SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Belinda Yuen © 2022 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved. Rights and Permissions This work is available under the Creative Commons Attribution 3.0 IGO license (CC BY 3.0 IGO) http:// creativecommons.org/licenses/by/3.0/igo. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions: Attribution—This is a background paper for “Silver Hues: Building Age-Ready Cities” which was produced by a team from the World Bank’s Urban, Disaster Risk Management, Resilience and Land Global Practice comprised of: Maitreyi Das, Yuko Arai, Vibhu Jain and Terri Chapman. For this background paper, please cite as follows: Yuen, Belinda. 2022. “Silver Hues: Building Age-Ready Cities Japan Background Paper.” World Bank, Washington, DC. Translations—If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an official World Bank translation. The World Bank shall not be liable for any content or error in this translation. Adaptations—If you create an adaptation of this work, please add the following disclaimer along with the attribution: This is an adaptation of an original work by The World Bank. Views and opinions expressed in the adaptation are the sole responsibility of the author or authors of the adaptation and are not endorsed by The World Bank. Third-party content—The World Bank does not necessarily own each component of the content contained within the work. The World Bank therefore does not warrant that the use of any third-party owned individual component or part contained in the work will not infringe on the rights of those third parties. The risk of claims resulting from such infringement rests solely with you. If you wish to re-use a component of the work, it is your responsibility to determine whether permission is needed for that re-use and to obtain permission from the copyright owner. Examples of components can include, but are not limited to, tables, figures, or images. All queries on rights and licenses should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; e-mail: pubrights@worldbank.org. Cover and chapter opener photo: Victor Popovic, Slovak Republic, Untitled, 2000, mixed media and collage Image courtesy of the World Bank Group Art Program. Cover design: Takayo Muroga Fredericks SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Belinda Yuen SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Abbreviations iv Acknowledgments v 1. Introduction vi 1.1 About the Country 1 1.2 Overview of Age-Ready Development 1 2. Current Age-Readiness 4 2.1 Building Adaptive Cities to Enhance Age-Readiness 5 Ensuring Long-Term Health and Care Support for Aging in Place 5 Housing for Aging in Place 9 Implementing Universal Design 12 Helping Renters to Age in Place 14 Public Housing for Older Persons 14 Redeveloping Older Public Housing Estates 16 Activating Community-Based Neighborhood Redevelopment Projects 20 Not One, But Several Options for Senior Housing with Care and Support Services 22 Alternative Communal Living Options for Older Persons 26 Encouraging Multi-Habitation Lifestyles to Support Declining Areas 27 2.2 Building Productive Cities to Enhance Age-Readiness 28 Enhancing Universal Accessibility 28 Retooling Compact City Strategies 29 Improving Urban Walkability 33 Leveraging Technology 35 2.3 Building Inclusive Cities to Enhance Age-Readiness 39 Enabling Social Participation through Work Opportunities 39 Supporting Lifelong Learning 40 Expanding Community-Based Activities 41 3. Conclusions and Recommendations 44 Annex: Main Report Executive Summary 50 Endnotes 62 References 63 ii SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Figures Figure 2.1. Toyoshikidai Area Aged Society Research Group 18 Figure E.1. Why Focus on Age-Ready Cities? 54 Figure E.2. Attributes of Age-Ready Cities 56 Figure E.3. Six Action Areas to Enhance Age-Readiness in Cities 57 Figure E.4. Six Steps toward Age-Readiness 60 Boxes Box 2.1. Japan’s Long-Term Care Insurance System 7 Box 2.2. Serviced or Assisted-Living Solutions: Two Examples 23 Box 2.3. Serviced Rental Housing: Two Examples 24 Box 2.4. Sogawa Legato Square and Portram Light Rail Transit 31 Box 2.5. Ofunato Ibasho Cafe 43 Table Table 2.1. Housing for Aging in Place 10 iii SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Abbreviations AARP American Association of Retired Persons AI Artificial intelligence BBC The British Broadcasting Corporation GDP Gross domestic product GPS Global positioning system ICT Information and communications technology IoT Information of technology JR Japan Railways LRT Light rail transit OECD Organization for Economic Co-operation and Development SHRC Silver Human Resource Centers UNDP United Nations Development Programme UN United Nations UR Urban Renaissance Agency USA Unites States of America Wi-fi Wireless networking iv SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Acknowledgments This background paper was written by Belinda Yuen as an input to the global report, “Silver Hues: Building Age-Ready Cities” which was authored by a team led by Maitreyi Bordia Das and Yuko Arai with Terri B. Chapman and Vibhu Jain as core team members. The global report and this background paper are a production of the World Bank’s Urban, Disaster Risk Management, Resilience and Land Global Practice. The background paper is expected to be read in conjunction with the global report. This paper has benefited from comments from Emi Kiyota, Victor Mulas and the World Bank Tokyo Office. Adelaide Barra provided administrative support, Lisa Ferraro Parmelee gave editorial support, and Takayo Muroga Fredericks designed the report. We end with a final word of gratitude to Sameh Wahba, Michelle Morandotti, the World Bank Art Program, and the Tokyo Development Learning Center. v Introduction 1 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER 1.1 About the Country Japan is an island country in East Asia, comprising five main islands—Hokkaido, Honshu, Kyushu, Shikoku, and Okinawa—with a total land area of 377,975 square kilometers (Geospatial Information Authority of Japan 2019). Located along the Pacific Ring of Fire, Japan is prone to earthquakes, tsunamis, and volcanoes. The climate is predominantly temperate, and in the late summer and early autumn, typhoons often bring heavy rain. Japan has a population of 127 million (Statistics Bureau of Japan 2015). As 73 percent of its land is forested, mountainous, and unsuitable for agricultural, industrial, or residential use, its habitable zones, mainly located in coastal areas, have extremely high population densities; Japan is one of the world’s most densely populated countries and is essentially fully urban, with 94.7 percent of its population living in cities (UN 2007, 2015; Statistics Bureau of Japan 2015). Japan has a highly developed free market economy, with a gross domestic product (GDP) of US$39,305 per capita (World Bank, n.d.). It is the second largest developed economy in the world (after the United States), the third largest by nominal GDP, and the fourth largest by purchasing power parity (World Bank, n.d.). A global leader in the automotive and electronics industries, Japan has made significant contributions to contemporary science and technology, notably in the field of robotics. It is ranked “very high” on the Human Development Index, with its citizens enjoying high rates of tertiary education and, as of 2019, the longest life expectancy in the world: overall life expectancy at birth is 84.5 years—87.5 years for women and 81.1 years for men (UNDP 2019). Despite the strength of its economy, Japan’s economic growth rate has declined since the 1970s. Its transition to a postindustrial society has been characterized by globalization, a sluggish economy, slow growth, and demographic decline. The population is rapidly advancing toward a super-aged population—that is, a population in which more than 20 percent are aged 65 years or older. 1.2 Overview of Age-Ready Development In 2015, 26.6 percent of Japan’s population was aged 65 or older, with one in six living alone and 4.7 percent residing in social institutions. By 2055, this age group is projected to comprise 40 percent of the population. Furthermore, Japan’s aging index—the ratio of its older population to its child population—is the highest in the world (Statistics Bureau of Japan 2015). Its population, which in 2015 ranked 10th in the world in size, is expected to shrink by one-third over the next five decades, retreating to 17th position in 2045 and 27th by 2065. The capital city of Tokyo exemplifies this trend. Tokyo has been experiencing population decline since 2012, with more deaths than births occurring, and the share of the population aged 65 years or older rising to 21 percent, making it a super-aged society (Tokyo Metropolitan Government, n.d.). Life expectancy in Tokyo aligns with the national average, with men living to 79.59 years and women to 86.35 years; females outnumber males, as the death rate for men is higher than for women in all age groups, with the disparity increasing among the older groups. Estimates indicate Tokyo’s population will 1 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER continue to decline (Statistical Bureau of Japan 2015). It is projected to shrink by 50 percent over the next 90 years, and, by 2100, almost half its residents will be over the age of 65. This trend could, potentially, threaten Tokyo’s current position as a global city and urban superpower. Japan’s shift toward a super-aged society is being fueled by a combination of demographic factors. These include declining marriage and fertility rates and increases in life expectancy enabled by advances in medical science and improved nutrition and living conditions (Muramatsu and Akiyama 2011). At 1.5 births per woman, Japan’s fertility rate is among the lowest in the world, and, as mentioned, its life expectancy is the highest. About 10 percent of Japan’s population were aged 75 years and over as of 2008, with increases projected to 20 percent in 2030 and 25 percent by 2055 (Ministry of Health, Labour, and Welfare 2008). The number of centenarians increased from 153 in 1965, when Japan first started collecting this information, to 69,785 (4.8 per 10,000 people) in 2018; more than 88 percent were women (Taylor 2018). The number of centenarians is expected to double to 170,000 in 10 years. Another trend is the rise in the number of older single-person or couple households as a result of various lifestyle and demographic changes, including a general decrease in average household size, the rise of smaller nuclear households, and the growing number of people who remain unmarried (Japan Times 2019). The proportion of older persons who want to live with their adult children declined from 45.2 percent in 1983 to 14.9 