In Japan, the Rising Cost of Elder Care—and Dying Alone

Itoko Uchida, 82, was counting on the nephew she raised to support her during old age. He refused, she says, forcing the Tokyo widow to pay 710,000 yen ($7,600) to a nonprofit, which will assist with her nursing home application and act in lieu of a close relative on health-care matters. Some 420,000 Japanese nationwide are waiting for a nursing home bed.

An erosion of traditional Confucian values, which stress the obligations children have to their parents, means fewer elderly are being cared for at home by relatives. By 2025, one in three citizens in Japan will be 65 or older, up from 12 percent of the population in 1990, the Organisation for Economic Co-operation and Development estimates. “The system is designed for the 1970s, when multiple generations lived together and family caregiving was thought to continue forever,” says Hiroshi Takahashi, a professor of health sciences at the International University of Health and Welfare in Otawara, north of Tokyo. “But that’s not the reality now.”