The Work Revolution: Elderly Care
SDGs Japan Portal interviews Tomoyuki Mita, Director at Akashia Okawa nursing home
The COVID-19 Crisis has shaken up the way we work. What will the consequences be?
SDGs Japan Portal spoke to Tomoyuki Mita, the enterprising Director at Akashia Okawa, a private nursing home in Hiroshima. Mita has been continually adopting new ways of tackling the problems faced by the industry, such as nursing staff shortages, in addition to the most recent challenges posed by the pandemic. He fervently believes that the way Japan and other ageing societies perceive care facilities needs to change, which begins with addressing the breakup of community — an ongoing process fuelled by the rise of the nuclear family, diversification of values and penetration of the internet, among other factors, which arguably has led to isolation and disenfranchisement.
“We were able to both create jobs and pay salaries to mothers who would not otherwise have been able to work, as well as allow our on-site staff to fully dedicate themselves to residents, leading to an improved quality of service.”
The elderly care sector is one that above all supports people. What is your approach at Akashia Okawa?
Tomoyuki Mita: We have thought a lot about what care providers can do to advance the SDG to “ensure healthy lives and wellbeing for all,” and our answer to that is:
1) We support residents in going about their lives in the same way as before.
2) Residents don’t come to the facility to be institutionalised; instead they are equipped with the tools to overcome the barriers that existed in their lives and adapt.
3) We do whatever possible to prevent the worsening of someone’s condition that is on the threshold between a healthy one and one that requires care.
I think it is important to maintain these principles.
For us, a care facility is not just a place to support the elderly but one that helps them to continue their normal way of life. With the declining population and ageing society, care homes are not special anymore, they are practically infrastructure, and so we have to keep them going.
As you know, procuring funding and human resources in this business is difficult. Our generation probably won’t see much change once we are elderly, but thinking about the next generation or the one after that…how are we going to ensure a smooth transition? I think it is the mission of this generation to start finding innovative solutions, and to address the problem of scarce human resources. A “work revolution” comes to mind.
The waiting lists for children’s nurseries issue is a hot topic, but what about those mothers who want to work yet cannot? In our sector, career progression is highly dependent on experience, and when an employee leaves to have a baby for example, there is a considerably high barrier to re-entry. If this barrier can be lowered, this will not only help mothers back into work (who want to work) but also alleviate the persistent labour shortage. This is how we can make this business sustainable. So we implemented a work revolution of our own at Akashia Okawa.
I’m always occupied with HR and I had given a lot of thought to the hiring of women around the time that the word “ikumen” [a term to refer to fathers who take time off work to help raising their children] came into fashion. When fathers do take time off it is usually a relatively short, defined period of time, whereas the time taken off by mothers by comparison becomes protracted and leads to unemployment in many cases. I’m sure many mothers feel they can no longer work even if they wanted to.
In Japan it is thought that some 87% of mothers hope to return to work again after childbirth, yet there are significant obstacles, from time constraints and availability of childcare to the receptiveness of employers and partners.
Mothers with very young children have few options but to stay at home if they cannot place them in childcare. So we thought, let’s allow our employees with kids of pre-school age, up to three years old, to bring them to work in back carriers, in what we called the “Working Mother Project.”
What were some of the key goals and observations?
We removed any tension or divide between existing and returning staff. Mums who are returning to work after a long time away have a period of adjustment in which they’re quite anxious and thinking “Am I doing the right thing?” But on top of that there are the perceptions that existing staff members might have of returning staff. On the one hand they might regard returning staff positively for contributing when there is a staff shortage, but on the other hand, there might be some rather negative perceptions of returning staff being able to start at the same level as them even though they have longer, uninterrupted experience.
We wondered about what we could do to create a positive working environment for existing and returning staff and reduce tension between the two. As a solution we established a new probation period for returning staff as “Nursing Supporters.”
In the elderly care sector there are rules that stipulate the minimum numbers of staff assigned to one resident. At Akashia we do not include our Nursing Supporters in this quota, which leads to increased labor costs as we have to hire new people from outside. But we are doing this nonetheless because becoming a sustainable business longer term won’t be possible if we get caught up in these immediate cost issues.
How about after the children reach kindergarten age?
Even at this stage we expect working mums to have certain time constraints, with the need to take off Saturday and Sunday afternoons from 3pm for example. This makes it difficult to move out of the Nursing Supporter role, but I didn’t want to dismiss this possibility completely. Parenting is the number one priority in a family, and I wanted to create opportunities while respecting this. So in April 2019 we began a “work at home” program.
“As schools began to close, some staff had to take time off to look after their kids. A number of negative consequences arise from this: staff are without income, there is greater pressure on the remaining staff to adapt to the shortage of help.”
Did I hear you right? “Work at home”? How is that even possible?