percent by 2003 (Ministry of Land, Infrastructure, and Transport 2003). In 2008, single- person and couple households constituted more than half of all households containing at least one person aged 65 years or older (Ministry of Health, Labour, and Welfare 2008), and single-person older households have been projected to increase to 17.7 percent of all households by 2040. This last prediction has raised concerns about social isolation, particularly because some older persons confine themselves to their homes after retirement (Yoshimura 2010). The socioeconomic challenges arising from an aging and declining population have been at the forefront of Japan’s political and public policy discourse since the rapid population aging trend was first recognized in the 1980s. Central to the aging population challenge is the decline in working-age population, which could lead to labor force shortages and lower economic growth (MacKellar et al. 2004). The shortages are aggravated by the rising costs frequently associated with aging, such as the costs of medication, hospitalization, and care for older persons, payment of social security, and general government debt, which stood at 238 percent of GDP by 2015 (Ogawa and Retherford 1997; OECD 2019). Recognition of these growing challenges has engendered a shift in aging policy toward aging in place and healthy aging, with older persons encouraged to remain active and in their existing communities for as long as possible. The idea is not only to improve the well-being of older persons and their quality of life, but also to reduce the burden on the state of providing for the burgeoning health and welfare needs of a super-aged population. Japan has implemented several policies, guidelines, and programs to promote healthy aging (Watanabe et al. 2018). As early as 1988, the Active 80 Health Plan was launched with targets related to nine lifestyle issues: diet, physical activity, rest, no smoking, modest 2 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER drinking, early detection of cancer, hypertension, obesity prevention, and dental health. In 2000, the Healthy Japan 21 Program was introduced, and, in 2005, the Shokuiku (eating education) Basic Law was enacted to ensure both children and adults develop healthy minds and bodies throughout their lives. In 2006, the Care Prevention Law was passed, and, in 2008, the government initiated a special health checkup program, including measurement of waist circumference and nutrition counseling to reduce the prevalence of metabolic syndrome and related diseases. The Healthy Japan 21 Program was updated in 2013 (phase 2) to focus on “smart” lifestyle, encouraging the population to embrace a smart walk, smart diet, smart breath (nonsmoking), and smart checkup (health check), and urging local governments to build senior “physical power-up” stations to improve the physical strength of older persons. In 2015, the Japanese government under Prime Minister Shinzo Abe proposed the ideas of a Smart Platinum Society (Abe 2015), a “hundred-year life,” and an “age-free society.” Further, under Society 5.0—Japan’s vision for its future—older persons are not considered senior citizens but are encouraged to stay healthy and to continue playing active roles in the labor force and society (JapanGov 2018). The new Guidelines of Measure for the Aging Society, announced in February 2018, outlined a multipronged approach to creating an age-free society, in which all people can continue to live within local communities as they age and make use of their motivations and abilities, depending on their hopes and aspirations. Information and communications technology (ICT), robots, and other such technologies will be in wide use to promote health through improved diets, more active lifestyles, and reduced tobacco and alcohol consumption. From the societal perspective, a healthier population is expected to lead to lower medical expenses, higher savings, and increased foreign direct investment (Bloom et al. 2018). Another characteristic of Japan’s aging experience is that, even though only a small proportion of the general population lives in nonurban areas, these regional villages and small towns typically have higher concentrations of older persons than urban areas. Many among the earlier generation of older persons have chosen to reside permanently in rural areas, while younger people continue to relocate to urban areas for employment opportunities. As a result, Japan’s rural areas are in rapid decline, with the rural population shrinking at a projected rate of 17 percent from 2018 to 2030 and 2 percent per year by the 2030s (Takeo and Dormido 2019). By the 2040s, rural depopulation in Japan is predicted to outpace other countries, such as Germany and the United States. Hundreds of small cities and towns are anticipated to become completely deserted and unlivable over time as schools and services disappear or become less accessible. In September 2014, a new minister and coordinating body—the Headquarters for Overcoming Population Decline and Revitalizing the Local Economy—were created within the Prime Minister’s Cabinet Secretariat to give renewed impetus to local revitalization and address the issue of rural depopulation. The goal is to overcome policy silos and to further collaboration among line ministries and across policy sectors to promote measures to stop population decline and revitalize local economies, by, for example, reducing in-migration to Tokyo from regional areas. 3 Current Age-Readiness 2 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Japanese authorities and cities are implementing several projects in housing and home- based care to facilitate aging in place. Some of these projects are reviewed below. 2.1 Building Adaptive Cities to Enhance Age-Readiness Since 1986, when official demographic projections first revealed higher than expected population aging, Japan’s housing policy for its older population has shifted from the idea of providing specific housing for older persons (typically in the form of institutional facilities) to enabling aging in place that will allow older persons to thrive within their communities. In addition to the faster than anticipated aging of society, this policy shift was motivated by a changing sociodemographic profile that led to a decline in traditional, multigenerational households and a rise in older single-person or couple households. In light of these trends, traditional assumptions about the care of older persons by family members or in institutional facilities have had to be reconsidered, and the provision of home- and community-based care and support services is now a key tenet of official age- ready policy. The focus is not simply on homes, but on communities and the provision of support to help older persons lead healthier lives. Of particular note is a holistic approach to housing for older persons that integrates living at home with care and support services and enables them to maintain independent lifestyles. The implementation of the Ten-Year Strategy to Promote Health Care and Welfare for the Elderly in 1989, the Five-Year Program for Housing Construction in 1991,1 and, more significantly, the Public Insurance Scheme for Long-Term Care in 2000, brought care for older persons out of the private, familial domain by improving universal access to formal care services in support of aging in place (Hiraoka 2006). Demand for such formal care services had increased as women increasingly participated in the workforce and moved away from their traditional roles as primary caregivers to older members of the family (Tamiya et al. 2011). Ensuring Long-Term Health and Care Support for Aging in Place The provision of care services to support aging in place is primarily consolidated under the Long-Term Care Insurance System, introduced in 2000. About 17 percent of persons aged 65 or older (more than 5 million) are covered under this system (Japan Health Policy NOW, n.d.) The Long-Term Care Insurance System was preceded by the Gold Plan, or the Ten-Year Strategy to Promote the Health and Welfare of the Elderly. The Gold Plan was enacted in 1989 by agreement among the then Ministry of Health and Welfare (now the Ministry of Health, Labour, and Welfare), the Ministry of Finance, and the Ministry of Home Affairs to promote the urgent preparation of facilities and in-home welfare services to meet the needs of Japan’s rapidly aging population. It was the first national plan to set specific targets, to be met over a ten-year period, for doubling institutional bed capacity and tripling home- and community-based services for older persons. Jointly run by central and local governments, the Gold Plan introduced day care facilities for older persons and the home helper system to support aging in place. While hugely popular, the Gold Plan 5 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER was not without its problems. It was very expensive, and government spending to finance it increased to the point of threatening tax hikes. Furthermore, local governments often lacked the manpower to manage adequately their responsibilities under the plan. The Gold Plan was also characterized by a lack of standardization in key operational areas, such as eligibility and fees, which could vary greatly among localities. In response to these issues, and partly influenced by social welfare programs in Germany and Scandinavia, the Long-Term Care Insurance Act was enacted in 1997, leading to the introduction in 2000 of the Long-Term Care Insurance System. The Long-Term Care Insurance System was formulated as a mandatory, public insurance system based on social insurance principles—that is, the benefits are provided to recipients regardless of income or family situation (box 2.1). The system is notable for providing only services (as opposed to cash allowances), unlike the German or Scandinavian programs. The Long-Term Care Insurance System brought two fundamental changes to Japan’s health system: the development of an integrated health care delivery system and a shift of the health system toward being more information based (Matsuda and Yamamoto 2001). It did so by embodying three basic concepts: • Support for the independence of older persons rather than just the provision of care • A user-oriented system for providing integrated health, medical, and welfare services from diverse providers based on the users’ own choices • Social insurance in which the relationship between benefits and burdens is clear The Long-Term Care Insurance System seeks to help older persons lead more independent lives and age in place even if they become dependent on long-term care. The aim is to provide a community-based integrated approach that combines housing and care to meet the diverse, yet individual, needs and preferences of an aging population. This is a departure from previous binary concepts of care as being either facility based or in the home. A main motivation behind the creation of the Long-Term Care Insurance System was the need to reduce the financial burden on the state of supplying institutional care to a rapidly aging population and the misuse of hospitalization for social reasons (that is, for nonmedical purposes and with very long stays because of a lack of in-home care services). In 2001, “social hospitalization” was estimated to account for one-third of health care costs for older persons; 43 percent of older persons who were hospitalized stayed for over six months in hospitals instead of in long-term care facilities, while 30 percent stayed for more than a year (Matsuda and Yamamoto 2001; Ogura and Suzuki 2001). Under the Long-Term Care Insurance System, about 70 percent of care recipients receive care at home (OECD 2015b). 