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Japan Prefers Robot Bears to Foreign Nurses
A country notoriously resistant to immigration is exploring the newest frontiers of elder-care.
NAGOYA, Japan — If you want a protector for the elderly, what’s better than a robot bear? Robear, “the strong robot with the gentle touch,” is a nursing-care robot — with a cuddly look — touted as strong enough to lift up elderly Japanese and bring them to the bathroom, but also gentle enough to provide them support as they sit down in wheelchairs.
But on a recent visit to Meijo University in Nagoya, Japan, where Toshiharu Mukai, the robot’s primary creator, works to improve the ursine care attendant, Robear had a problem with his circuitry and wasn’t moving anywhere. Robear was developed at RIKEN, a partially government-funded research institute, and is the product of substantial Japanese government subsidies designed to promote elder-care robots. But Mukai says the robot isn’t ready for prime time and may not be for decades.
Robear, it turns out, is a little too rough for his job, especially considering elderly people’s “fragile skin.” “It’s more of an academic robot,” Mukai says of his creation, noting that Robear also struggles to maneuver in small Japanese apartments. Mukai says there are more practical robots available, such as Paro, the miniature robotic plush seal that keeps up basic chatter with elderly Japanese to ward off dementia. Then there’s Kirobo Mini, the robot recently unveiled by Toyota that wobbles like a toddler to provide companionship to the legions of childless Japanese women.
But there’s still no robot that can provide emotional support for the elderly, listen to their needs, wash and care for them, and otherwise make their twilight years happy. “Our robots can’t replace human labor yet,” Mukai acknowledges.
That’s a problem for aging Japan, one of the world’s oldest countries and also one of its most immigration-resistant. The Japanese government says that, due to a shrinking labor force, as well as greater demand for elder-care, the country will be short 380,000 health nurses by 2025, though many independent experts put the figure closer to 500,000. The most obvious solution would be to import nurses and care workers from nearby Southeast Asian countries, like the Philippines and Indonesia, where unemployment remains a persistent problem for trained nurses. But so far labor migration is only happening on a limited scale.
“I would say that before accepting immigrants or refugees, we need to have more activities by women, elderly people and we must raise our birth rate. There are many things that we should do before accepting immigrants,” Prime Minister Shinzo Abe said in 2015, in a reflection of long-standing Japanese resistance towards accepting outsiders. Demographers project Japan will lose more than a third of its total population by 2100, when around half the population will be age 60 or higher. “It’s true Japan has a major labor shortage,” said Jotaro Kato, of the Asian People’s Friendship Society, which fights for migrant rights in Japan. “We only welcome migrants from the back door.”
Japan’s traditional xenophobia has made life difficult for outsiders living here. During Japan’s prewar colonial years, the country brutally employed millions of Chinese and Korean forced laborers to work in factories and mines — and enslaved tens of thousands as “comfort women” throughout the empire. The country’s first major immigration decision came after World War II, when Japan had to decide what to do with the 2 million Koreans living in Japan who had come to Japan as workers and forced laborers. Most went home. The 600,000 Koreans who stayed after 1947 lived an uncertain existence for decades; primarily holding resident alien status, they were shunned at school and work and formally prevented from taking management positions in the civil service. Professional detective agencies specialized in ensuring that prospective spouses didn’t have Korean ancestry.
At various points Japan has sought to open itself to foreigners. During the 1980s economic boom the country relaxed visa requirements for ethnic-Japanese Brazilians looking to work in Japan. However, Japanese-Brazilians had a very difficult time fitting in; by the late 2000s the Japanese government started programs to pay Brazilians of Japanese descent to fly back to Brazil for good. Butch Pongos, a Filipino migrant rights activist who has lived in Japan for over a decade, and who works on the cases of Filipino brides and migrant workers who are struggling to stay in Japan, said that Japanese coldness to foreigners remains a feature today. “Immigration rules are becoming tighter and tighter and there is so much pressure on them to go back to Philippines,” he says of his clients.
At a time when pro-immigration, multicultural policies are being firmly challenged by Donald Trump, as well as by ascendant right-wing movements across a fast-aging Europe, Japan’s dire situation illustrates what happens to countries that get old but refuse to grow up and accept the necessity of immigration.
A few hours’ train ride outside of industrial Fukuoka, deep in farm country, on the southern Japanese island of Kyushu, is the Yuai Village elder care facility, average age 84. In the main room, elderly Japanese are grouped silently in wheelchairs, some spooning food idly into their mouths. A crew of care workers circles among them, speaking in Japanese and attending to those in need. But here in Saga, a dozen of the care workers are Indonesians — Batak Christians from Northern Sumatra.
