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Nationwide introduction of multi-currency TimeBanking in Japan by JCSA

Date interview: November 1 2016
Name interviewer: Paul Weaver
Name interviewee: Jill Miller
Position interviewee: Independent researcher


Values Providing alternatives to institutions New Doing Negative side-effects Internal decision-making Experimenting Emergence Competence development Civil Society organizations Adapting

This is a CTP of initiative: Volunteer Labour Bank/Network (Japan)

The Japan Care System Association (JCSA), established in 1982 by Michiko Kanema, developed a nation-wide TimeBanking network. This was only the second nation-wide network to become established in Japan; the first being the VLB/VLN. The JCSA nevertheless operated largely in rural locations within the Japanese regions, whereas VLB/VLN (and later NALC) operated largely in urban centres. The interest in JCSA as a CTP focuses less on it being an alternative to VLB/VLN and more on the innovations it brought to TimeBanking, introducing and experimenting with new ways of doing timebanking by operating a multi-currency form of TimeBanking. This combined the use of both time and money currencies for the first time by an organisation operating nation-wide. Although at the time this was contentious and raised acceptance issues among the members of TimeBanks in Japan, who were then still mostly middle-aged women, mixed-currency systems later grew to become the dominant form of care-providing TimeBanks in Japan. Mixed-currency TimeBanks were later organised by other TImeBanking networks with a wider membership spectrum that included the active elderly and men as carers as well as middle-aged women. The forms of TimeBank that ultimately became dominant in Japan are those that remunerate carers at least partly in money.  

Formed originally as the “Kagawa Aged Welfare Research Group”, Kanema founded her organisation in 1982 on the island of Shikoku. The name of the civil society organisation was changed to the Japanese Care System Association in 1991. From the beginning, the focus of the organisation was to provide care support to the elderly living in their own homes. This was later extended also to providing care in care centres that the organisation established nationwide. Ultimately, the group also developed and operated care homes for the elderly. The group has also extended care to other groups in need of care in society, including the disabled, those suffering abuse or domestic violence and the homeless. This broadening is reflected in the name change and other labels, such as the group motto.  

The predominant motivation – home care for the elderly – is related to the context at the time that the group was founded. The societal aging problem had begun to precipitate very real problems in society by the early 1980s. The problems of an aging society were made more acute by the tradition that caring for the aged was still regarded then as a family responsibility despite the fact that, in the context of Japanese economic development, young people from around Japan (including remoter rural areas) were increasingly being employed in Japanese industry and the commercial economy. The outmigration of youth from rural areas of Japan to take jobs in urban centres contributed to producing a particularly acute situation for the frail elderly left behind, now living longer and living alone in their own homes in rural areas, but without family or state support.  

In the 1980s, despite the strong growth of the Japanese economy and forecasts that Japan would soon overtake the US as the world’s largest economy, the central government was unwilling to commit more funds for helping the aged. That only came later with the policy changes leading first to the Gold Plan (1989) and then to the Long-Term Care Insurance Law (2000/01). In the early 1980s, care and social work in Japan (beyond provision by kin within the family) was organised largely by government agencies appointing untrained volunteers to specific care and welfare cases. These volunteers came mostly from highly-privileged (societally-elite) backgrounds and were motivated by a sense of duty.  

The JCSA initiative therefore arose in the context of growing problems of an aging society, inadequacy of government response, inadequacy of existing care and welfare interventions, strong government reluctance to devote additional funds to elderly care, and an increasing tendency, instead, for government actively to encourage regional and local efforts toward mutual self-help.  

Within this context a discussion began within Japanese society about how to respond to the newly perceived care and welfare problems of the unsupported elderly. Many local responses emerged, mostly involving groups of local women organising care at the local level. Mostly, these were spontaneous initiatives in villages around Japan, but there were also some more organised faith-based initiatives, for example of the Christian church. Whereas most of these initiatives remained at the level of local responses by untrained volunteers, the scale of Kanema’s ambition was much greater. To adapt to the changing societal context, she aspired to establish a wholly new approach to elderly care and to establish a nation-wide care network. Ultimately this would involve and contribute to a transformation of volunteering as conceptualised and practised in Japan.  

Importantly, the organisation did not begin as a TimeBanking organisation, but as a volunteer organisation, operating entirely with totally unpaid volunteers until 1985. In 1985 the internal decision was made to switch to a system of incentivised volunteering, through which carers would be rewarded with either/both time credits and small money payments. This decision followed from a process of consultation and a survey of group members by Kanema and represents new ways of doing both timebanking and volunteering.  