6 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER BOX 2.1. JAPAN’S LONG-TERM CARE INSURANCE SYSTEM The Long-Term Care Insurance System in Japan is funded by social insurance matched by public funds. Premiums are paid by all residents aged 40 years or older, based on income; all residents aged 65 or older are eligible for benefits. Eligibility for services is assessed through a 74-item questionnaire pertaining to the activities of daily living, with preliminary categorization by computer algorithm and finalization by an expert committee. Recipients then select a care manager to formulate a care plan, consisting of a weekly schedule of services, commencing upon approval of the plan. The care plan is revisited for reassessment regularly (typically every six months to two years) or as requested in the case of a decline in health. Users of the Long-Term Care Insurance System have access to an integrated, comprehensive range of health, medical, and welfare services. Most crucially, they are able to choose services and providers to suit their needs and preferences, covering the gamut of community-based, in-home, and institutional services. These might include home help, visiting nurses, assistance with daily activities (such as bathing), house modification for the installation of age-friendly features, provision of assistive devices, day care, rehabilitation, and short-stay (respite) care. Also available are subsidies for the costs of care services in private senior housing and in group homes for persons with dementia. Service providers include both public and semipublic organizations, as well as nonprofit and for-profit organizations. For-profit organizations are not allowed to manage long-term care facilities. The Long-Term Care Insurance System takes a “decentralized yet centralized” approach, in which the national government uniformly implements the overall scheme. The national government also determines eligibility and care certification standards, prices for each level of care and services (reassessed every three years), and the proportion of costs to be paid by recipients; copayment has been set at 10 percent (or, since 2015, 20 percent for persons above a certain income level). Local governments are the main insurers; premiums may vary by municipality to take local differences into account. Regulation of the service providers, in terms of licensing and supervision, is also under the purview of local governments. This approach has helped foster collaboration, not only between governments at the national and local levels (as was the case under the Gold Plan) but between agencies, with the Ministry of Health, Labour, and Welfare and the Ministry of Land, Infrastructure, and Transport cooperating on a range of policy issues, such as the provision of senior housing and care support. Sources: Morikawa 2014; Shimizutani 2006. 7 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER As part of the evolution of the Long-Term Care Insurance System toward the delivery of community-based integrated care, local governments have been establishing Comprehensive Community Support Centers in every municipality since 2006. Successors to the In-Home Long-Term Care Support Centers, they serve as community focal points where volunteers, social workers, and health care professionals are available to support residents (regardless of whether or not they are eligible for services under the Long-Term Care Insurance System). The centers provide advice and information about available care options, help coordinate and manage services, and, crucially, promote preventive care to reduce the need for long-term care. An impact of the Long-Term Care Insurance System has been the induction of new actors into the elder care and housing sectors and the expansion in scope of existing agents. Commercial care and housing providers have entered the housing market for older persons, resulting in an increase in private housing options catering to older persons. Social welfare organizations, which had previously been mainly involved in providing conventional nursing homes for older persons, extended their operations to include services such as adult day care centers and in-home care. These organizations also began to establish small-scale, community-based multifunctional facilities (see below), offering services such as day care, short-term (respite) care, and 24-hour emergency care at the local level to residents living within certain specified areas. The Long-Term Care Insurance System has expanded the accessibility of in-home and community-based care services, resulting in an increase in the use of formal in-home care services. Between 2000 and 2010, the number of older persons receiving in-home and community-based care services, such as home help and day care, increased by 203 percent (Tamiya et al. 2011). Importantly, the Long-Term Care Insurance System shifted some of the responsibility for the care of older persons to the state; it is no longer entirely (or primarily) the responsibility of family members. Studies have been inconclusive on the effects of the Long-Term Care Insurance System and its services on the health and functional status of older recipients (Olivares-Tirado and Tamiya 2014; Tamiya et al. 2011). It appears that although the services offered can help older persons maintain their health and lifestyles, they may not contribute to improving them. Additionally, notwithstanding favorable reports on the extent to which the use of formal services reduces the burdens on family caregivers, the system has been criticized for not doing enough in this respect. The provision of some services that may be particularly important to family caregivers, for example, such as night-time home visits, tends to be inadequate due to financial and logistical difficulties, while others, such as respite or short-term stay services, tend to have long waiting lists because of high demand and limited capacity. One of the main challenges facing the future of the Long-Term Care Insurance System is the cost of its operation. Having been well-received by the public, and in consequence of continued rapid population aging, the costs of maintaining the Long-Term Care Insurance System are increasing and can be expected to continue to rise. Public expenditures for the system increased from 3.6 million yen in 2000 to 10.4 trillion yen in 2016, and they are projected to double to 21 trillion yen by 2025 (Brucksch and Schultz 2018). As social insurance contributions cover only part of the costs, the remaining costs are borne by the 8 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER sukiyaki / Shutterstock government, as part of the budget, and have been paid for mostly by public debt. This defers the costs of the Long-Term Care Insurance System to subsequent generations, who will be faced with a greater financial burden. Balancing long-term care costs and benefits will be a continuing challenge. With the anticipated super-aged society, the need for appropriate care and support arrangements will endure in the future. Housing for Aging in Place Support of the government (both national and local) for the development of age-friendly housing in a variety of forms has coincided with a need to improve the quality of houses and the redevelopment and revitalization of older housing estates for a modern, aging society (table 2.1). During the 1950s and 1960s, public housing was aggressively built to accommodate population increase in major metropolitan areas, with the Japan Housing Corporation (the present-day Urban Renaissance Agency) building danchi (literally, “group land”)—that is, multifamily housing estates in concrete apartment structures.2 Over 30 percent of the residents of danchi are now at least 65 years old, as compared to 26.6 percent of the total population (Nippon.com 2019). Responsibility for the provision of public housing fell within the purview of the central government from 1966 until the introduction of the Basic Housing Law in 2006, with the central government establishing a series of five-year housing construction plans. The introduction of the Basic Housing Law, however, shifted responsibility for the establishment of such housing plans to local governments, with priority on providing affordable housing for older persons to enhance residential living standards (Kose 2019). A further notable characteristic of the housing landscape of Japan’s older population is the high incidence of home ownership. The majority (84.9 percent) of people aged 65 and over live in housing that they own (Hirayama 2010). 9 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER TABLE 2.1. HOUSING FOR AGING IN PLACE HOUSING OCCUPANCY/OPERATIONAL AGE-FRIENDLY FEATURES SERVICES OFFERED/AVAILABLE OPTIONS FOR ARRANGEMENT OLDER PERSONS Private homes Typically owner Home modification Services available include occupied; majority (84 support programs only what an individual percent) of those aged available to eligible may be eligible for under 65 or older live in private older residents under the Long-Term Care housing they own. the Long-Term Care Insurance System. Insurance System; some municipalities also offer support at local level. Projects to Typically built in the The typically high Facilities offering elder redevelop 1960s–70s, these proportion of older and child care, as well as existing residential estates are residents at these estates other welfare and support housing now aging, both in terms makes implementation services, are often a part of estates of infrastructure and of age-friendly features the redevelopment project. population; residents within the home and who moved in when the in the surrounding estates were first built neighborhood a key are now older. consideration for redevelopment projects. Rental housing Private rental housing. Availability of barrier-free Services available include rental housing is limited, only what an individual but a government-led may be eligible for under registration scheme the Long-Term Care for age-friendly rental Insurance System. housing is available to help older renters. Public rental housing Barrier-free features, A “life support advisor” for older persons—that such as stepless floor is onsite and available 24 is, “silver” housing design, handrails, and hours a day to support projects—includes an emergency reporting and attend to residents’ multigenerational public system, are available. concerns housing with welfare facilities that are also available to older renters. 