And then, no one wanted to be a care manager anymore2


Hey, Geto-kun, do you hate non-sorcerers?”

“I’m not sure. I used to think that sorcery existed to protect non-sorcerers. But lately, something like the value of non-sorcerers within me is wavering. The preciousness of the weak. The ugliness of the weak. I can no longer discern or accept those differences. The self that looks down on non-sorcerers, and the self that denies it. It’s like a marathon game of sorcery. The vision at the end is so vague that I don’t know what’s genuine.”

“Neither of those is the real you. You’re not at that stage yet. You, who look down on non-sorcerers. You, who deny it. These are just potential thoughts. It’s up to you to choose which one becomes your truth.”

“Hey, this person can’t do anything. Please get a helper in here quickly.”

The other day, I, as a person receiving livelihood protection, entered the home of an elderly person I manage as their care manager, and a woman in her 70s whom I had never met before said these words to me without even greeting me.

As a care manager, I sometimes encounter third parties who suddenly appear like this, despite not being family members.

And usually, people like this, without even greeting me or asking about the circumstances, come in and emotionally express their thoughts loudly.

How would you feel if a stranger suddenly threw such words at you emotionally and loudly without any prior introduction?

Fear, anxiety, anger, and other feelings may arise, but they are all negative emotions, aren’t they?

The example above is just one instance, and such incidents occur almost every day, causing care managers to feel drained, develop depression, and ultimately quit their jobs, creating a “chain of negativity” that never seems to stop.


According to a survey conducted by the Ministry of Health, Labor, and Welfare in 2018, 60% of care managers answered “yes” when asked if they had experienced harassment from users or their families in the past year.

Also, in terms of the number of workers’ compensation claims in 2019, the top industry was social welfare and caregiving services.

Mental disorders such as depression are one of the reasons for workers’ compensation claims in the social welfare and caregiving industry, which includes harassment from users or their families.

Compared to 2009, ten years ago, the number of workers’ compensation claims in the social welfare and caregiving industry has increased fourfold.

By the way, the second-highest number of workers’ compensation claims was in the medical industry, and the impression is that there are many people in school education who are on leave due to depression, which was ninth.

You can understand how mentally drained people working in social welfare and caregiving services are.

This applies to the medical industry as well, but many people think that they can use various caregiving insurance services such as helpers, day services, and welfare equipment if they wish, and they recognize care managers who enable them to use these services as good care managers.

However, the job of a care manager is not to provide services.

The job of a care manager is to support users in living independent daily lives according to their abilities.

In other words, helpers, day services, and welfare equipment are means for users to live independently in their daily lives, not the purpose of using them.

To put it directly, the simpler the person, the more they accept a “simple world.”

A “simple world” is a worldview where everything is either entirely good or entirely bad.


However, the world is complex.

No one person moves the world, and even within one person, there are both good and bad aspects.

“Negative capability” is the ability to accept uncertainty and unresolved issues.

The first article of the basic policy on the personnel and operation of care manager offices states that home care support services (care manager offices) must be provided in a manner that allows users to live independently in their homes as much as possible, taking into account their ability to lead independent daily lives even when they require care.

However, the reality is far from this basic policy.

Many care managers deviate significantly from this basic policy by listening to the opinions of emotionally loud individuals like the one mentioned earlier, and despite the fact that the caregiving insurance services they provide end up inhibiting users’ independence, they often create care plans that inhibit independence according to the demands of emotionally loud individuals.

And most people mistakenly believe that a care manager who incorporates many services is a good care manager.

Emotionally loud people perceive the world as a “simple world,” so they cannot understand abstract concepts like the ones mentioned above.

Furthermore, sadly, many care managers and caregiving/medical professionals have the same tendencies.

Perhaps because of this, medical professionals tend to want to include services.

This is also an issue of “education” that has cultivated a worldview where those who express opinions different from one’s own are considered enemies, but that’s a topic for another occasion.


For example, helpers.

Helper services are divided into ① physical care and ② daily living support.

① Physical care: support that involves direct contact with the user’s body, such as excretion, bathing, and changing clothes.

② Daily living support: support for household chores such as cooking, shopping, and cleaning.

I believe that most of ② daily living support hinders independence.

If we follow the basic policy mentioned above, ② daily living support would involve partially borrowing the support of helpers and learning how to do household chores from them so that users can eventually do them on their own, thus supporting their independence.

However, in reality, even when users themselves have the ability to do things, helpers perform all support for cooking, shopping, cleaning, etc., just like housekeepers.

In response, users and their families say whatever they want, such as “the seasoning is bad” or “this area is dirty.”

Cooking and shopping can be done by purchasing necessary items online.

Cleaning can be done by using a Roomba, etc.

Laundry can be done by purchasing a washing machine with a dryer.

Rather than providing a housekeeper-like service at a 10% burden to elderly people with excess time (the actual burden amount is around 200 yen for one hour of household assistance), it would be better to provide household assistance at around 200 yen for one hour to child-rearing generations who have neither time nor mental resilience.

I propose that the user burden ratio for household assistance be set at 50%. A limit should be set on the duration of household assistance use. Even for livelihood protection, I feel that policies such as making users pay 10% rather than receiving services for free are necessary for caregiving insurance and medical care.

Once people get used to something easy, they don’t want to let go of that ease.

If helpers visit several days a week and do household chores according to their wishes, even if users have the ability to do things themselves, they will be reluctant to give up that ease.

As a result, users’ abilities are hindered.

People who can only see the world as a “simple world” cannot understand the logic mentioned above.

And they perceive those who cannot understand as enemies.

As a result, care managers who try to understand and practice the essence of their work often come under attack from those who cannot understand.

Therefore, the younger and more capable they are, the more likely they are