In 1985 Kanema’s group introduced its new combination of mixed currency TimeBanking in place of regular timebanking or voluntarism. The carers were free to choose between cash payments, time saving points, or a combination of both. Kanema sought to distinguish her model of TimeBanking from other models by renaming time credits/points as ‘time stocks’ and also by differentiating the ‘time-stock’ and monetary value of different kinds of service. Initially under her system, household duties were valued at 1 unit of time or 500 yen; ordinary care was 1.5 time units or 750 yen; and nursing care was 3 time units or 1,500 yen. However, differentiation of services was discontinued within the first year of operation, making the value of all services equal. The unit of account was to be represented only by the time spent giving/receiving service. A conversion rate between time stocks and yen was (necessarily) maintained. These arrangements represent different values and principles from those of ‘purist’ timebanking and establish different kinds of new social relations.  

In June 1991 the Kagawa Aged Welfare Research Group was renamed the Japanese Care System Association. This was accompanied by a partial shift from giving care in the homes of the elderly to setting up (initially seven) centres that could also provide other services, such as day care. The peak number of centres attained was ca. 40. Carers could continue to choose to receive time credits, money or a combination of the two, but greater stress was placed after 1991 on time savings as compensation.  

In subsequent developments the JCSA has broadened the range of the care it provides both to the elderly and to other groups in society. In respect to care for the elderly the JCSA has moved also into the operation of care homes. This has resourcing implications since care home operation requires infrastructure, equipment and personnel. Smaller care homes have often been established and usually these are premises in the Japanese regions that are otherwise disused and are often handed over for use by the JCSA at little or no cost.  

The JCSA also switched and adapted to the changing legal context to supporting all groups in society needing care. Under the provisions of the 2000/01 LTCI Law, the elderly were better catered for than previously, so were less in need of being singled-out as the main focus for support efforts. By contrast, other groups remained without adequate state support, including the disabled, the young, and those affected by abuse, domestic violence and homelessness. While the JCSA continued to care for the elderly, its work expanded to include these other groups as well. The JCSA also became an important source of training and certification of carers, providing courses that meet government standards for home help and carer qualifications and helped its members to develop competences. In 2004 the JCSA incorporated under the Non-Profit Organisation (NPO) Law.  

Karema’s initiative therefore involved TimeBanking from 1985 onward, but her initiative differed in significant ways from that of Mizushima and the VLB/VLN. Mitzushima’s model had combined within-group vertical and horizontal time exchange (a form of incentivised volunteering as mutual aid) with an extra component of pure volunteering. This pure volunteering within the VLB/VLN often involved supporting carers working within care institutions for the elderly. Indirectly, this also gave support to the institutionalised elderly. However, for the JCSA, the elderly in need of care was the direct target group and JCSA support was oriented toward people living at home and otherwise unsupported or inadequately supported. Kanema especially targeted dementia sufferers. Another important distinction is that Kanema focused and adapted her activities largely on the Japanese (rural) regions where the need for elderly care in the home was most acutely experienced, whereas Mizushima built a national network of city-based TimeBanks.  

In developing her response to the care needs of the unsupported rural elderly, Karema first tried conventional volunteering, but then introduced a modified form of mixed-currency TimeBanking. This provided ‘time shares’ for service and/or modest payments for giving care. Care recipients paid modest sums for the care received. Most of her members (as with the VLB/VLN) were local, middle-aged housewives with no special qualifications in care. Later, Kanema particularly recruited women with qualifications in care and nursing in order to transform the organization so that it could also train and certify a cadre of carers and support competence development. This was a step toward the organisation and her membership becoming more ‘professionalised’. The focus on dementia may have been influential in this. Kanema was one of the first in Japan to draw attention to dementia and the special care needs it entails.  

From the perspective of societal transformation, this CTP contributed to changing Japanese conventions about roles responsibilities for elderly care in Japan, and (more broadly) about volunteering. It contributed to the emergence and mainstreaming in Japan of the concept of ‘paid volunteering’, which remains (from the perspective of a world-view) essentially unique to Japan. The innovation marked a further shift from traditional voluntarism, which in the sphere of social work was largely undertaken traditionally as a matter of duty by female members of the upper echelons of Japanese society, toward the wider engagement of Japanese citizenry based on organised and incentivized volunteering. If Mizushima had contributed to a first shift (achieved using time credits/points) Kanema broke new ground in introducing ‘paid volunteering’ through which volunteers received non-market rates of payment alongside or instead of time credits (which she called time ‘stocks’). This was achieved in the cause and context of creating a new approach to resourcing welfare delivery in Japan.  