10 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER HOUSING OCCUPANCY/OPERATIONAL AGE-FRIENDLY FEATURES SERVICES OFFERED/AVAILABLE OPTIONS FOR ARRANGEMENT OLDER PERSONS Housing for Licensed private housing Barrier-free features are Typically, various support older persons for older persons available. and nursing care services, with care (yuuryou roujin homes)— such as meal services and and support this is privately operated home help, are provided. services rental housing that exists in various configurations, catering to self-sufficient older persons and those who require assistance with daily living activities, as well as offering luxury options for the affluent. Serviced housing Barrier-free features are Nursing and medical for older persons (a available. care support services special category of are available, with privately operated rental regular contact with housing), includes many and monitoring ofolder facilities that also serve residents. as community-based welfare hubs for medical and care services. Small-scale, Typically, these facilities Barrier-free features are Care and nursing services multifunctional are privately operated available. are available, with residential care by social welfare additional emphasis on facilities organizations. participation in local community activities. Group homes Typically ground-up Group homes specifically Support and help services, initiatives organized for older persons typically such as meals and cleaning by the residents include barrier-free services, are usually themselves or by social features and wheelchair available in group homes welfare organizations, accessibility. specifically for older group homes can persons. be specifically for older persons or multigenerational, with both rental and ownership configurations. One notable type of group home caters specifically to persons with dementia. 11 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER As Japan’s economic policy has moved toward privatization, private-sector participation has been increasingly encouraged (Kose 2019). In 2001, the Act on Securement of Stable Supply of Elderly Persons’ Housing provided support for more owners of private rental housing to accept older persons as tenants. The Housing Safety Net Law in 2007 further urged the private sector and nonprofit organizations to supplement publicly operated housing for older persons and other population groups with rental housing. Another area of private-sector participation is the provision of community-based, age- friendly housing options. These small-scale, multifunctional care facilities represent a shift toward the provision of home-based care as part of the trend toward a holistic approach to aging focused on improving the well-being and quality of life of the older population. The emergence of privately organized communal living arrangements for older persons, like group homes, additionally indicates a willingness on the part of the aging population to consider and seek out new housing arrangements that suit their individual needs and preferences. In summary, over time, a wide and evolving range of housing options (public and private) have become available. A selection is reviewed below to give a sense of the adaptive actions underway in Japan to support aging in place. Implementing Universal Design Following official recognition in 1986 that Japan’s population was rapidly aging, the Building Research Institute, under the Ministry of Construction (now the Ministry of Land, Infrastructure, Transport, and Tourism), initiated a major five-year (1987–92) research and development project to identify measures for preparing the built environment to address the needs of an aging population. Discarding prior ideas of special housing for older persons, the project was centered on the concept of “design for all ages”—that is, barrier-free or “universal” design, in particular with respect to residential building design and town planning issues. Taking an evidence-based approach, the project invited participation from professionals and private-sector housing providers and used residential surveys and experimental studies to gain an understanding of the needs and experiences of older persons who are aging in place. As a follow up, the Ministry of Construction released the Design Guidelines for Dwellings for the Ageing Society in 1995 to promote the construction of age-friendly housing where residents could live from cradle to grave. While barrier-free design principles had been applied to some extent since 1981 in conjunction with the UN Year of Disabled Persons and the UN Decade of Disabled Persons, the 1995 Design Guidelines set out a comprehensive series of recommendations for the construction of age-friendly, energy-efficient, and durable housing. Existing Japanese Building Standard Law at the time did not take into consideration older persons or persons with disabilities—a deficiency the Design Guidelines sought to rectify. Their aim was to support aging in place by creating housing that would be responsive to the changing needs of occupants while reducing the need forspecific housing and institutional facilities for older persons. Age-friendly recommendations detailed in the Design Guidelines included the following: 12 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER • The removal of level differences within dwellings (Japanese houses have traditionally utilized level differences to separate spaces within the house—for example, at the entrance to facilitate the removal of shoes; between corridors and habitable rooms; and between toilet and bath area) • The installation of handrails at essential points, such as the stairs, bathrooms, hallways, and entrances • The widening of corridors and doorways to accommodate the use of wheelchairs The Design Guidelines were applicable to both public and private housing (condominiums and detached houses). But implementation was not mandatory. Their widespread adoption in new housing did not begin until 1996, when the Housing Loan Corporation of Japan (a public organization, which at the time was the major body for low-interest mortgages) incorporated the barrier-free and energy-conscious housing design concepts from the Design Guidelines into its eligibility requirements for preferential interest rates. The National Pension Housing Fund, a public organization affiliated with the Ministry of Health and Welfare, effected a similar scheme. As a result, major housing providers such as the Sekisui House and Asahi Kasei changed their housing designs to comply with the Design Guidelines (suggesting the importance of incentives when guidelines are not mandatory). By 1999, more than half of Housing Loan Corporation clients had incorporated age- friendly design concepts from the Design Guidelines. The impact of the Design Guidelines in terms of improving the age friendliness of existing buildings, however, was limited. In the 2010 Housing and Land Survey published by the Ministry of Internal Affairs and Communications, less than half (48.7 percent) of surveyed private housing was found to be appropriately equipped with age-friendly features for older occupants (Ministry of Internal Affairs and Communications 2010). Only a small portion (about 18 percent) of available rental housing was barrier-free. Additionally, the market for barrier-free rental housing in Japan tended to be opaque, generally making it difficult to obtain information on whether a particular property was barrier-free. The promotion of barrier-free modifications to existing housing remains an important but difficult aspect of enabling aging in place in Japan. As mentioned, Japanese houses are typically small, with multiple floors, making accessibility difficult for those who use walkers or wheelchairs. Home modification has been supported by local government grant programs, with 70 percent of all municipalities offering some kind of home improvement program by the end of 1990s (Makigami and Pynoos 2002). In Tokyo, for example, local and metropolitan governments co-fund the home improvement scheme, which is subsequently financed through the national Long-Term Care Insurance Scheme. Since 2000, financial assistance of up to 200,000 yen for home modifications has been available to those eligible for long-term care assistance under the Long-Term Care Insurance System (see below). Self-supporting older persons—that is, those who do not need or are ineligible for long-term care—are unable to receive financial assistance under this system, even if they need or could benefit from age-friendly modifications. Only a limited number of municipalities have implemented policies to support these older persons. 