Japan is a “superpower” of an unusual kind, a “death-in-hospital” superpower: 80 percent of its people die hospitalized, though preferring to die at home and, if they but knew it, quite able to in many cases, says Shukan Gendai (Dec 23).
Other developed countries do significantly better, notably the U.S., where 35 percent of deaths occur in hospitals; Britain, 40 percent; France, 60 percent. Why is Japan so laggard?
Easy access to hospital beds via remarkably inclusive national health insurance is surely part of the answer, but that’s hardly a reason for a preference to end life at home going unanswered. The tentative explanation emerging from Gendai’s account is lack of awareness of other options. Sick? Hospital. The association is reflexive and blunts alternative thinking.
Hospitals do us very good service. They cure illness and prolong life. But at best they are bleak places. How can a mass gathering of the ill, the infirm and the dying be otherwise? The life you live in a hospital is not your own, it’s the hospital’s. You eat when the trays come round, dine on what’s provided; if the food’s not bad so much the better but it’s more likely to leave you grumbling than satisfied. You sleep when the lights go out, wake when they come on. There’s a late-night TV program you enjoy? Too bad.
A health ministry study Gendai cites examines what hospital patients look at most of the time. Generally speaking, those placed near a window stare out the window; those near a wall, at the wall; otherwise, at the ceiling. Without pushing the inference too far, the impression is of joyless apathy.
We’re introduced to a family that said no to all that. “Makoto Ozaki” (a pseudonym) felt he owed his father whatever care a home environment required. The father was 88, with terminal liver cancer and mild dementia. Makoto, 59, and his wife lived in Saitama on the first floor of a two-story, two-generation home; the father lived upstairs. That was the first change to be made as the climb became too much for him. Room was found for him downstairs.
“My wife and I nursed him,” says Makoto, and certainly that’s the big “if” in home family nursing. If the son or daughter is married, it’s a cooperative venture. Internal resistance can crack a marriage. “All his life dad loved sake, and every night before bedtime the three of us would have a cup, just sitting and talking over old times, or watching baseball – he loved baseball too. You can’t drink in a hospital. We consulted our family doctor, who said it’d probably do him more good than harm.” So it did, apparently – he died happy, and as for Makoto, “I was able to be with him when he breathed his last; it was very hard at times but now I can honestly tell myself, ‘I did my very best for my father.’”
How you confront death is, in a way, as important as how you confront life. Alternatively put, confronting death is part of confronting life. Life involves choosing how to live; dying, choosing how to die. Circumstances limit possibilities, but where you die, at least, is often within individual control. Death in hospital is forced on some but by no means on all who simply take its inevitability for granted. Equipping a home for care is surprisingly simple, Gendai hears from architect Satoshi Tanaka, who specializes in the requisite renovations.
Falling is the gravest danger. Aged bones break easily and mend with difficulty. Railings offer the best support and can be strategically installed. Non-slip flooring is a popular choice – a bad one, says Tanaka. Non-slip socks and slippers are better and very much cheaper. Beyond that, almost everything needful can be rented by the month, and with 90 percent of costs covered by nursing care insurance, you end up paying, say, 6,040 yen a month for a suitable bed, 1,200 yen for railings, 430 yen for ramps, 1,200 yen for wheelchair and so on, the biggest expense on Gendai’s list being purchase for 80,000 yen of a (non-rentable) portable toilet.
Supporting social infrastructure is surprisingly ample – surprising because the high rate of hospitalization suggests the contrary. Perhaps what’s available is not generally known. Daycare centers and home nursing meet various levels of need. Caregivers circulate through neighborhoods assisting with household chores. Some localities are better covered than others, but even where services are sparse or overburdened, the magazine finds, the neighborhood clinic can generally put you in touch with someone qualified to map out a solution.
Advance planning is crucial, Gendai stresses. Whatever needs to be done is doable but there’s a lot of it and best begun when healthy and vigorous. Death is one of those things we prefer not to think about, when not staring it in the face. We'd better.
© Japan Today
14 Comments
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TrevorPeace
We're all born to die. Best to manage it, when you have that option.
GuruMick
My Mother in Law is 89 and spritely....has some spine curvature due to a lifetime habit of avoiding the sun.
But she's in no pain.
Yet her Doctor orders bone density tests etc.
Why ? She's unlikely to join the Olympics.
It's probably overservicing but the Doctor is a good fellow and I respect him.
I guess in an aging population you treat the aged.
My own mother wanted to die at home in her bed but my father wouldnt allow it.
Father died in hospital also.
Nurses put the nearly deceased semi upright in bed, leaning left.
Think about it ?
If this happens to you get up and out immediately.
