The elderly who do not need so much medical care stay at the nursing homes in Japan. But if they need continuous medical care, they stay at the geriatric hospitals in general. These geriatric hospitals are like long term clinic(lågngvardkliniken) in Sweden.

There are l, 197 geriatric hospitals in Japan and about 151,905 elderly patients stay there in 1991(Source:Research of medical facilities by Ministry of Health and Welfare) . All of them are private hospitals and the "profit-making" organization so called "Medical Foundation" run the hospital.

Recently more and more elderly occupy the hospitals' beds and if more than 60% of the beds are occupied by the elderly aged 70 and over, the hospital is registrated automatically "geriatric hospital " .

  The average guideline concerning the number of stuffs at the geriatric hospital is as follows. 
(Japanese Ministry of Health and Welfare official guideline)

  The elderly at the nursing homes can stay there as long as they wish and most of all of them stay there until they die. But the patients at the geriatric hospital "are supposed to" go back to their own home when the medical treatment is over. But the reality is not so easy. The geriatric hospitals have so many serious problems now as follows.

One of the problems is that about half of the patients do not need medical care any more but stays at the hospital because of the "social reason".  They have no place to go back. This means that the geriatric hospital is used as a "hotel function" or "Housing for Elderly".

One of the reasons is that the families refuse to take care of elderly at home again. In general Japanese house is very small, so some children feels glad actually if the elderly parents move to the hospitals.  And sometimes daughter in law and her mother have the serious conflict at home. And sometimes the families are very tired to have taken care of the elderly at home and do not want to or can not take care of their parents at home any As I wrote before, the number of home helpers are very more, few in Japan.  And to ask for the public welfare service is a shameful for the family in Japan.  It is rather hard for the families to take care of the elderly at home by themselves.  Many relatives try to take care of the elderly at home by themselves, but sometimes that effort results in the destruction of the family.  "Family Destruction", which comes from too much burden of taking care of their family, is one of the serious social problem in Japan now. In Japan family can get the subsidy about 5,000 YEN(333 SEK) per month from the municipality if they take care of the bedridden or senile dementia elderly at home.  But this subsidy is too little.

So to build the housing for the elderly or the sheltered housing ( servicehus ) are needed to reduce the number of the "medically ready treated" patients at the geriatric hospitals and the nursing homes.

    Figure.11 shows the international comparison of the period ofthe inpatient. 

  Japanese ALOS is the longest in the world. One of the biggest reasons of this is that the ALOS of the patients aged 70 and over is 91.1 days(Research of Patients by Ministry of Health and Welfare in 1987). And the following  Table.15 explains the reason more in detail. About half(48.4%) of the patients aged 70 or over stays at the hospitals more than six months!  

   So this is now becoming a serious financial problem also. To use the geriatric hospitals' beds for the "hotel function" is very expensive way for the society. One of the reasons of this long ALOS in Japan is that the such elderly as stay at the nursing homes in other countries stay at the geriatric hospitals in Japan.  

And another problem is the mixing of the different kinds of patients. Both the patients who need constant medical treatment and the patients who do not need constant medical treatment stay at the same wards or at the same hospitals. Sometimes dementia patients and the bedridden patient s and the rather healthy patients stay at the same ward. But this mixing of the elderly is almost the same problem in Japanese nursing homes also. 

Another problem is that the low standard of the number of the care stuffs.

In order to compare with the Japanese facilities, I will write the short explanations about the old age homes and nursing homes in Sweden.  

   In 1990 there we re some 850 municipal old-age homes ålderdomshem) with around 39,000 places for elderly people unable to cope at home even with the aid of the home help and the home nursing services.  

　Most residents of old-age homes live in small single rooms (approx. l0-15 m2) with their own toilets. Residents may bring their own furniture with them. Meals are served communally at set times.  

    Nursing Homes ( sjukhem ) provide care for longer periods.  In Sweden, two general types of nursing home have developed. Central nursing homes are usually attached to geriatric department and function essentially as an annex. These seem to be diminishing in importance.  Local nursing homes are usually independent of hospitals.   

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