13 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Helping Renters to Age in Place Although the majority (85 percent) of older Japanese live in housing that they own, those who seek to rent typically face difficulties and prejudice when navigating the general rental market. Many private-housing landlords are unwilling to accept older tenants because they perceive the arrangement as risky—for example, they see older persons as being more likely to start fires out of forgetfulness (for instance, by neglecting to turn off the stove) and more likely to default on rent payments. They also want to avoid problems that might arise in the event of death. A 2002 official survey found that 42.3 percent of private landlords had a policy of rejecting single older persons as tenants, while 30.9 percent rejected older couples (Taniyama 2009). Overcoming such prejudice on the part of landlords and facilitating access to the rental market is an important issue to address for aging in place, especially among the older poor. Furthermore, according to the OECD (2020), 17 percent of poor households in Japan spend a significant portion of their income—over 40 percent—on housing costs. Alleviating the financial burden of housing, especially for the older poor, is another critical aspect to supporting aging in place. The Japanese government has been sensitive to the issues faced by older renters. The Act on Securement of Stable Supply of Elderly Persons’ Housing (Act No. 26 of 2001, enacted by the Ministry of Infrastructure, Land, Transport, and Tourism in collaboration with the Ministry of Health, Labour, and Welfare) introduced a registration scheme for age-friendly rental housing with the twin aims of encouraging more private owners of rental housing to accept older tenants and increasing the visibility and accessibility of barrier-free rental housing to older persons. To be eligible for registration, properties have to be fitted appropriately with barrier-free features suitable for older persons with reduced capabilities; the act proposes the Design Guidelines as a standard against which to judge the age friendliness of housing units. In return for registering their properties, the scheme seeks to allay landlord concerns regarding older tenants by, for example, guaranteeing the rents of older tenants. In practice, however, its success in increasing access to age-friendly rental housing has been limited, as the layouts of rental units are typically unsuitable for older occupants (for example, because they have many level differences), and the costs of installing barrier-free features often deter landlords from improving these properties. To address this problem, the Act on Securement of Stable Supply of Elderly Persons’ Housing was revised in 2011 with the aim of increasing the supply of rental housing for older persons, particularly affordable units that are barrier-free and offer nursing and care services. Public Housing for Older Persons The supply of public housing in Japan is limited, accounting for about 6.8 percent of the national housing stock (Xu and Zhou 2019). The construction of new public housing units has fallen significantly from its peak during the postwar rebuilding period. The vast majority (about 90 percent) of construction in recent years has been rebuilding existing stock. Even so, age-friendly public rental housing, with barrier-free features and some care and support services, is available to low-income or vulnerable older persons at below market value rents. These rental units are provided by local governments, with financial support from the central government. 14 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Examples include the Silver Housing projects, introduced in 1987, which provide barrier- free public housing specifically for older persons (singles and couples aged at least 60 years). The units are fitted with barrier-free features, such as stepless floor design (no level differences), handrails, and an emergency reporting system. Additionally, a life support advisor is onsite, providing 24-hour support and information to residents. Another option is multigenerational public housing with integrated welfare facilities, such as the Kengun Housing Complex in Kumamoto. These housing complexes offer care and support services and cater not only to the needs of older persons but also residents of all ages, including families with young children and persons with disabilities. Rebuilt in 2003, the Kengun Housing Complex has a welfare center on the ground floor that offers nursing care, community life support, meal delivery, and child-raising support services, as well as a tearoom to encourage resident interaction. The welfare services are provided by a nonprofit organization. The Housing Safety Net Law, enacted in 2007, sought to address limitations of public housing by encouraging more effective use of existing housing stock to give priority to persons in need, including older persons, in securing housing. Revisions to the law in 2017 added measures to make available for rental the increasing numbers of vacant privately owned units. A registration system was implemented, with local governments connecting the owners of these units with prospective renters. Financial assistance was extended to subsidize rents and for renovating registered housing units—for example, with barrier- free modifications for older or disabled renters. Aside from expanding the supply of rental housing, the Urban Renaissance Agency (UR)3 has implemented measures to promote active lifestyles among its older renters of public housing. Among UR rental housing residents, 35 percent are over the age of 65, and 39 percent of households live with older family members (Urban Renaissance Agency, n.d.). These measures include the following: • Mimamori Services (calling and counseling services) are provided for older tenants, excluding those in remote locations. • Rental discounts of 5–20 percent are offered to promote proximate living of family members who move into UR rental housing within a two-kilometer radius or into residences within an area specified by the Urban Renaissance Agency. • Community medical and welfare centers offer easy access to home medical nursing and care services. • Mixed communities are adopted to encourage intergenerational interaction and participation—for example, through the provision of open spaces and communal facilities that entice older persons to go out and meet others. 15 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Redeveloping Older Public Housing Estates For local municipal governments, an important aspect of housing policy for older persons has been the redevelopment of older housing estates, which is implemented in partnership with the Urban Renaissance Agency. The public housing estates targeted for urban revitalization are typically new towns developed in the 1960s and 1970s. The inhabitants, many of whom moved in when the estates were first built, have aged together with their homes (for example, in Tokyo’s “bedtown” of Kashiwa). Existing infrastructure in these housing estates, such as transportation and health facilities, is often insufficient to cope with the changing needs of the increasingly older population. Many older housing estates now have large numbers of older residents; the proportion is generally higher than the national average and close to the projected numbers for a super-aged society. Younger generations are typically not attracted to these housing estates, as they lack employment opportunities and family-raising support facilities, which further contributes to the disproportionate numbers of older persons in the resident populations. These populations are declining and the numbers of vacant housing units rising. The vacancy rate is estimated at 13.5 percent (8.2 million vacant houses), mostly in regions far away from Tokyo; half of these houses have been vacant for over five years (Kobayashi 2015). Urban revitalization projects aim to create an inclusive, age-friendly environment that addresses the needs of residents of all ages. This includes increasing support for families with young children and for older persons to age in place through the construction of age-friendly housing and improved access to integrated community- and home- based care. The idea is to create communities in which people can grow old where they have always lived. Two notable examples of housing redevelopment projects, undertaken by local governments in collaboration with the Urban Renaissance Agency, are the Toyoshikidai Housing Estate, Kashiwa, and the Model Projects for Sustainable Residential Districts, Yokohama. Toyoshikidai Housing Estate, Kashiwa. Originally built in 1964 as rental housing, both the buildings and population of the Toyoshikidai Housing Estate have aged. Revitalization was initiated in 2004 as the result of a partnership among Kashiwa’s municipal government, the Urban Renaissance Agency, and the Institute of Gerontology at the University of Tokyo. Prior to reconstruction, the housing estate had 5,000 units in 100 five-story residential buildings with no elevator access. The initial resident population of about 10,000 had fallen to around 6,000 by 2004. By 2010, over 40 percent of the population were at least 65 years old, as compared to the national average of about 20 percent. With an older population that already reflected the super-aged Japanese society projected for 2060, the Toyoshikidai Housing Estate offered a testing place for age-friendly ideas and social experiments to find ways to deal with the challenges a future society would face. Forming an integral part of the rebuilding project were community discussions among the Kashiwa municipal office, the Urban Renaissance Agency, and Toyoshikidai residents. The discussions informed and shaped three main strategies of the Urban Renaissance Agency’s approach to aging in place: 16 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER • A care support system to help both older persons and families with children by, for example, providing them with health care services in the community • A social life support system to create community spaces that facilitate interaction and communication among residents • A physical and spatial environment where residents can live comfortably amid scenic and ecofriendly (for example, low carbon emission) surroundings In 2010, the Kashiwa municipal office, in partnership with the Urban Renaissance Agency and the Institute of Gerontology, formed the Toyoshikidai Area Aged Society Research Group to address a range of health and social welfare issues (figure 2.1). Researchers from the institute conducted interviews and seminars with key stakeholders, including older persons. Their findings revealed several needs of older persons: • A need for social connectedness. Declining physical independence was particularly pronounced among older persons who were living alone and had minimal social contact. • A need for work opportunities. More than 80 percent of older respondents indicated they would like to work after retirement and still had the capacity to do so. • A need for healthy meals. Many of the older persons who lived by themselves would rarely eat home cooking, which led to a tendency to become undernourished and exacerbated health problems. Nishihama / Shutterstock 17 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER FIGURE 2.1. TOYOSHIKIDAI AREA AGED SOCIETY RESEARCH GROUP Urban farming Kashiwa Farm volunteer cooperative using fallow Kashiwa Agricultural Admin. Division, land Agricultural Committee, etc. FARM Vegetable factory Daiwa House in residential Urban Renaissance Agency area Kashiwa Roof garden Urban Renaissance Agency in rebuilt (placement in rebuilt housing housing under study) Community eatery Urban Oversight/ Aged Society FOOD Urban Renaissance Agency Renaissance management Research Group (participation by private business Agent organization under study) Mobile sales and home meal delivery Day care and Kurumi Kindergarten, CHILDCARE after-school Sugiura Environmental Project, University Kashiwa City Child and Family Division of Tokyo support Lifestyle Tokio Marine Nichido Better Life Service, SUPPORT support and Kashiwa Senior Citizens Support Office, enhancement Social Welfare Council, etc. Source: Adapted from University of Tokyo, http://www.u-tokyo.ac.jp/content/400022034.jpg. A range of policy tools and model programs implemented in response to these findings included the following: • Barrier-free housing, with the old five-story residential buildings replaced by new, barrier-free condominiums (10–14 stories), equipped with elevators to improve accessibility and mobility for residents. 