And then, no one wanted to be a care manager anymore5


“A good person… That… I don’t really like that way of putting it. Because, it feels like it’s just calling someone who is convenient for you a ‘good person.’ I don’t think there is anyone who is convenient for everyone. Even if someone is useful to someone, they might be a bad person to someone else… So, if Annie doesn’t go along with this plan… Annie will be a bad person to me…”

These are Armin’s words from “Attack on Titan.”



Who is the person who receives daily home care (helpers), despite being able to do things themselves and having family members, gets help with cleaning, laundry, and shopping, uses home visits by doctors and their support staff, goes to multiple hospitals such as psychiatry, orthopedics, and ophthalmology to get lots of medication, uses home nursing even though they only chat, borrows beds and wheelchairs through welfare equipment rental, and goes to day care (day service) twice a week, all without paying a single yen?

The answer is, a welfare recipient.

The other day, during a certification survey for long-term care insurance, an elderly person’s husband claimed to me that “Japan is a harsh country for us common people.” I couldn’t help but respond with my opinion, saying, “There is no country as kind to the common people as Japan.”

Whether good or bad, when I traveled to Calcutta, India in 2008, all those equivalent to welfare recipients in Japan were homeless, and there were many people dying on the streets. After traveling in India, I realized how wonderful Japan’s social security system is. After all, there are no people dying on the streets and you won’t become homeless if you apply for welfare.

However, after starting to work in the care and welfare field, my view on Japan’s social security system has changed.

I have seen many people who, despite being able to work, continue to receive welfare while lying that they are willing to work. I have seen many welfare recipients rush to pachinko parlors as soon as they receive their welfare payments. I have seen many welfare recipients who, because it’s free, have helpers visit every day and demand more cleaning than necessary, and when explained that it can’t be done, they become furious.

Of course, I understand that there are people who genuinely need welfare. However, once people experience comfort, they become determined not to give it up.

For example, it might be considered rational for a 30-something welfare recipient with a mental illness to choose to continue receiving rent, living expenses, and medical expenses through welfare instead of getting a job, earning about 100,000 yen, and having their welfare stopped or reduced due to employment. As a “consultation support specialist,” I also handle procedures and support for welfare recipients with disabilities who hope to work and graduate from welfare, by helping them use services like “transition support for employment.” However, out of the 18 people I have supported in this way, none have been able to graduate from welfare through employment.

I believe welfare recipients should have some out-of-pocket expenses for medical and care services. Welfare benefits should have a time limit. Additionally, I don’t think welfare recipients need to live in urban areas.

And here is where it gets darker.

The so-called “auntie care managers” with an average age of 55 do not question the above issues. Of course, regardless of age, there are some who have such doubts, but they are very few. They often believe that providing services is what makes a good care manager. Providing services may give the illusion of supporting the elderly (users). Many people mistakenly believe that providing services is the job of a care manager. However, the structure of long-term care insurance, where care managers cannot bill for their fees unless they provide services, is also problematic.

Furthermore, the elderly and their families evaluate care managers who act according to their wishes as “good care managers.” But this is just interpreting someone who is convenient for them as a good person, as Armin’s words at the beginning suggest.

Is a care manager who provides support like shopping for someone who can go shopping themselves a good care manager? Is it a good care manager who provides cleaning support from a helper when the person can clean themselves or has family members who can help? Is a care manager who continues to affirm the demands of welfare recipients who don’t pay a single yen with a smile a good care manager?

Generally, people who work in care and welfare have a desire to help someone. From a psychological analysis, this kind of approval desire can be seen as being fulfilled by supporting the elderly. This mismatch creates the problems mentioned above.

Providing services satisfies both the provider and the recipient, so is it not good? However, the money comes from the taxes we pay.

The current elderly, who are the most economically comfortable generation, may be able to use as much long-term care insurance services as they want. But for our generation in our 30s and 40s, it is unlikely that we will be able to use long-term care insurance services like the current elderly.

Moreover, companies where many care managers belong often have their own home care (helper) service offices, day care service offices, home nursing offices, welfare equipment offices, etc., and social welfare corporations that receive subsidies from local governments also have special nursing homes for the elderly, and if there is a medical institution, they have clinics and home visit medical services.

In other words, elderly people and their families request services from care managers according to their convenience, care managers gain a sense of self-affirmation by feeling useful, and the companies or organizations where these care managers belong benefit by using their own services.

Even if you question this, no one feels it’s a problem. Even if you raise a question, you are suppressed by the logic of numbers.

My company advocates the worldview of “first making those who work in care happy in order to make those who receive care happy.” As part of this effort, I work on counseling, supervision, and other tasks. Many care managers apply for this, and care managers who are mentally exhausted and develop depression continue to leave.

And those who leave are always the young and capable ones. Unfortunately, most care managers do not analyze the above issues or take actions to address them, but go about their daily work without much thought. In other words, the few care managers who think and act on “Is there a way?” reach me.

Initially, I conveyed messages like “Let’s work hard together.” But recently, I have been conveying a different message. That message is, “You should quit.”

And the stress from work inevitably affects the family after returning home. If you are a young and capable person in your 20s or 30s, you are likely living with a wonderful partner and lovely children. It is very sad when the stress from a low-paying job with no personal growth ends up directed at the family.

Even if you are not a care manager or have never interacted with one, please recognize this reality and support us. Care managers are undoubtedly the key to “long-term care insurance.” Without care managers, you cannot use helpers, day services, or borrow beds.

The worst-case scenario is a time when no one wants to be a care manager.