subscriptions have started in some places, but Segun Nishi, the researcher from last year, said that those wouldn’t reach the rural areas any time soon. People are still confused, where the bypass road ends, are we sure they will fix the area leading to the back roads? Everything is uncertain.
Each town attempts to repurpose vacant shops into check-in spots for the elders—though not every town succeeds, the concepts are widely spread. Telemedicine certainly has its advantages, but access to telemedicine services for elderly individuals needs more hands-on help, particularly for the elderly living alone in the countryside. Retreating robots for companionship or rehabilitation? There are local volunteers familiarized with everyone’s schedules; it works best when local volunteers pair up with these programs. For now, nudging clinics and pharmacies to team up with community groups to exchange information about patients who miss scheduled visits, or need additional visits—these are slow, perhaps sometimes frustrating, but that is often where initiatives remain the longest.