The incompatibility of voluntarism with providing individual care to the elderly in their own homes under the prevailing cultural conventions of the mid-1980s could partly be resolved by allowing ‘token’ payments for care, but how these payments were then used raised further questions for TimeBanking. In the years thereafter this has been handled in different ways by different TimeBanking organisations leading to several different variants of the basic TimeBanking model in Japan: ‘pure’ timebanking and three different ‘mixed currency’ models. These three variants of the mixed-currency models include: (i) all payment being made only to the organisation (not to its members); (ii) threshold systems, where a minimum level of time credits must be achieved by a member each month before any money is paid to the member; and (iii) flexible choice systems, where a member can decide the balance between payment in time credits and monetary payment.  

The primary focus of the JCSA throughout most of its history has been on delivering care by organising middle-aged women as carers to provide care for (predominantly) the elderly. This distinguishes it from some later TimeBanking organisations, such as the NALC, which enlisted the soon-to-retire and newly-retired active elderly (predominantly men) as carers and also constituted an organisation providing social activities for its members. This social aspect also offers an incentive and reward for volunteering, but of a still different kind.

Co-production

Kanema was, by profession, a qualified social worker and carer. She states that she became aware of the issue of elderly care in the early 1980s when she was a professional home helper for the Takamatsu City social welfare council. She also became convinced through her experience that a new approach was needed to help the aged in her area. Her attention to the wider significance for Japan of the issue of elderly care was raised by her meeting with a Japanese journalist while she was on a study tour in Europe to look at policy and practice in home care solutions, and found that he too was covering questions relating to an aging society. From the outset her ambition was set at developing a new approach and implementing this nation-wide. The scale of her ambition distinguishes her initiative from many other local-scale initiatives that appeared around the same time.  

Kanema was affected by cases (often tragic) she came across professionally, including the case of a young woman who had committed suicide owing to the stress of leaving paid employment and returning to the countryside to look after her aged parents. At this time, cases of suicide and of double- and triple- deaths involving carers under stress killing their aged parent(s) before committing suicide, were not uncommon in Japan and were symptoms of growing and unmitigated levels of stress building in Japanese society over the lack of solutions for elderly care. Kanema wrote that she approached her Departmental Head to ask for more resources to assist home carers struggling to provide care, but was told the City was unable to increase levels of support. This convinced her that support for carers and for the elderly living unsupported would need to come from within the community, from those with spare time and energy. In her model, middle-aged housewives would become carers.   

At the same time as Kanema established the JCSA many other groups of women who also observed the same problems around the unsupported elderly living in their own homes became active in home care as well. Kanema was by far not the only person recognizing, acknowledging, and addressing the emerging demand for home care, but whereas most other initiatives that emerged at that time were purely local, Kanema had aspirations to provide home care for the elderly nation-wide. Her initiative is the only one from this period that achieved the scale of a nation-wide network.  

Kanema obtained initial financing from the Japan Life Insurance of 10 million yen (at that time approximately US $4000), which helped her to set up her project.  

There are contradictory accounts of the influence of the VLB/VLN on Kanema. In her writing, Mizushima refers to Kanema as having been a member of the Takamatsu branch of VLB/VLN in 1982, remaining there for one year, leaving to establish a VLB/VLN-styled organisation, and taking several members of the Takamatsu Branch with her. This would be consistent with the usual way of establishing new VLB/VLN TimeBanks. These were routinely formed as split-off groups from growing TimeBanks in-keeping with Mizushima’s ideas to keep the size of each TimeBank quite small in order to enable strong group relationships to form. Mizushima also reports that the introduction of paid volunteering had negative side-effects and led some members who disagreed with this development to return to the VLB/VLN. However, in her own account of the establishment of JCSA, Kanema makes no mention of once having been a member of the VLB/VLN and does not refer to Mizushima or the VLB/VLN as influences on her project. Equally, just as TimeBanking had been pioneered earlier by the VLB/VLN, the concept of paid volunteering had been pioneered already in the care sector (from 1981) by another organisation, the Tokyo Assistance in Daily Life Association.  