I choose a cocktail of drugs and wine ,at home, when it''s my turn
HopeSpringsEternal
Here's a difference I've noticed...several doctors I know, who do side jobs to earn extra cash, always enjoy telling me about number of old people that died on their often night shift. They seem strangely excited about it.
Always thought so strange but never comment/change subject fast etc. Clearly, it's cultural, expect it's tied to island mentality focused on preserving resources, more practical etc. Death's not a Quazi taboo subject in Japan like in western countries, people don't shy from subject.
keech2
We spent years planning my wife's death, planned for her death at home, got a DNR and had things planned as much as possible.
We had help in the home whenever she was home from the hospital.
We started off with one week in the hospital and three weeks at home. When home, three days a week at daycare (9:00 -16:30 Tuesday, Thursday and Saturday).
On days she was not at daycare (Monday, Wednesday and Friday), we had helpers in the morning to help keep the house clean and keep her company, nurses in the afternoon to help feed her lunch, change her clothes, wash her body and hair, change her diaper, etc. Physical therapist in the afternoon to keep her muscles from atrophying as much as possible. And a helper in the evening to help her eat dinner and change her in to her pajamas. Sunday was the only day when we were on our own.
As her disease progressed, it switched slowly to three weeks at the hospital and one week at home and then as things got really bad, 3-4 days at home and 3.5 weeks at the hospital.
She came home for the last time in the beginning of October and for the next 7 weeks, we had so much help everyday. It was amazing. They were taking care of her and of my daughter and me. They would always check in with us, kick us out of the house so that we weren't stuck in the house all day. A complete support system.
On the night she died, we called the care manager after she passed and she and a nurse came. They helped us clean her up, put her in clean clothes, did her hair, laughed and cried with us and then they called the ambulance to take my wife to the hospital to have her declared dead. We had brain samples taken from her at the hospital (her request) to help people better research her disease.
These folks were super kind, amazingly efficient and just what was needed for the last 3.5 years of her life.
They are wonderful and they don't make anywhere near as much money as they deserve. We would have been in such worse shape mentally, physically and spiritually without them.
Now, the fire department and EMTs are a completely different story. They managed to anger everyone; my daughter, me, the care manager, the nurse, my wife's doctor, the two obachans from next door and across the street, who came in to say good-bye to my wife...everyone. Looking back, it was actually quite impressive that they were able to anger so many people so much in 5 minutes.
That being said, all of the people who cared for my wife and family are some of the best people that I have ever had the pleasure of knowing.
And all of it covered by insurance.
The key to it all is the care manager that weaves through the labyrinth of the national, prefectural and local insurance systems to get all the care that is possible.
Laguna
keech2, I am sorry to hear of your wife's passing. My wife died last September. At-home care was encouraged, with the cost heavily subsidized. They brought in a hospital-style bed to replace her futon, and caregivers visited almost daily - not that I needed them, but they did on occasion give useful advice.
If faced with a similar situation, don't hesitate to contact your local government.
wallace
keech2,
thank you for your very moving comment about what must have been a very difficult time for you and your family.
Laguna
sorry for your wife's passing.
wallace
How can anyone vote down the comments by Keech2 and Laguna?
keech2
Laguna,
I'm sorry for your wife's passing. It's the most difficult time. I will suggest some counseling. It's working for me, but that choice is yours. I'm very glad that your wife was able to pass at home. It really makes a difference to help loved ones go out on their own terms. I hope that you'll be able to move forward and enjoy the rest of your life.
Wallace,
Thank you for your kind words. It was difficult but we got through it and the people who came to us were just wonderful.
Laguna
Thank you, Keech. The loss of a spouse is difficult for anyone, but particularly so for non-Japanese. Fortunately, I have permanent residency, so my visa status will not be affected, but she was my strongest link to Japan.
Some have asked whether I will "go back" to the US, but after 30 years here, there is no place for me to go back to. Plus, I love where I live. I'm gonna live here till my time comes, then join her in our family tomb.
keech2
Laguna,
It is difficult.
My wife actually was not Japanese, but our daughter was born and raised here. She is my connection to Japan. It's her home.
We have permanent residency and, like you, I have no plans on going back. There's no real reason for it.
I wish you all the best. Good luck in your future.
wallace
Good luck to keech2 and Laguna going forward. I have no intention to return to my home country.
zibala
Keech2, very sorry for your loss of course.
What did the EMTs and fire rescue crew do to upset people?
Asking as a certified EMT in the States . . .
keech2
Zibala,
It's a very long story, but it all comes down to a lack of professionalism and empathy on their parts. The nurses had never seen EMTs or firefighters act in such a way. The obachans even gave them an earful.
It was really surprising.