Beginning in 2008, the Japanese government began allowing some hospitals and health care facilities to hire nurses and care workers from Indonesia, the Philippines, and Vietnam. So far, around 3,800 total have come to Japan. The Japanese government sets high standards for the incoming nurses: They must speak near-fluent Japanese and pass the same exam Japanese nurses and caretakers must pass. Though the migrants are provided with months of language training, it’s often not enough. So far, most foreign nurse trainees have failed and are sent home; as of 2014, only around 20 percent of Indonesian nursing applicants passed their exam, according to data compiled by Ferry Efendi, an Indonesian researcher. The ones who pass, though, are the rare foreigners who can stay in Japan forever, and even bring their families along: a golden ticket to the “land of the rising sun,” as Indonesians still sometimes refer to Japan.
Mindo Betni Sihombing, 24, said the combination of caring for the elderly while also studying for difficult exams was stressful. “Life’s a little precarious. I’ve already started worrying about the future. If I don’t pass, I have to go home and find work,” she said. Mindo, like many Indonesians, is in a tricky bind in Japan; she’s a trained nurse, and will soon have to pass rigorous exams to be officially registered as a care worker. Even if she succeeds in passing the exam, however, she will mostly be used for relatively unskilled care work and has no authority to diagnose problems or administer medicine. “All of my capabilities as a nurse have gone,” she said, blaming the time spent studying Japanese and the tedium of menial care work, “It’s really regrettable.” Many of the caretakers shared her mixed feelings — they were treated respectfully by their employers, but were thinking of heading home and starting families anyway, in part because of the monotony of caring for the elderly in a rural town.
But the Indonesians working at the Yuai Village facility draw rave reviews from their boss, who say it’s difficult to find skilled workers this far from a major city. “The Indonesians are very calm; they are not very aggressive, they are sincere, they don’t create many problems, they are liked by elderly,” said Mieko Nishimura, their supervisor. Walking into an interview conducted in Bahasa Indonesia, a language she doesn’t speak, Nishimura asked hopefully, “Do they intend to stay here with us?”
Reiko Ogawa, an associate professor at Kyushu University, says the Japanese government program to import nurses has been successful in many ways because “for the first time migrants are seen in a positive light, especially Southeast Asians.” Thanks in part to the stringency of Japanese government regulations, nurses and caretakers imported under the government program don’t face the same level of abuse as Southeast Asian care workers in Hong Kong or Taiwan. The workers in Japan live in dorms and apartments provided by the health care facilities that employ them, a safer environment than those of their counterparts in Hong Kong and Taiwan, who tend to stay in family homes, where they are more vulnerable to sexual harassment and physical abuse.
But others are more critical of the Japanese government program, in part because the program’s rigidity requires the Japanese government to invest large sums to train foreigners to learn the language and pass Japanese nursing exams, even though many nurses repatriate eventually. The program has been running for nearly a decade, yet fewer than 4,000 health workers have entered Japan and there are no signs of imminent expansion. “We’re talking about a couple hundred here, a couple thousand there,” said Gabrielle Vogt. “Meanwhile, the health worker shortage in Japan is at half a million and that number is supposed to increase dramatically. If we were talking about serious action, we would have to be talking about higher numbers.”
The lack of foreign labor drives up the costs of a health care system that is already under severe strain. Since 2000, the Japanese government has established long-term care insurance which middle-aged people pay into to fund the government’s care for them in their old age. But Japan’s budget to GDP ratio is among the world’s highest, and the pension and insurance system are widely considered unsustainable. Wako Asato, a professor at Kyoto University, said, “The annual budget growth is much higher than GDP growth. It’s not healthy at all. When I teach, students never believe that Japan is a welfare state. For seniors, yes, but not for them.” One study found that Japanese young people are more pessimistic about their future than young people anywhere else, with a significant chunk expecting to work until their death.
Keiji Inaba, the middle-aged executive of a care facility employing nine Filipino care workers and nurses, agrees that any solution to take care of Japan’s elderly involves importing more foreign care workers. “The labor shortage is very serious. Care facilities are already very full,” he said. “There are already more than 500,000 elderly people on a waiting list.”
It’s one reason for the kodokushi phenomenon:—“silent death.” Thousands of elderly Japanese die alone in their homes every year, sometimes undiscovered for weeks or months at a time.
Inaba said he was stunned when he visited an elderly care facility in San Francisco and all the care workers were foreigners. “The staff was composed of Filipinos, Indians, and Mexicans. There were no American care workers in America! So maybe Japan will have to become like that.”
But with the government so slow in accepting foreigners, he isn’t convinced. “My worry is: Who will take care of me?” he said. “Maybe robot will be the one.”
So, a proud nation’s future rests on Robear. But even Toshiharu Mukai, the robot designer, says that migrant care workers are a better solution.
“Japanese are not open to foreign workers probably because we were afraid of culture gaps,” he said.
“Little by little we should shift that mentality, we have to. The world is changing. But I think it takes years, long years, 100 years for this.”
Will Robear be ready to go by then?
“Maybe,” he said. “It’s difficult to see the future.”
This reporting was supported by the International Reporting Project.
Photo credit: JIJI PRESS/AFP/Getty Images