18 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER • A community eatery at the center of the neighborhood to provide healthy meals to older and younger residents (for example, breakfast for working adults and snacks for children en route to school or club activities), while also providing an intergenerational place for older persons to meet and socialize with peers and the community. • A life support project to establish community-based support systems for older persons who are able to live alone but may require some assistance with daily activities, such as shopping. • Social participation projects to address problems of social isolation that may arise after retirement, such as the Second Life Platform Project, which provides job placement and information on other activities for older persons (see below). Such projects encourage participation in “sense-of-purpose” employment, ranging from child care to community support to gardening and cultivating the surrounding farmland, depending on individual interests and abilities; the installation of benches in various locations of the housing estate; and the establishment of community cafes in vacant stores to support local networking and community bonding. • An integrated community-based care system with improved home-based care (that is, medical/nursing/caring services) to better support aging in place. A community care support center and an information sharing system using ICT for patient medical records are developed. Residents have access to 24-hour (home-based) care through clinics and home nursing stations situated centrally within each condominium block. This is the first home for older persons that is equipped with all aspects of the integrative community care system in Japan. • A Guidebook for In-Home Nursing and Multi-Disciplinary Collaboration: The Kashiwa Model, published in 2014, outlined rules for a functioning collaboration, based on the Kashiwa experience. Additionally, the Kashiwa Medical Collaboration Center (involving the Kashiwa doctors’ association, the Kashiwa orthodontists’ association, and the Kashiwa pharmaceutical association) was established to provide information and advice and coordinate in-home medical care. These efforts were reflected in the amendment of the care insurance laws in 2015, scaling the in-home medical and nursing collaboration project nationwide. While formal evaluation of the impact of the Toyoshikidai rebuilding project has yet to be made available in English, a 2018 report on its achievements suggests the project has had some success, with older residents able to live comfortably, contribute to the local economy, and support their individual needs through employment (University of Tokyo et al. 2018). The challenges include a need for further promotion, education, and the training of, for example, hospital staff and local people on integrated community support and in-home care. 19 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Model Projects for Sustainable Residential Districts, Yokohama. In the City of Yokohama, housing redevelopment projects have focused on revitalizing aging suburban residential neighborhoods. From the 1950s to the 1980s, Yokohama experienced rapid population growth due to large-scale migration into urban areas, specifically the Tokyo metropolitan area within which Yokohama is located. To house this expanding population, large-scale residential districts—apartment complexes consisting of at least 500 housing units— were constructed in suburban areas, mostly in the 1970s. By the 2010s, these residential areas had high proportions of older residents (31 percent), typically higher than the city or national average (around 20 percent), with few new residents moving in (OECD 2015a). In response, the Housing Regeneration Department of the City of Yokohama launched a series of “Model Projects for Sustainable Residential Districts” to revitalize suburban residential neighborhoods, such as Tama-Plaza and Toka-Ichiba. Conceived as public- private partnerships, the model projects leverage the private sector to create residential areas that respond to the needs of residents of all ages, including older persons and families with children. Participation from other sectors and stakeholders, such as the Urban Renaissance Agency, research institutions, nonprofit organizations, and local residents, is also emphasized. The Toka-Ichiba Model Project, initiated in 2011, is based on a long-term (50-year) agreement between the City of Yokohama and private developers. The aim is to build a sustainable residential community where multiple generations can live and work together. The model project includes rental housing for older persons, co-located with a day care center and community activity space, as well as condominiums catering to multigenerational families. Essential facilities, such as those offering childcare and welfare services, are provided with the help of private capital and integrated within the housing complexes for greater accessibility. A key feature of the Toka-Ichiba Model Project is the public-private community management system where, under the 50-year agreement, the city provides the basic plan and direction under which the developers and residents cooperatively manage their residential areas. The idea is to have a flexible management system that is responsive to the diverse and changing needs of the community. Activating Community-Based Neighborhood Redevelopment Projects On a much smaller scale, machizukuri projects, organized by nonprofit organizations or community groups, have emerged in recent years with the growth of residents’ interest in improved living environments (Sorenson and Funck 2009). Machizukuri (literally, “town making”) is generally associated with community/neighborhood planning, in which residents themselves lead redevelopment to enhance the local environment for aging in place (Evans 2002). Emerging out of environmental movements, machizukuri projects combine small-scale redevelopment of residential buildings or shopping streets with community building to support the social connectedness of older residents. They demonstrate the willingness of local people to work together to improve the livability of their neighborhoods when government policy does not provide support for renovation, as is generally the case with private property. 20 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER 247Journey / Shutterstock Sugamo in Tokyo is a popular destination that draws 20,000 visitors daily—mostly older women—to the Koganji temple, which is located midway along a shopping street of 800 meters, popularly known as the “Harajuku for grandmas”—a reference to Tokyo’s famous Harajuku shopping district (Heine 2008). Working with older residents, the self-organized business community there has contributed to a machizukuri project that has developed a barrier-free environment where open spaces, such as gaps between buildings and vacant lots, are transformed into social places. An unused pedestrian crossing is converted into public space, with bollards serving as seats and a welcoming environment for older persons. In some municipalities, such as Kobe and Tokyo (Setagaya ward), machizukuri activities are supported by a machizukuri ordinance. The Kobe Ordinance, for instance, has three key participatory planning components: • A machizukuri council, representing local residents at the neighborhood level • A system that makes professional services, especially for planning activities and paid for by the city, available to the machizukuri council • A procedural structure for the city to accept a machizukuri proposal officially from the machizukuri council and develop a machizukuri agreement that will eventually be implemented Merely establishing the system, however, is not sufficient to carry out a successful machizukuri project, as the citizens must have the capacity to participate, make proposals, and get involved in government decision making. Another challenge is Japan’s highly centralized planning system, where city planning laws cannot undo public decisions on infrastructure that was planned during the 1960s or prevent inappropriate private land development. In consequence, machizukuri community engagement is highly heterogenous, depending on the role and receptivity of local governments and residents to shared management of urban spaces. 21 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Not One, But Several Options for Senior Housing with Care and Support Services Several types of serviced senior housing have evolved to address differing lifestyle preferences and needs. Fee-charging homes for older persons (yuryou roujin homes). These are privately operated, licensed homes for older persons that typically also offer residents some care and support services. The market for such homes has grown rapidly in recent years, partly due to provisions in the Long-Term Care Insurance Law of 2000 that allow older persons living in licensed private senior housing to benefit from long-term care insurance and the operators of such housing to apply for reimbursement for eligible services under the Long- Term Care Insurance System. Another factor is the strong demand from older persons themselves because of long waiting lists for alternative options, like publicly operated long-term care facilities. Demand for higher-quality options is growing with the general rise in single-person and couple older households and the aging of the baby boomer population, who are financially well off; 80 percent of Japan’s total personal financial assets are held by persons aged at least 50 years (Nikkei Weekly 2010; Statistics Bureau of Japan 2018). To qualify as such homes, establishments must conform to various government requirements relating to staffing, management, and facilities, like the size of each unit and the services offered. They typically also include communal spaces, such as common meal areas and recreational spaces, and provide various support and nursing care services, such as meal services, home help, and health management, as well as assistance with daily life activities, like bathing. Residents typically pay monthly fees covering rent, management of the home, and services (where applicable). Some licensed private senior housing also requires an