The ‘innovation’ that constitutes this CTP is therefore the act of combining two earlier innovations and for the first time successfully rolling out this new approach to delivering elderly care on a national scale.  

Related events

Several ongoing trends and events contributed to this CTP.  

The policy stance of the Japanese government was important. It remained reluctant to commit money to elderly care in spite of the economy at this time growing strongly. The commitment to fund elderly care came only later (1989) with the Gold Plan, but even then the costs implied by providing fully professionalised care were found too great to provide universal state cover. The state-backed Gold Plan only reached a small percentage of those most in need of care, which was provided for by increasing the numbers of state-paid carers and state-provided care institutions.  

A revised approach to arranging financial resources for elderly care on a universal basis was introduced in 2000/01 in the form of the Long-Term Care Insurance (LTCI) Law, which introduced a mandatory insurance scheme for those aged 40+. Effectively, this meant that Japanese citizens aged 40+ were obliged to contribute to the costs of their own elderly care through mandatory state-mediated insurance. Claims under the LTCI scheme are met from premiums and tax revenues and cover 90% of care costs (with the remaining 10% met by care recipients).  

By the time that Kanema founded her group, there was already a strong pent-up demand for unmet home care needs, especially for dementia sufferers. Around 670 people attended the ceremony establishing her organisation in 1982. A subsequent meeting to discuss the needs of dementia sufferers scheduled for 1.5 hours lasted for 4 hours. These are cited by Miller (2008) as indicators of the strength of unmet demand at that time.  

This strong pent-up demand owes to the trend of population aging throughout the post-war period, the out migration of the young from rural areas due to strong economic growth, and the policy priorities of the Japanese government to prefer investment in economic growth over funding elderly care.  

The occurrence of tragic multiple deaths (often reported in the media) – where carers, those cared for or those needing care but not receiving support became victims of intolerable stress and resorted to suicide – was a significant problem in Japan at this time, drawing attention to the problem of elderly care and the need for new ways of doing and solutions.  

Against this backdrop, the traditional conceptions, conventions and practices in Japan surrounding responsibility for elderly care and those surrounding volunteering came to be revisited as part of an emerging societal conversation about how best to respond to the newly-perceived and increasingly urgent need for new approaches.  

In respect to care for the elderly in their own homes, as pioneered by Kanema, traditional Japanese cultural perception of volunteering was inconsistent with traditional cultural conventions requiring reciprocation. There was also an issue over labour shortages, which Kanema noted in her autobiographical account of events.  Care work is demanding, but low status. Incentivised/paid volunteering was a way to address and to adapt to the shortage of carers.  

Important here also is that payment to volunteers had been pioneered already in the arena of care by another organisation, but only at the local scale. Just as TimeBanking had been pioneered before (by Mizushima), payment to volunteers had been pioneered already in 1981 by the Tokyo Assistance in Daily Life Association. Effectively, Kanema took two existing innovations, combined them, experimented and made them relevant to transformative change at the societal level by virtue of her (successful) ambition to apply her approach at the national scale by making her organisation a national network. This was reflected in the name change in 1991 to Japanese Care System Association, JCSA.  

All of these contributed to the internal decision (taken after surveying her members) to introduce a multi-currency TimeBanking scheme that included cash payments for giving/receiving care.  

Later, the money streams created under the LTCI scheme became relevant for the JCSA and its subsequent development, empowering but also disempowering the organisation. The LTCI scheme and the money streams it provided had a greater impact on the JCSA than most other TimeBanking organisations in part because of its major emphasis through most of its history on caring for the aged, which is the focus also of LTCI. The LTCI Law made money available for payments to carers, including those from non-profit organisations, such as the JCSA. However, the funds available under the LTCI scheme also led to the establishment of commercial care companies, creating some competition for carers between NPOs and commercial providers and, to a lesser degree, competition also for clients. Also, other NPOs entered this area of work. This had negative side-effects on the JCSA as some members are reported to have left the organisation to take up better-remunerated care positions with commercial organisations established under the stimulus of the LTCI Law. By 2008 the number of JCSA centres had reduced from its peak of 40 to 26.  

Use of time stocks reduced across Japan after the introduction of the LTCI scheme. With all Japanese aged 40+ having to pay insurance premiums it made less sense to many Japanese to save time stocks as a guarantee of care in old age, since the LTCI scheme provided this. Furthermore, 90% of the cost of care was covered under the scheme, such that the cost of professional care to those receiving it under the LTCI scheme was only 10% of actual cost, often making this cheaper than JCSA care.  

