Intergenerational co-located care, Japan
Jacqueline Cassidy
Tuesday, January 3, 2023
CYP Now has teamed up with the Churchill Fellowship to publish a series of articles summarising key findings from studies undertaken worldwide by Churchill Fellows (see below). This is an abridged version of "Intergenerational Co-located Child and Eldercare: Tackling disadvantage through an assets-based approach to eldercare and childcare services" by Jacqueline Cassidy.
Jacqueline Cassidy is director for practice and Scotland at the national fostering charity The Fostering Network and has more than two decades’ experience in senior positions in UK children's organisations. For her Churchill Fellowship she conducted research on intergenerational co-located care, undertaking visits to Japan, Singapore and the USA in early 2020 just before the Covid-19 pandemic. This article provides a summary of her key findings on shared care approaches in Japan.
UK CONTEXT
Nearly one in four children in Scotland were living in poverty before the pandemic and the figure is expected to rise to 38 per cent by 2030/31 if there is no significant policy change. The experience of too many children in Scotland is one of: lack of food and good nutrition, poor clothing, inadequate housing, and fuel poverty. The educational impact of poverty is clear from an early age with children from higher income families significantly outperforming those from low-income households – by age five, there is a gap of 10 months in problem solving development and of 13 months in vocabulary. We need to consider support strategies for children in the early years to develop skills that their richer counterparts have developed.
Anecdotal feedback from early years childcare settings is that many children living in deprivation are often arriving at school struggling with skills such as self-feeding with cutlery, toileting and fastening buttons and with limited vocabulary compared with their peers from wealthier families. In turn, residential care evidence shows older people often experience limited personal contact, low self-worth, and declines in their physical and mental health wellbeing.
By creating a system of shared care for older people and children, we can draw on the untapped assets of older people to help address challenges experienced by children growing up in poverty and disadvantage and improve their wellbeing, alongside positive outcomes in the wellbeing of older people.
There are good examples of intergenerational practice in Scotland but there are currently no facilities where residential care services share spaces with early years settings or out-of-school care settings with a pro-active programme of daily engagement. Physically co-locating services with a facilitated programme of engagement allows for deeper relationship building through shared activity including sharing meals, playing and learning together, which in turn improves outcomes for older people and children.
SHARED CARE APPROACHES
Shared care settings, where children and older people are cared for in the same space are still in their infancy internationally. There is no single type of setting; the most common is early years care inside a residential care setting for older people, but others are day care settings for both children and older people, and some are communities where older people live alongside children and their families in a mutually supportive relationship. Addressing disadvantage is not a common driver for the shared care settings that currently exist but the impact of shared care is something that has the potential to transform communities in Scotland.
The children's sector in Scotland is focused on how to improve outcomes for children experiencing disadvantage through the expansion of early learning and childcare and this model of care may offer benefits as part of that agenda.
JAPAN CONTEXT
The traditional culture in Japan, and across much of Asia, is to have multi-generational families where grandparents are supported by their children and grandchildren, and where, in turn, grandparents care for grandchildren in a shared family home. However, now, more older adults are living on their own or in care homes experiencing the same loneliness and isolation that their European peers are experiencing.
Yoro Shistesu, meaning “facility for children and elderly”, were first established in Japan in 1976. Shared intergenerational sites now exist in different forms across Japan from day care to long-term residential with growth driven by demographic change. While local and national government are interested in them, there is no co-ordination or clear policy drivers to support their development further. Several of the settings that I visited reflected the traditional multi-generational family culture.
ASSETS-BASED APPROACH
Japan provided the best examples of how we might address issues of poverty-related disadvantage through an assets-based approach to child and elder shared care.
The sites I visited in Japan had the fewest barriers to engagement, and in several there was “natural” engagement that echoed family living. These settings provided most opportunities for building deeper relationships led by children and adults.
The greater the opportunities for engagement and for relationship building, the greater the opportunities for assets exchange, and to create a system that could support children who are experiencing challenges created by systemic poverty.
WELLNESS CENTRE, KUWANA
This incorporates several different shared care sites and intergenerational programmes. Led by the inspirational Dr Tago, it is a strengths-based model which is embedded across a range of intergenerational settings.