initial deposit. Unlike long-term care facilities, which are primarily operated by government or social welfare organizations, the majority (about 75 percent) of licensed private senior housing owners are for-profit entities. The providers are generally private companies and include major corporations, such as Toyota and Panasonic. Private-sector motivation for entering the senior housing market is varied and includes the following: • As part of business diversification strategies, particularly to capitalize on the growing “silver market” in light of the aging population • As a means of repurposing “non-core” facilities, such as employee dormitories that are now surplus following widespread corporate restructuring in the 1990s • Based on human resource considerations to provide senior housing for company retirees or the parents of employees 22 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER These residences vary considerably, with different configurations, catering not only to self-sufficient older persons who require minimal care services but also to those who may need more assistance with daily living, 24-hour home-based nursing, or long-term care. Some, similar in concept to retirement communities and villages in the United States, are high-quality, resort-like residential developments for older persons. Residents are provided with landscaped green spaces, hotel-like amenities, and 24-hour services and care. Importantly, these developments are usually integrated within the community in existing neighborhoods where residents are able to maintain their lifestyles, health, and independence while continuing to live in familiar surroundings (box 2.2). BOX 2.2. SERVICED OR ASSISTED-LIVING SOLUTIONS: TWO EXAMPLES Panasonic Age-Free Life and Care. Panasonic Corporation has developed the Age-Free Life House in Owada. Designed by “living environment planners” who understand both architecture and nursing care, it provides home remodeling services for nursing care, based on construction circumstances and the physical condition of individuals. Additionally, Panasonic has developed home care service centers (Panasonic Age-Free Care Centers) and stores that specialize in care products and home renovations (Panasonic Age-Free Shops) across Japan. They offer older persons who live at home a range of services, including regular-visit and short-stay caregiving programs, day services, and care management. Sun City Residence. More than 80 percent of residents living in developments created by Tokyo- Based Half Century More Co. Ltd. are within a 10-kilometer radius of their former households and neighborhoods. The Sun City Residence of Tachikawa (one hour from the center of Tokyo) offers 500 autonomous apartments in four buildings that also house common spaces, living and dining rooms, and entertainment and physical conditioning spaces with spa amenities. The buildings are set amid landscaped gardens. A medical care establishment with nursing staff for 90 beds and extra support systems is also located within the premises. The housing, furniture, flowers, lighting, and environment are designed with consideration of mobility distances, functional deterioration associated with aging, and the needs of the residents. Other Sun City developments, such as the Half Century More Sun City Takatsuki, located in the Takatsuki suburb midway between Osaka and Kyoto, further support residents in maintaining connections with their community by providing shuttle bus services, coordinated with the public transportation system, and transportation to a variety of offsite activities, such as sporting events and festivals. Access to green spaces and courtyards, as well as indoor communal facilities and amenities, encourages residents to develop and maintain connections with their fellow residents. The Half Century More development at Sun City Takarazuka in Osaka includes a ballroom, swimming pool, billiard room, and clubrooms, as well as traditional tearooms and baths. Individual housing units are designed to be flexible and responsive to the needs and preferences of residents, utilizing, for example, movable lattice partitions to create layered spaces. Sources: Panasonic website, https://www.panasonic.com/global/corporate/management/business-initiatives/ agefree.html; Belles Demeures Magazine 2019. 23 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Serviced housing for older persons. Created as part of a joint initiative by the Ministry of Infrastructure, Land, Transport, and Tourism and the Ministry of Health, Labour, and Welfare following the 2011 revision of the Act on Securement of Stable Supply of Elderly Persons’ Housing, the aim of serviced housing for older persons is to increase the supply of age-friendly rental housing through the provision of construction subsidies to the private sector. It is defined as barrier-free housing with nursing and medical care support services and is subject to various requirements to be eligible for registration with prefectural governors: • Housing units must have floor areas exceeding 25 square meters, except in cases where the development provides sufficient communal spaces (in which case, floor areas as small as 18 square meters are acceptable). • Each housing unit must have its own toilet and wash basin. • Regular contact and monitoring must be available to ensure the well-being of older residents, as well as to provide support to residents by listening to their concerns and offering advice. • Housing providers are subject to obligations regarding rental contracts and information disclosure to protect the interests of residents. In addition, a dedicated website is set up to connect providers of serviced housing with older persons looking for such housing. While not mandatory under the registration system, support services, such as meal provision and household help, are commonly offered. Many developments serve as community-based welfare hubs for medical and care services, incorporating clinics, home nursing care centers, adult care centers, and so on (box 2.3). BOX 2.3. SERVICED RENTAL HOUSING: TWO EXAMPLES Cocofump Hiyoshi in Yokohama City opened in 2010 on land rented from the Urban Renaissance Agency. The development has a site area of 3,370 square meters and gross floor space of 5,233 square meters and is an eight-minute walk from the subway station. Its 85 rentable units are divided between units for independent living and long-term care housing units (70 percent) that cater to the different care needs of older persons; the development is 97 percent occupied. Nursing care and home-visit long-term care are located on the same property, as well as an adult day care center, a clinic, and a dispensing pharmacy. In addition, a nursery school is operated by the same company within the property, with the aim of encouraging multigenerational interaction. Residence Ajisai-no-oka opened in 2008 in Hadano City, Kanagawa Prefecture, and provides a comprehensive range of care and housing services. Besides serviced housing for older persons, the development includes group homes for persons with dementia and those requiring long- term care, as well as community-based medical and nursing services, such as home-visit nursing and long-term care. Sources: Cocofump Hiyoshi (https://www.adr-reit.com/en/portfolio/list/archives/153) and Residence Ajisai-no- oka websites. 24 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Small-scale, community-based, multifunctional care facilities. With the emergence of the “takuroujo” (literally, a “home-like place”) in 2006, community-based multifunctional care facilities have gained traction as an alternative to institutional facilities—in general, operating on a small scale while still providing comprehensive support for aging in place. Like the yuuryou roujin homes, these facilities have benefited from the introduction of the Long-Term Care Insurance System and are emblematic of a trend toward residentialization of facilities for older persons. Offering residents greater autonomy than institutional facilities, they emphasize maintaining normal day-to-day life and continuing engagement with the community. They typically offer care services, such as day care, respite (short stay) care, nursing, and group living, while encouraging participation in local activities. Some of these care facilities, particularly those located in small towns, also incorporate satellite facilities, supported by health care institutions, that specialize in providing care tailored to the individual needs of local residents. These community-based, multifunctional care facilities are primarily privately managed, ground-up initiatives led by the social sector. They generally do not conform to a single model, and among the common configurations are the following: • The single house type offers services in a single large house; an example is Sakura Home in Hiroshima. • The multiple house type offers services in two or more houses that are adjoined or modified to be adjoined, such as Ikoi in Hiroshima. • The satellite development type offers a large-scale facility scattered within and embedded in the community, usually as part of a nursing home or condominium with care facilities; Sendan no Mori in Miyagi is one such facility. Among its services, Sendan no Mori offers “reversed day services,” in which staff bring some older residents out of the nursing home during the daytime to a small house in the community. In the specially cultivated homelike environment of the small house, residents are able to behave as if they were in their own homes. Although government subsidies have been made available to such establishments, such as under the Long-Term Care Insurance System, their small-scale nature can create challenges with regard to profitability and resource management (for example, negative profitability, small renumeration, large initial expenditure for equipment). Other issues that may arise are shortages of qualified staff and unstable management (Ohara 2006). Following Japan’s declaration of a state of emergency for the COVID-19 pandemic, many day care and short-stay facilities for older persons closed temporarily to avoid infection and stop the spread of the disease among the older population, who are more vulnerable to it (Japan Times 2020b). About 20 percent of infected people are aged 70 or older, and 83 percent of deaths are among this age group. Care facilities for older persons have difficulty keeping social distance because of the nature of the services they provide; creating confined spaces for those who are affected is often difficult, as each room is shared by several residents. A chronic shortage of care workers makes care facilities for older persons especially subject to adverse effects from COVID-19. 