However, the JCSA has continued to develop arguments in favour of time stocks as offering more than just the basic care guaranteed by the insurance scheme. The JCSA argues that it offers a quality caring relationship that extends to the giver and receiver of care having time together to socialise and for informal acts of kindness that improve the quality of life and wellbeing of the aged but are not reimbursable under insurance. For some (especially for those sceptical of government, which is often seen in Japan to be unreliable) time shares offer greater reliability than government schemes. Government has shown continuing interest in time stocks because of the cost savings it can deliver.  

At the societal level, paid volunteering has become a ‘characteristic’ feature of modern-day Japanese voluntarism. At the level of TimeBanking, mixed currency systems involving payments to carers have become the dominant form of TimeBanking in Japan.  

Contestation

The decision to introduce payment for service as well as or instead of time credits was contentious. However, it is this aspect that makes this a critical turning point, since this is the first instance of a mixed-currency model of TimeBanking operating on a national scale in Japan. Mixed-currency models later came to dominate the Japanese TimeBanking scene.  

In order to understand why a mixed currency-approach was introduced and why this was contentious it is important to appreciate that under the traditional values and cultural conventions of Japan that were still dominant in the mid-1980s, voluntarism was a challenging concept because it was to considerable extent incompatible with the provision of care to the elderly in their own homes. The nature of Japanese social relations traditionally places high importance on reciprocity. As the TimeBanking system was only newly introduced in this context, those needing care had not been able to be members of schemes earlier, so could not ‘pay’ for care using credits already banked (i.e. along the lines of vertical mutual aid). Yet, under the cultural conventions of the time, receiving help from volunteers was considered shameful. Many elderly people preferred to refuse help rather than suffer the stigma of receiving charity while others tried to offer their carers some monetary payment in return for care to meet cultural requirements for reciprocity in the relation.  

As those in need of care did not have time credits to exchange for help, charging small amounts for care provided an alternative and was a way to ensure that care was affordable and that offers of care were not rejected. There were also arguments in favour of carers receiving payments sufficient to cover their out-of-pocket expenses in providing care, such as travel costs. Token payments for giving and receiving care were therefore introduced as a pragmatic way of addressing the cultural sensitivities within the cultural norms of the time and securing delivery of care to those needing care. But there was also a need to recruit more carers to cover the labour shortage and to cover the fixed costs of the organisation.  

Turning to payment of volunteers for work marked a sharp break with tradition.   Millar (2008) states that: “The introduction of paid volunteering was an extremely radical move that attracted a good deal of controversy.” While Kanema’s group did not pioneer the practice, it was the first to introduce it on more than a very small scale. “Kanema’s move marked the start of a new approach just as Mizushima’s TimeBanking system had done nearly a decade earlier” (Millar, 2008, p. 186).  

Some members of Kanema’s group felt that payment was not in the spirit of volunteering. In her accounts of Japanese TimeBanking, Mizushima wrote that some members of Kanema’s group who joined originally from the Takamatsu branch of the VLB/VLN re-joined the VLB/VLN when Karema introduced the multi-currency approach. Payments for giving/receiving care were small and in no way constituted a market-level salary for the carer. However, for some members, the concept of receiving any payment was inconsistent with the ideals of voluntarism, so the introduction of payments was controversial, especially at that time.

In her book, Kanema explains her decision as intended to place the helper and the helped on the same level in contrast to the traditional model of volunteering as charity under which the privileged aid the under-privileged. Equality of helper and helped is conceptualised also as part of the “ties of life” that link generations through reciprocal care offered by one generation to another and taking different forms through the journey from infancy to old age. This is reflected in the title of the JCSA quarterly newsletter, “Magokoro”, which is also incorporated into the name of some of the centres later set up by the JCSA. Miller (2008) explains this as an amalgamation of the words mago (grandchild), ko (child) and ro (old) and is intended to symbolise the links between the generations and the dynamics of aging as a life process.  

The issue continued to be a source of concern for many members of the organisation and was a factor in the 1991 decision to rename the organisation, revitalise its image and activities, and place greater stress on time stocks. Kanema later wrote about the significance of time stocks in the changing context of decline of traditional neighbourhood mutual assistance and the compensating growth of citizen’s groups based on mutual support. She refers to voluntary service as an important source of ikigai or self-realization for the members of her group (Miller, 2008).  

