Japan’s “Nursing Murders”

Rising Need for Elderly Care

Japan’s population continues to gray, with 27.3% of citizens now being 65 years old or over. This has resulted in an increasing number of elderly people who require nursing care. The Cabinet Office’s 2014 annual report on the nation’s aging society reported that in 2013, around one in four people aged 75 or over needed to be cared for and that in most cases, they were being looked after at home by family members. And the 2014 Comprehensive Survey of Living Conditions found that in around 60% of households, a family member would live together and play the main caregiving role should someone require care.

The strains involved in such a task can at times become too much to bear, however. There has been no end to “nursing murder” cases in Japan in which caregivers take the life of their charges and sometimes go on to kill themselves.

The Pressures of Caregiving

National Police Agency statistics for crimes ascribed to “caring fatigue” indicate that there were 356 arrests for murder, 15 related to inducing or abetting suicide, and 21 for bodily injury resulting in death between 2007 and 2014. Meanwhile, Cabinet Office statistics show that fatigue from caregiving was the main factor in 2,515 suicides from 2007 to 2015; in 1,506 cases, or around 60% of the total, those taking their own lives were people aged 60 or over. In just a decade since these statistics began being recorded, the pressures of caregiving have caused an alarming number of deaths.

One feature of the murders is that they are frequently committed by men and that women are often the victims. Based on my analysis of newspaper reports, some 70% of victims were women and around 70% of assailants were men. While the number of male caregivers has been rising in recent years, women are still much more likely to take on this responsibility. This suggests that compared to women, men find it more difficult to cope with caregiving challenges. I have also found that in around 30% of care-related crimes, the culprits themselves had a disability or were in poor physical health. From this, it is clear that greater support needs to be provided for the caregiver.

To prevent such tragedies in the future, individual incidents should be thoroughly scrutinized to trace the process leading to the act of taking another’s life. Obtaining information on the difficulties faced by caregivers, what triggered each incident, and whether someone could have successfully intervened would help improve the kind of support provided. There is also a need to build a database of past cases and conduct quantitative analyses to detect patterns and examine the possibilities of stepping in before fatal crimes are committed. The National Violent Death Reporting System in the United States collates and performs multifaceted analyses of data from multiple sources related to deaths caused by abuse, for example, with the aim of averting similar cases. While there may be a limit to the information that can be obtained, especially when assailants also take their own lives, Japan, too, should collect all relevant data and construct a database. This can be used as a basis for interdisciplinary research and analysis by experts in criminology, social policy, medicine, social welfare, and other fields, with the aim of enhancing related policy measures.

Understanding Motives

Caregivers driven to committing nursing homicides usually cite one of two causes when asked about their motives by police officers or prosecutors: caring fatigue and despair over future prospects.

To reduce caring fatigue, situations must be prevented from escalating to the point where caregivers feel trapped. There is an urgent need to improve access to nursing services. Caring for someone with dementia who needs to be watched at all times can be particularly exhausting. The long waiting list for admission to public nursing facilities for the elderly must be shortened to enable caregivers to seek nursing help when they need to. When caregivers are overburdened, they can easily have a breakdown. Intervention by a third party is also essential when caregivers themselves have health issues, have a poor relationship with their charges, or in other ways lack the capacity or motivation to fulfil their role. If caregivers suffer from depression or other severe mental issues, they must be able to promptly contact a healthcare manager and receive treatment. They should be provided the same kind of expert assessment as people requiring nursing care to ascertain their health requirements and their fitness as caregivers.

Killings motivated by despair over the future, on the other hand, usually are not prompted by a situation that has reached crisis point. Rather, seeing that there is no hope for an improvement in the condition of their charges and feeling overwhelmed, caregivers choose the only option that seems open to them, sometimes taking special care not to inconvenience others in the community. One example was a shocking incident in a small village in Fukui Prefecture in the winter of 2005 involving a man in his eighties, who felt his own health deteriorating, and his wife, also in her eighties, who suffered from dementia. “I will die with my wife,” the man wrote in his diary, before taking her to a local crematorium in the middle of the night, climbing inside a furnace holding hands, and lighting a fire that consumed them both. The woman had reached a state of dementia where she could not be left alone but was not so helpless as to be near death; the couple did not have financial problems; and yet, without consulting anybody, the man chose to die a quiet death with his wife.