At Hikari no Sato, there is a small residential eldercare setting sharing the site with a wraparound club providing childcare before and after school. The older residents, many with dementia, help the children in the afterschool club with their homework.
The young people come after school and share a snack with the older people before starting their homework. The food and homework take place at a large kitchen table in a kitchen setting, which gives the whole thing a natural family feeling. After homework is done, they go to the small, shared garden that they have planted together, or the children are free to play games while the elders potter about or sit and watch. There is also a separate indoor play area which includes books, games and a climbing wall.
Dr Tago has used a range of tools to map outcomes for children's homework, behaviour (manners) and independence. For the elderly residents, they feel “useful and youthful”.
Across the street is a day care centre with nursery setting, where there is shared programming. In the downtown area, there is a further setting with care home residents and an afterschool attached. The two groups interact in different ways including older people with dementia teaching young people how to cook.
Teaching the children to cook has resulted in healthier eating for the children, learning cooking skills, and for those with dementia, enabling them to share their skills.
KOTOEN, TOKYO
Visiting Kotoen was one of the highlights of my Churchill fellowship. It has been a nursing home for 58 years and has had a shared facility with childcare for 32 years. Initially, they were separate facilities, but gradually they were integrated with shared spaces and communal activities bringing the two communities together.
There are 120 one- to five-year-olds in the setting. The long hours in care reflect the Japanese working culture: the first children arrive at 7.15am and the last children leave at 7.30pm (although the core hours are 9am to 4pm). Within Kotoen, there are 50 elderly residents including many who are socio-economically challenged.
Every day the children have morning exercise outside with the older people joining in from a sitting or standing position on the side of the yard. After the exercise routine the children have time with the residents to play and mingle – there were a lot of cuddles and clearly some favourite “grandparents”. Later in the day, some children run a daily mile around the building and older people cheer them on. Whilst the exercise is not optional for the children, the mingling is, and all the activity is optional for the older people but for many residents it is the highlight of their day.
The main nursery setting is fully integrated within the care setting, not adjacent or closed off, as I saw in other places. There are no doors, locks or barriers and the space is open and fluid. An area for physiotherapy for older people overlooks a large, shared space which leads into the nursery.
The shared space between the main nursery space and physio area is set up like a large amphitheatre. It is used for naps, storytelling, shows and shared activity.
IMPLICATIONS FOR PRACTICE
Nowhere I visited was a “copy and paste” example of how we might deliver co-located care in Scotland, but there were elements across the settings that could be drawn together to address the needs of children living in communities of disadvantage through a shared care approach.
We need to consider a strategic response that tackles a range of social challenges: shared care that includes early years childcare and wraparound childcare services focused on sharing skills and building relationships. The vision must have clear outcomes for children and young people rooted in respect for children and older people and the need for humanity and dignity in how we treat them. Currently, policy and budgets are sitting in silos and these need to be integrated. Shared care approaches can be an efficient use of resources and improve outcomes for both children and elders.
The expansion of early education in Scotland is an opportunity for different approaches to childcare, as are the discussions around childcare provision for vulnerable children and families in the vital first 2000 days. Even when space is a challenge, are there creative solutions that combine an outdoor nursery and a care home setting?
We need strategic level support for shared sites in areas of significant disadvantage with support and investment from the public sector built into the approach at the outset.
This is not a request for full funding from government, but fiscal stimulus that could drive provision. An investment in communities of disadvantage will reduce costs savings in the future. Addressing the needs of young children living in poverty not only benefits those children and families, but it also reduces costs for a whole range of services across their whole lifetime and brings benefits to society through their increased capacity and contribution.
ABOUT THE CHURCHILL FELLOWSHIP
The Churchill Fellowship is a national network of 3,800 inspiring individuals whose mission is to find the world's best solutions for the UK's current challenges.
Up to 150 Churchill Fellows are funded each year to visit the world's leading practitioners and projects on a topic of their choice – from social policy to healthcare to education and more – and bring back new ideas for their communities and sectors across the UK.
Any UK adult citizen can apply, regardless of qualifications, background or age. Fellows are chosen for their potential as change-makers, not their past track record or status.
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Find out about fellows and their ideas at www.churchillfellowship.org
