In the past in Japan it was quite natural that the families took care for the elderly. Recently the elderly became live much longer, but the responsibility of elderly care is still on the family and the pubic elderly care has not developed in Japan. Most of the family care givers take care of the elderly without getting money and without getting help by the homehelpers. 

And the number of stuffs at the Japanese facilities is about half compared with those in Sweden. This is another reason why there are so many bedridden elderly in Japan.  

On the contrary, the cost for the health care for the elderly in Japan is about half than that of Sweden and the social service cost for the elderly in Japan is about one tenth than that of Sweden . So from the　standpoint of the cost, Japanese elderly care is much more "effective".

But the Japanese "effective" elderly care resulted in 700,000 bedridden elderly. So to tell the truth, the Japanese way is not "effective' -in the real meaning- at all.  

 The privatization of elderly care is much more popular in Japan . Because Japanese people believed that "If we privatize the elderly care, the profit-making organization would compete each other and the quality of the care would improved and the cost will be reduced". But this is not true in Japan.

Most of the Japanese geriatric hospitals are private profit-making organization . But the quality of the care has not improved . On the contrary, the quality of care at the private  geriatric hospital is too bad. Some people say that "It is worse than hell" . Why? The answer is quite simple. Because there is no competition at all. The number of facilities for the elderly in Japan is too few, so even if the quality is very low, many people apply for the beds. There is usually waiting list to the geriatric hospitals in Japan. Unfortunately, in this situation, there is no incentive for the private hospital to improve the quality.

How about the cost? It is not so cheap. The private geriatric hospitals tend to use expensive medicine, because it is more profitable for them.  

 　In Japan social service was believed only for the poor people. So people prefer health care to social service. But it is expensive and not always correct to take care of elderly by health care . In Japan the ratio between health care expenditure and the social service expenditure is very imbalance. To improve the care for the elderly effectively, Japanese elderly care must be changed to the "social service oriented model" from the current "health care oriented model" and to the "home health care oriented model" from the "hospital care oriented model. 
In order to increase the sociaI service expend i ture , the introduction of the national public care insurance system ( like in Germany) may be necessary.  

Sweden and Japan is a different society. But even if the society is different, it mainly depends on the aging rate what kind of resources are needed at the society and the need of the elderly care. So it is true that the elderly care in Japan is very bad now, but we can notice that the current situation in Japan is similar to 1960's in Sweden, when the aging rate was about 12% in Sweden also.

*Ack now I edgemen t 

I would like to express my special thanks to the following people who have guided and helped my research and writing this report. In this report I wrote mainly about the Japanese elderly care, but to research the elderly care in Sweden, many people helped me for the last four years. Through my research in 1992 and 1993. I wrote mY second book in Japanese "Sweden Hatu Sundemita Koreishakai"(The Aging Society in Sweden. Mineluva Publishing Company in 1993). In this bDok I wrote about the trend of the Swedish elderly care in 1990's. 

First and foremost : Lektor Per Gunnar EdebaIk gave many impcrtant advises to my report. He made it possible for me to research at the Department of Social Work in Lund University. Without his encouragement and constructive criticism. I could never write this report. 

I would like to thank to Professor Sune Sunesson, who kindly accepted il]e to the series of his research seminars. I could get many important viewpoints about mY research from these seminars. 

Lektor Agne Gustafsson at Department of Political Science in Lund University often took me and my wife to the political meetings. I could learn the importance of the local government and the democratic ideology in Sweden by him. 

Ms.Birgitta Borafia, who is the secretary of the research course, helped and encouraged me kindly. 

Ms. Johanna Lundb~ck helped me so much. She has gathered 25.000 articles about elderly care in the newspapers for the last 16 years. To read the articles is the easiEst way to gather the information for the foreign researcher. Without these articles. I could never research the changing elderly care in Sweden. 

　Ms . Tove Klette (SocialkorrLrnunalrad in Lund) and Ms . Karin Sandberg  (Socialchef i Lund) helped my research so much. Without their kind support , I couId never visit and practice at the institutions in Lund. 

　Dr.Kaj Kogeus, Ms.Annelie Hollo and Ms.Lillemor Cedergren, who are research associates at SPRI, encouraged me so much and gave many important information about the health care in Sweden. In particular, by the help of Ms.Annelie Hollo I could translate and publish the book "Helmma pa Baltzargarden - Om vard av aldersdementa i gruppboende" (by Dr.Barbro Beck Friis) in Japan and introduce group living to Japan. 

　Professor HaraId Swedne r at Goteborg University made me possibIe to practice at the Servicehus Bjorkebo in Harmmaro Municipality. And lektor Hilja Tuulik Larsson(Health College in  Varmland) , and Mr. Lars Bostrom(Socialchef i Hanunaro) and Ms.Britt Marie Gustafsson(Aldreomsorgenschef i HarrLrnar6) took care of me very kindly . I have had the good fortune to study the development of the elderly care in Hammar6 throughout these four years .

Dr.Barbro Beck Friis(Overlakare at Motala Hospital) taught me the importance of the Quality of Life in the elderly care. HBHC(Hospital Based Home Care) and the group living are very important information for the future of Japan.    

Dr.Yuzo Okamoto, who is the chief doctor at the Hannan Chuo Hospital in Japan, recouunended me to write this report and gave many important information.  

Mr.Yoshitaka Okumura, who is researching the Swedish elderly care in Stockholm, have helped my research so much. 

My wife Yayoi is writing the report about "The Political Decision Process of the ADEL-reformen" . She also helped and  encouraged me every day at home.

In the 2lst century, the elderly population will certainly increase rapidly in all over the world. And the elderly care will be one of the most important issues in the world. The experience of Sweden in the elderly care field is very precious for all the people in the world.    

I hope that the Swedish elderly care, which: is the best in the world" will develop more and more and continue to be the model of the world.

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