There have been other examples of similarly heartbreaking incidents. Having had a painful experience caring for her dementia-stricken mother, a woman attempted with her husband to end their own lives, hoping that by dying early they would be able to leave their daughter a larger inheritance and also prevent imposing the same kind of hardship on her. Such deaths driven by despair may become more common in the years to come. Crimes motivated by caring fatigue may be easier to prevent through such policy measures as requiring caregivers to undergo assessments and offering respite care (short periods of professional nursing so family caregivers can take a break). Despondency over future prospects, by contrast, is a more deep-rooted problem that cannot easily be alleviated by changing policy. It requires a full rethinking of how society should look after those requiring nursing care and the expected roles of caregivers.

Some three decades ago, welfare specialist Ōta Teiji noted the importance of focusing on the needs of caregivers as well as their charges and building a society where they do not become isolated when taking on responsibility for looking after others. In Japan today, caregivers face gradual social isolation; they may be forced to quit or change their jobs because of caring responsibilities or be unable to find the time to maintain friendships.

Perhaps because it is an issue that is very close to home, Japanese people are deeply uneasy about the burdens of nursing care. In a 2010 survey by Carers Japan of 10,663 people in five locations who had not yet experienced being a caregiver, 84.5% expressed concern about the prospect of having to provide care. In a 2014 nationwide survey of 6,195 people aged 20–69 by the Meiji Yasuda Institute of Life and Wellness, 38.0% of men and 45.0% of women stated that they were very worried about nursing in general. These are startling results. A vague unease about nursing is preventing us from imagining a bright future.

If taking on caring responsibilities did not result in isolation, if we were able to maintain our relationships, enjoy leisure time, and live as we please, then caregivers would not feel driven to consider death as a solution. Strengthening the foundations for public support to caregivers is an urgent issue.

Learning From Other Countries

In 1997 Japan enacted the Long-Term Care Insurance Act, which qualifies people aged 65 or over requiring care and those aged 40–64 certified to be in need of nursing support to receive public care services. There is, however, inadequate legislation for supporting caregivers. Although the act calls for community support projects to provide assistance to families, municipalities are not obligated to carry out these activities. Further, while there are legal provisions pertaining to caregivers, they are focused on protecting elderly patients and preventing abuse, rather than addressing caregiving needs.

By contrast, great progress has been made over the past two decades in other countries in enacting legislation for helping caregivers. For example, in Britain, support for caregivers extends beyond encouraging continued home care. Under the Care Act, caregivers are treated as individuals playing a role in society, and the law seeks to prevent them from becoming isolated because of their responsibilities.(*1) In Australia, there is a growing movement to provide more support for caregivers, including a basic federal act and various forms of state legislation. These countries consider the particular requirements of caregivers, establish laws that include them in society, and set aside funds to support them. Municipalities also notify caregivers and service providers about relevant laws and conduct assessments of caregivers, using these as a basis for paying benefits for appropriate services. Recently, there have been moves to provide comprehensive support to households as a whole. These initiatives could act as a guide for Japan’s future assistance to caregivers.

Conclusion

Nursing homicides keep recurring in communities throughout Japan. To prevent such tragedies, we must humbly confront the facts, study past cases, enhance policy measures, and establish a system to provide greater public support to caregivers.

There is much we can learn from countries that have already established such systems. Shedding light on the needs of caregivers as well as those receiving care would help to assuage people’s fears and enable them look to the future with hope. We must build a society where caregivers, too, can lead fulfilling, dignified lives while looking after loved ones. This, I believe, holds the key to reducing the number of nursing-related tragedies.