It’s perfectly reasonable to be surprised; nursing care has a strong on-site, hands-on image. And 70–80% of this work is just that. But the remaining 20–30% is administrative work, such as record-keeping and event planning, and until then on-site staff were having to take time out-of-hours to complete it. We simply had to reform the system away from reliance on our hard-working staff to do overtime, and with that, we started a model whereby our working mums would take these tasks home with them. Specifically, we send reports to 70 families every month with letters and photographs, which our staff can do between their childcare and housework.
With this model we were able to both create jobs and pay salaries to mothers who would not otherwise have been able to work, as well as allow our on-site staff to fully dedicate themselves to residents, leading to an improved quality of service.
One year on, what is the “work at home” situation like now?
Those staff working from home were promoted to counselors. Due to the pandemic, we have been conducting our interviews over Zoom, and teleworking is becoming the norm.
Tell us about the other project of yours, the Medaka School. What is the model?
The Medaka School works much like the Working Mothers Project in that employees bring their kids to work. The difference is that this is for those children in the first few grades of elementary school, and they come to do their homework and study, and help with simple care tasks.
We started the School in March 2020 partly in response to the spread of COVID-19. As schools began to close, some staff had to take time off to look after their kids because there were no facilities available or they couldn’t find another family member to help. A number of negative consequences arise from this: staff are without income, there is greater pressure on the remaining staff to adapt to the shortage of help, and the quality of service goes down. Staff shortages like this are a fatal problem in the elderly care business.
So this system allows staff to watch over their kids while they work, right?
Yes. While both projects were primarily about enabling mothers to keep working, I realized we were also enabling something very important…
And what was that?
Children’s socialization. To give you one example, the first child to join us as part of the Working Mothers Project was very shy and until coming to the facility had spent little time around adults who were not his parents. In this new environment, he would hide behind his mum and was wary of his surroundings, he would cry when hugged by a stranger. Of course, the residents enjoyed his presence and doted on him like their own grandchild. The child gradually warmed to them, maybe because he felt they were on his side…now when a resident calls for him, he will happily sit on their lap, or go to their room to play.
I expect that child will have an easy time making friends once he enters kindergarten as a result of being at the facility and learning where he stands in a group setting. I hope he considers going into the care profession in the future! In that sense I think this kind of experience is excellent training for the next generation of care workers.
The concepts of Gemeinschaft and Gesellschaft that I learned during my student days come to mind. The former refers to the kind of groups we cultivate naturally: friends, family, community; while the latter refers to those we create for a specific purpose, to produce something. I feel we place too much emphasis on Gesellschaft: efficiency, productivity, profitability. Quick results take priority over sustainability. But in order to realize the SDGs, some kind of “Gemeinschaft Movement” might be in order to bring us together into caring, support networks.
Certainly, I feel both our projects are a form of community building and ought to continue. It was the children we hosted at the facility who taught me that.
This is what the SDGs are all about!
Fostering Healthy Lifestyles; Encouraging Open Community
I heard about an interesting vending machine that lives here. Tell us more about that.
In simple terms, it’s a vending machine that connects to a pedometer. The vending machine is connected to a smartphone app called “Coke ON” and you receive points for reaching your target number of steps that you can redeem at the machine.
Interesting idea. Why did you install it?
The Ministry of Health, Labor and Welfare releases the life expectancy figures for each prefecture every three years, and in the 2018 data, the life expectancy for Hiroshima women came out as being the lowest in the whole country. One reason given for this is that we are highly dependent on our cars to go short distance owing to all the mountains around here. I myself am guilty of using my car just to go to the nearest convenience store.
With few opportunities to take extended walks, I started thinking about ways we as a facility could tackle this problem. Coming across the Coke ON app, I felt it could be and help residents feel more motivated to exercise.
So the virtual stamp rallies and reward aspect makes it fun.
Yes, but there are some other advantages: you can customize the design on the actual machine, so we placed a kind of slogan on it: “Lowest Life Expectancy in Japan!!!” to send a clear message about this problem. We also place seasonal messages about heat stroke prevention and influenza, to draw attention to these issues. We are also able to customize the product selection and limit it to healthy beverages suitable for our residents. In this way the vending machine makes a contribution towards extending people’s life expectancies.
We are using the vending machine to send a message about the facility being integral to the community. Care homes are subject to the perception of being off-limits to the public. As I said before, elderly care is not a “special” thing but a part of everyday life, so I want the facility to be open to the community. Of course, we cater to visitors coming specifically to see a resident, but encouraging the involvement of who don’t not have any particular relationship with the facility, or who don’t have the courage or think they are not interested, has been a concern of mine. So I hope through the vending machine we can reach out to such people and lower the barriers to visiting us.
What has been the result so far?
It has only been on the premises since April 2020, and so we need to wait a little longer to see the full potential of it, but so far staff have said they actually look forward to going on a walk. Because our staff are members of the local community, I think it will certainly take off.
I’ve always thought a care facility should extend beyond being simply a building. I think this project has become a gateway for the creation of a care facility that is not merely an entity but an extension of the local community.
I will continue to actively think about the lives and activities of each generation in this community of ours going forward: a bit like planning a town!