The Daughter Who Became Staff

Nobody appoints her. There is no conversation in which the family considers the options and selects a person. What happens is that somebody has to go over on Tuesday, and she is the one who can, and then Tuesday becomes Tuesday and Thursday, and by the following spring she is the one who knows which cupboard the incontinence pads are in and what time the tablets are and which GP answers the phone.

Japan has the oldest population in the world — roughly twenty-nine per cent of people here are sixty-five or over, and no other country is close on that measure. So this is not a minority experience. It is a stage of life that a very large share of women in this country will pass through, mostly without ever having been asked whether they agreed to it.

This page has two halves and they are both necessary. The first is a mechanism — the specific things that exist, that most carers have never heard of, and that convert an impossible situation into a merely hard one. The second is the part no government page will write: what happens to a person when she stops being a daughter and becomes staff.

The selection runs on a few rules that nobody states out loud, and stating them is the first useful thing this page can do, because a rule you can see is a rule you can argue with.

Rule one: whoever lives nearest. Rule two: whoever has the most flexible work, which in a country where women are disproportionately in 非正規 employment means, reliably, the woman. Rule three: whoever has already shown they will. The third is the cruellest, because it means competence is punished — the person who handled the hospital admission well in March is the person the family turns to in April, and the reward for being good at it is more of it.

And a fourth that operates in a particular way here: the expectation that falls on a son’s wife. The old obligation of the 嫁 to care for her husband’s parents is much weakened and is by no means dead, and it produces the specific modern situation of a woman providing intimate daily care for two people she did not grow up with, while their biological children are at work.

None of these is a decision anybody would defend if it were put to them as a proposal. They are defaults, and defaults only survive as long as nobody reads them aloud. So read them aloud. "We have never actually discussed who is doing this, and I have been doing it because I live twenty minutes away" is a sentence that changes a room, and it is not an accusation — it is a description.

Here is the most useful section of this page, and it is useful because the thing it describes is genuinely good and genuinely under-used.

Japan has had national long-term care insurance — 介護保険 — since 2000. Everybody pays into it from the age of forty. It funds home helpers, day services, short stays, equipment, home modifications and residential care, assessed according to need. By international standards it is a well-designed system. And it does absolutely nothing until somebody applies.

The application is for a 要介護認定 — a care-needs assessment — made at the municipal office. An assessor visits, a doctor gives an opinion, and a level is assigned that determines what is available. This is the step families skip, sometimes for years, usually because they believe things are not bad enough yet, or because applying feels like an admission about a parent. Neither is a reason. The assessment costs nothing, having a level and not using it costs nothing, and the level takes weeks to obtain — which means the family who applies early is the family with options during the crisis, and the family who waits is applying from a hospital corridor.

And the single fact most worth carrying away: every municipality has a 地域包括支援センター, a community comprehensive support centre. It is free. It will advise anybody caring for an older person, including before any application, including when you do not know what you are asking. Most carers in this country have never heard of it. If you take nothing else from this page, take that name and the fact that you may simply telephone them.

Two more things nobody tells families. Once a level is assigned a ケアマネジャー writes the care plan, and that person becomes the family’s main contact — and if the relationship does not work, you may change them. People almost never do, because almost nobody knows it is allowed. And 介護休業 exists in law: leave for family care, with a benefit paid, which can be split across periods. Take-up is low for the same reasons menstrual leave take-up is low, but knowing it exists changes what you are choosing between.

Around a hundred thousand people a year in this country leave their employment to provide family care. The large majority are women. Government policy has had a stated target of reducing that number to zero, and the number has not gone to zero.

What makes it worth a section of its own is that leaving is almost always presented, internally, as the obvious and loving thing — and it is the decision with the worst long-term arithmetic available. Re-entry after a care gap is harder than re-entry after a childcare gap, because the gap is often longer, ends unpredictably, and lands at an age where this chamber has already documented what happens to women in the hiring market. The income does not come back. The pension contribution does not come back. And the care ends, eventually, leaving a person who is sixty, unemployed, bereaved and financially exposed.

So the honest advice is not "do not do it" — sometimes there is no other arrangement, and nobody writing a page knows your situation. It is: do not do it before you have called the support centre, obtained the assessment, met the care manager and found out precisely what the system would provide. An extraordinary number of people resign from a job while holding an entitlement they never activated, and they do it out of love, which is the part that makes it hard to say and necessary to say.

Here is the thing that actually breaks people, and it is not the hours.

You stop being a daughter. You become the person who manages the toileting, who reads the label on the ointment, who decides whether today’s confusion is worth a phone call. The relationship you had is replaced by a role, and the role is unskilled, unpaid and intimate in ways that both of you find difficult. Visiting your mother and washing your mother are not the same activity, and once the second one starts, the first one has usually stopped happening.

