Real-life dramas are playing out in the Japanese countryside: several “sudden death bodhisattva” have popped up and amassed endless streams of worshippers, many of them elderly.

The deity, known as Ksitigarbha in the original Sanskirt and Jizo in Japanese, is seen as a deity of immense compassion who seeks to save beings trapped in hell. His elderly worshippers have one simple appeal when praying to him: that at the end of their lives they die quickly rather than drag on in old age. It’s a mindset that differs markedly from humans’ desire throughout history to live longer, but reflects the despair prevalent among many seniors in Japan. 

With advances in modern medicine and highly developed live-saving technologies, people are living longer. In 2015, the life expectancies of Japanese men and women had reached 80.79 years and 87.05 years, respectively, up six years and seven years from 30 years earlier.

But “healthy living” has not gained ground even as life spans have grown longer.

Many Japanese are very unhealthy in the last 10 years of their lives, with some unable to live independently because they are confined to a bed long-term, require help when going to the bathroom, or are being kept alive by artificial respirators.

Their family members are often forced to give up their lives and jobs to take on the heavy caregiving burden.

“Even if this body continues to live, what’s the point?” wrote Takanori Fujita in the sequel to his best-seller “Down and Out Elderly” published this year, reflecting the laments he heard from countless senior citizens. 

This insecurity over elderly living has made the idea of “preferring to die with dignity rather than dragging out an ignoble existence” an increasingly popular wish and turned “sudden death” Ksitigarbha into local stars.

That insecurity has also been stirred up in Taiwan, which will become a super-aged society by 2025 when one in every five people will be 65 or over. Taiwan is the world’s most rapidly aging country and will likely need only eight years to go from an aged society (with 14 percent of the population 65 or over) to a super-aged society, compared with 11 years in Japan and 16 years in the United States. The chronic diseases and disabilities plaguing Japan’s elderly that feature prominently in Fujita’s works are being quickly replicated in Taiwan.

Downwardly Mobile Middle Class

Beyond the problem of chronic disease, elderly people are being caught in vicious cycles of poverty and loneliness.

“After Japanese retire, they still have 30 years to live,” Fujita says with a concerned tone. “Taiwan’s post-retirement life is also very long. This is a world that we have never experienced before but are facing now.”

The 35-year-old Fujita has already been engaged in social work for 15 years. He currently works for a nongovernmental organization he founded, providing counseling and resources to people with suicidal tendencies or those constantly in trouble with the law or in and out of jail.

He has slowly come to appreciate the major impact that an aging society is having on Japan, as a growing number of those seeking his advice are seniors 65 and over. Many of them are homeless, unable to afford rent, or unwilling to seek medical care out of fear they couldn’t pay their bills. Some are not even able to scrap together three meals a day and forced to eat weeds to survive.   

What surprised Fujita the most was that many of the seniors he counseled had worked at banks or big companies and earned excellent salaries, only to have their lives upended by unforeseen situations.        

In some cases, people were laid off by their employers when they were middle aged, but they did not pay attention to financial planning and failed to accumulate enough to support their retirement lives. Others had to quit their jobs to take care of ill parents or partners and eventually burned through their savings to pay medical bills or caregiver fees. There were also those set back by having to take care of adult children who were unemployed or earning low salaries and could not support themselves.

Also among the unfortunate are husbands who spent their lives buried in their work and ended up in late-life divorces that left them alienated from their friends. These men often do not understand how to manage money and blow through their savings, or don’t understand how to take care of themselves, resulting in constant ailments.

In fact, these senior citizens face three types of “poverty” after they retire: “income poverty,” “savings poverty,” and a poverty of personal relationships. These deficiencies have increasingly consigned this group to the category known as “karyū rōjin” in Japanese, translated as “low-class elderly people” or “down and out elderly people.”

In 2016, Japan had roughly 11 million of these “down and out elderly.” In other words, one out of every three Japanese seniors have such low retirement incomes, they rely on government welfare benefits to survive.

Problems Only to Get Worse

“When they were middle-aged, they were ordinary people. Will I become like this in the future?” Fujita wondered, prompting him to write stories aimed at getting society to pay attention to this widespread problem.

When Fujita’s book titled “Down and Out Elderly: The Impact of the Coming Collapse Brought on by 100 Million Elderly People” was published in 2015, it caused a huge commotion. The book sold 220,000 copies and Fujita gave 247 speeches in the space of a year while also doing interviews with leading Japanese business media Nikkei and other media outlets. Even Japanese officials, who in the past refused to acknowledge that “Japan has people who are that poor,” took action by conducting a poverty survey. A parliamentarian even invited Fujita to participate in policy discussions.

Two years later, we asked Fujita if he was still afraid of getting old. “I still worry,” he admitted. “This is a relatively unsettled time.”

But during the past two years, he has seen Japanese society take a positive turn, and he felt Taiwan could also take action, in four different ways.

1. Plan for retirement, no matter how old you are

Changing mindsets is the first step. Many elderly Japanese have begun to ask themselves the question, “What will I do in the next 30 years?” A growing number have begun to actively plan their retirement years and think about things like how to manage their finances and take steps to prevent disease. They are also taking part more often in community activities to avoid interpersonal alienation.  

2. Knowing how to ask for help

Japanese society constantly pushes the idea of “seeking help.” “Japanese people have a lot of pride and feel very embarrassed to tell others about family matters,” Fujita says. But seeking help early on can prevent a problem from turning into a future tragedy, and books and websites are increasingly informing people how to get advice and apply for the necessary resources, he says.

3. Reviving a ‘mutual-help’ culture

Japan’s younger generation has shown a dedication to change and wants to revive the country’s traditional culture that values “mutual-help.” “You shouldn’t devote your entire life to your work. People’s lives should be well-rounded,” says Fujita, who outside of his job still finds time to help out at his child’s kindergarten and participate in community association activities while also making sure to spend time with his wife. “You don’t want to be in a situation where after you retire and you no longer work, you have nothing left. If there are strong partnerships, the problem of a poverty of relationships is eased.”

4. The Need for Government Intervention

Fujita believes that the most effective solution, however, is reforming government policies and spending. He has argued that the government should increase taxes to improve health insurance and the related social security system.

“Japan, South Korea and Taiwan have similar cultures. We always think we should take care of our own family matters, so after we get old, we tend to live on our own and be responsible for ourselves,” Fujita says. In contrast, Scandinavian countries and other social welfare states impose high tax rates but also deliver strong social benefits, so people don’t have to worry about life after retirement.

“There has to be a balance between personal responsibility and government responsibility,” Fujita argues.

But isn’t there a chance that tax increases will spark a public backlash or even friction over generational injustice?

“That concern absolutely exists, but you have to convince people that the money they are paying will be given back to them in a different form in the future,” Fujita says. “(The difficulty of promoting this policy) shows that we don’t trust our government, and people naturally resist. The government needs to earn people’s trust.”

The difficulty of getting people to buy into policies that address the problems associated with increasingly aging populations in both Japan and Taiwan reflects how daunting the challenges really are in preventing the rise of a class of “karyū rōjin,” the “down and out elderly” in society.

Translated from the Chinese article by Luke Sabatier

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Additional Reading

♦ Preparing for the Golden Years
♦ The 2015 Quality of Death Index: Ranking palliative care across the world (The Economist)