Miller (2008) writes that the most controversial aspect of the JCSA and (later) of the Sawayaka Welfare Foundation (SWF), another important TimeBanking organisation, has been their advocacy and application of monetary payment for their volunteers. The Japanese government has supported the concept of paid volunteering, seeing it as linked to mutual and reciprocal help. A 1994 Ministry of Health and Welfare proposal on volunteering noted that it was not against the principles of volunteering for gratitude and expenses to be exchanged between people doing activities and those benefitting from them (Takahashi, 1997 quoted by Miller, 2008). Tanaka et al (2003) describe the practice of paid volunteering as “a unique Japanese form of volunteering”.  

Miller notes, however, that this goes beyond condoning just payment of travel expenses for volunteers. Whereas the practice is acceptable when the volunteer has other reliable sources of income, such as a pension, payments are not high enough to provide an adequate lifestyle for workers forced to rely on them alone. Miller quotes an interviewee who was left for a while without income after her two charges both died. Some enter paid volunteering and rely on such payments. They “risk becoming a new class of working poor in Japan” (Miller, 2008).  

Anticipation

The CTP concerns the internal decision making within JCSA and the introduction of mixed-currency TimeBanking and its application in delivering care to the elderly in their own homes.  

The need for new arrangements in elderly care had been foreseen by Mizushima since the 1940s and 1950s, but society as a whole was slow (and the Japanese government still slower) in acknowledging and addressing the problem. By the 1980s, the ‘problem’ was already upon Japanese society, but because much of the day-to-day reality and fall-out from unmet care needs was hidden behind the closed doors of people’s homes and was felt more in rural areas than in the cities, the problem was overlooked (especially by the State) for a long time. By contrast, the problems were very evident to Kanema because she saw them first hand in her daily practice in her professional capacity as a social worker. The challenge was also evident to many in the rural areas who also, like, Kanema, sought to develop solutions. What distinguishes Kanema is less any unique anticipation of the challenge, and more her awareness of its scale and therefore also of the scale of the response needed; i.e. a totally new approach to elderly care and a nation-wide implementation. Kanema is also ahead in understanding the significance of dementia as a growing challenge that implies special care needs and arrangements.  

The ‘innovation’ constituting this CTP is neither the invention of TimeBanking nor of paid volunteering, since both were already pioneered by others; rather, it is the combined use of these to form mixed-currency TimeBanking and rolling this out nationally in addressing care of the aged. This was not anticipated by Kanema, who initially based her operation on voluntarism. The innovation rather emerged as a response to acceptance difficulties that volunteers encountered and the need to address the shortage of carers.  

Knowing that introducing mixed currency TimeBanking to her operation would be controversial, Kanema consulted her membership before introducing the system. Finding an operational model and judging its acceptability involved a balancing act over the first, crucial, years of its operation, beyond which both the need for such a system and sensitivities surrounding it lessened. Her successful navigation through these crucial first years was based upon anticipation, experimentation, learning and sound judgement.

Learning

Kanema invented neither TimeBanking nor paid volunteering, but combined and used these in order to overcome cultural barriers to providing care to the elderly in their own homes and chronic shortages of carers. She learned from actual experience about what worked and did not work and made several changes to her ‘system’ in the course of its development, adjustment to context and need, and refinement. Early attempts to provide care demonstrated that her targeted aims could not be met through pure voluntarism, so she introduced and experimented with mixed-currency TimeBanking. She first differentiated care tasks and allocated different time share and money values to different tasks, but learned very quickly that this was not helpful and she reverted to the conventional TimeBanking approach of valuing all services equally.  

She broadened the scope of her operation in response to the changing context and needs, offering elderly care first in homes, but later in centres and institutions, and extending care to other groups in society once the care needs of the elderly were more adequately provided for in the post-2000 context of the LTCI Law.  

Having first recruited untrained and inexperienced members, she learned that she required more highly-trained carers to achieve her goals. She therefore recruited trained and experienced carers and nurses as members in order to help train her other JCSA members. She developed her training programmes, which became an element of JCSA activities alongside care delivery. JCSA programmes offered professional qualifications and certification recognised by the Japanese state (e.g. under the provisions of the Gold Plan, 1989). Training can be considered as a move toward professionalization of the JCSA and ‘professionalising volunteers’.

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