That is a bereavement, and it arrives long before the death. Two things are being lost at different speeds — the person, slowly, and the relationship with the person, quite quickly — and because the first loss has a socially recognised shape and the second does not, the second gets no acknowledgement at all. A woman grieving a mother who is still alive has nowhere to put that, and frequently does not even name it to herself.

On top of which sits the resentment, and then the guilt about the resentment, which is heavier than the resentment was. You can love someone entirely and also want your Saturdays back. Those two facts do not cancel and they do not make you a bad daughter; they make you a person doing an enormous amount of unpaid work while being told, mostly by yourself, that a good person would not mind.

And if there is a person in this who is confused, or frightened, or occasionally cruel in the way that illness makes people cruel — being spoken to like that by a parent, while wiping that parent, is one of the more corrosive experiences a person can have, and almost nobody says so out loud. Saying it here is the point of this section. It does not make you disloyal. It makes you accurate.

A language produces a compact word for a situation only when that situation has become common enough to need naming quickly. Japanese has two here, and both are worth knowing because both describe people who are usually certain they are the only ones.

老老介護 — old caring for old. A wife of eighty caring for a husband of eighty-four, lifting him, managing his medication, and being at higher risk of injury doing it than he is of anything she is protecting him from. It is extremely common in the oldest society on earth and it is the arrangement most likely to end with two people in hospital instead of one.

ダブルケア — carrying childcare and eldercare at the same time. A woman in her forties with a child still at school and a parent beginning to need help, holding both against a working week that this chamber has already shown has no slack in it. The word exists because the demographic arithmetic made it inevitable: births later, parents living longer, and the two curves crossing over one person.

Neither word is a diagnosis and neither entitles anybody to anything by itself. But both are worth saying at the support centre, because a person describing 老老介護 or ダブルケア is describing a recognised category of difficulty rather than a private failure to cope — and the assessment for a parent can take a household’s whole situation into account when somebody says what that situation is.

There is usually a brother. Sometimes a sister in another prefecture. Frequently they believe, sincerely, that things are basically fine, because the information they receive comes from the one person who is too tired to explain.

The conversation that works is not the one about fairness, because fairness arguments invite a defence and a defence ends the conversation. The one that works is arithmetic, delivered flat. Hours per week, tasks in a list, and what specifically you want: this weekend each month, or the medication ordering, or the money for a day service. A request with a number in it is answerable. A feeling of being unsupported is not, and will be met with sympathy and no change.

And if the answer is no — which it sometimes is — the useful move is to stop spending energy on persuasion and spend it on the system instead. The support centre does not need your brother’s agreement. Neither does the assessment. A great many carers spend a year trying to change a sibling and could have spent the same year getting services in place.

Telling a carer to look after herself is the standard advice and it is close to useless on its own, because the hours have to come from somewhere and she already knows they do not exist. So the order matters: mechanism first, then rest, because rest with no source is just another thing she has failed to do.

One: telephone the 地域包括支援センター this week, before deciding anything else. Not when it gets worse. This week, as reconnaissance.

Two: get the assessment even if you will not use the services yet. An entitlement in hand is what turns a future emergency into a phone call.

Three: use a short stay — 短期入所 — once, early, before you need it. Most families first use respite care in a crisis, which means the first experience of it is frightening for everybody. Using it once when things are stable turns it from an emergency measure into a known quantity, and it is the single most effective thing for preventing the collapse that ends in 介護離職.

Four, and only after the first three: one recurring block of time that is yours, defended like a shift. This shelf has an essay on what that block is for and why it is not selfish, and the argument is the same here with one addition — a carer is the load-bearing element of somebody else’s survival, and load-bearing elements are inspected on a schedule rather than when they fail.

Almost nothing on this page is us. The support centre, the assessment, the care manager, the respite bed and the leave entitlement are the substance, and a service that positioned itself as an answer to any of that would be selling comfort against a problem with a real solution.

The narrow honest thing is this. A carer’s body has become an instrument for handling another body — lifting, wiping, steadying, monitoring. It is touched constantly and attended to never. Unhurried contact in which she is the one being attended to, with nothing to manage and nobody to monitor, is not a treatment for anything and will not give her back a single hour. It is simply the opposite experience to the one her week is made of, and for some people that is worth an afternoon.

And where what is happening is depression rather than exhaustion — and in carers the two look almost identical from the outside — that is a doctor, and the support centre will also help with that. Carer depression is common, it is not weakness, and it is treatable.

Nobody appointed you. You were selected by proximity, by flexible hours and by having been competent once, and the arrangement has never been discussed because arrangements that suit everybody else are never discussed.

You are allowed to want your Saturdays back while loving her completely. You are allowed to find it unbearable to be spoken to like that while wiping her, and to say so to somebody. And you are allowed to make one phone call this week, to a free office in your own municipality, staffed by people whose entire job is to tell you what you are entitled to — which is the least dramatic sentence on this page and the only one that changes anything.