25 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER beeboys / Shutterstock Alternative Communal Living Options for Older Persons Communal housing arrangements have become increasingly widespread as an alternative housing option for older persons since the enactment of the Law to Promote Specified Nonprofit Activities in 1998. These houses first emerged in Japan in the 1970s as a welfare measure taken by local governments in remote regions. They gained traction following the 1995 Awaji-Hanshin Earthquake as a means to accommodate older persons who had lost their homes. Growing numbers of older persons are actively choosing such communal living arrangements, all the more notable because house sharing in general is traditionally not common in Japan. The majority are women, particularly those who are divorced or widowed. Group home projects are typically highly individual and strongly influenced by their initiators and residents. Rather than adhering to a standardized pattern, they cater to a variety of ideals, preferences, and needs. Among the initiators are nonprofit and welfare organizations, as well as residents themselves. People typically become aware of these projects through word of mouth. Group homes may be organized as rental or owned properties. While some group homes are solely for older persons or persons with dementia, multigenerational arrangements also exist. Some, but not all, group homes receive government subsidies— an example of group home arrangements that typically receive government subsidies are those specifically catering to persons with dementia. Group homes specifically for older persons usually provide support and help services in a barrier-free (wheelchair- accessible) environment to support aging in place. Often organized by a nonprofit or welfare organization, they include regular meal preparation services, cleaning, and general assistance. Multigenerational projects, in contrast, typically focus on mutual help and communal activities, with household tasks such as cleaning and gardening, as well as the preparation of shared meals, organized and managed by the residents themselves. The physical layout of group homes usually consists of about ten complete private living spaces and a set of common spaces where residents can congregate for meals and other gatherings. Typically located within residential neighborhoods, they actively seek to 26 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER engage with the surrounding neighborhood through organized activities that are open not just to group home residents but to anyone from the neighborhood. Many provide opportunities for older persons to interact with the community and younger generations. Some even incorporate a restaurant on the ground floor (with a separate entrance from the living spaces) where visitors are welcome. These provide additional opportunities for incidental encounters and social interaction. Among other examples of facilities that may be integrated into a group home project to create more opportunities for intergenerational bonding are a pediatric clinic or an afterschool place for elementary school children. The older population’s preference for communal living may be a response to insufficient available housing alternatives or because other existing choices do not meet their needs or liking. As mentioned above, for example, older persons face difficulty and prejudice in the general rental market. Furthermore, unlike institutional facilities, which have been criticized for segregating their residents from society, group homes provide a more familiar environment where they can live independently according to their own individual preferences while remaining connected to and engaged with the community. Encouraging Multi-Habitation Lifestyles to Support Declining Areas According to the 2006 Toshi Chiiki Report (City Regions Report), 40 percent of baby boomers in Japan were willing to change living places when they retired (Murakami et al. 2009). A key motivation was the physical condition of the housing in which they lived; most Japanese housing is constructed of wood, and people generally expect they will have to be rebuilt after 20 or 30 years. Some also expressed a desire to return to their birthplaces where their aging parents live or to relocate permanently to small towns outside the metropolitan areas after retirement. Yet others wished not to choose between the city and the country, preferring the koryu-kyoju (multi-habitation) lifestyle. Ownership of a second home has become realizable with a highly developed transportation network and a surplus of housing at declining prices in rural areas. Those who live part time in the country also place importance on the availability of care services, good local transportation and landscape quality, and personal safety in the second home. These considerations have led to a national program to promote multi-habitation with three components to revitalize declining areas: long-term vacation (for example, by promoting rural landscapes for vacationers, developing long-stay vacation packages, and encouraging visitors to stay longer), themed tourism (for example, by developing thematic travel and new types of tourism around concepts such as health and wellness and hobby-based travel experiences), and permanent residency (for example, by offering permanent residency to those who have no preexisting connection to the particular area). The Ministry of Internal Affairs and Communications has launched an information website (Promotion of Multi-Habitation: Rural Living Guide), which is maintained by the Research Committee for Depopulated Areas. It has encouraged depopulated areas, such as Hokkaido, to promote permanent residency and regenerate local amenities, including shops, health care, and community activities. The aim is to attract retiring in-migrants and, by doing so, improve the general living conditions and quality of life for the existing aging communities (Murakami et al. 2009). A challenge to this approach is a lack of appropriate housing in the areas to which in-migrants want to move. 27 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER 2.2 Building Productive Cities to Enhance Age-Readiness Spatial accessibility is an important pillar of the vision to build a universal society where everyone, including older and disabled persons, can live comfortably and participate in society. Various strategies have been introduced to optimize infrastructure provision and its accessibility for the aging population. Enhancing Universal Accessibility To create a more inclusive urban environment outside the home, the Ministry of Land, Infrastructure, Transport, and Tourism has advanced, as part of the implementation of national land and transportation policies, age-friendly and barrier-free design principles, applied to, for example, sidewalks, public buildings, and the transportation system. In 2006, the Law for Promoting Easy Mobility and Accessibility for the Aged and the Disabled (the Barrier Free Law) was ratified, succeeding the Law for Promoting the Construction of Easily Accessible and Useable Designated Buildings for the Aged and the Physically Disabled (the Heartful Building Law), issued in 1994, and the Law for Promoting Easy Public Transport Mobility for the Aged and the Physically Disabled (the Barrier-Free Transport Law), issued in 2000. The new Barrier Free Law unified, within a single legal framework, accessibility guidelines for new and existing buildings and for public transportation operators and facilities. The intention was to facilitate the targeted and integrated implementation of mobility and accessibility measures in priority development districts—that is, designated areas in which facilities used by older and disabled people in their daily lives are located. An example of priority development districts are passenger facilities, such as railway stations and their immediate surroundings. Barrier-free rail transportation system, at the station (left) and inside the train (right). Photo credit: Belinda Yuen 28 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Additionally, the Ministry of Land, Infrastructure, and Transport issued the General Principles of Universal Design Policy to guide the design of facilities that are “easily and freely used anywhere, by anyone” (Ministry of Land, Infrastructure, and Transport 2005). The creation of these guidelines was based on a thorough examination of national land and transportation administration policies, as well as discussions with national and international experts. The aim was to create an inclusive, barrier-free environment through the enhancement of public transportation systems and the promotion of the Free Mobility Assistance Project, a national project that used network technologies and ubiquitous communicators (portable terminals carried by pedestrians) to offer free mobility assistance and information about traveling in cities since 2004. The motivation was to improve accessibility, as recognition of continuity and movement to destinations could be unclear and difficult in Japan due to a lack of street names. Retooling Compact City Strategies The Ministry of Land, Infrastructure, Transport, and Tourism has, since the 1990s, actively promoted the notion of the compact city (a city of short distances) to improve the competitiveness of Japanese metropolises, arrest urban sprawl, and optimize the provision of infrastructure and services. It has increasingly been applied by local governments as the basis for creating age-friendly urban environments and addressing the problem of shrinking cities with declining populations and work forces. International evidence suggests that compact city strategies to reintroduce density and concentrate urban development around key urban nodes can improve economic and social sustainability through more efficient city management (de Roo and Miller 2000; Jenks et al. 1996). A key strategy is to encourage dense urban development around city centers, supported by public transportation networks. Besides enhancing the efficiency of infrastructure and the provision of services, compact city strategies aim to increase the mobility of residents by improving access to facilities and services while reducing dependence on private vehicles. These strategies can boost the independence and well-being of older persons, who are often more dependent on public transportation than the general population. Revitalization of city centers as a result of compact city strategies can also bring new activities and opportunities for older persons and other residents and make the city more attractive to new residents. At the national level, support for compact city development was evidenced by an amendment to the Act of Special Measures for Urban Renaissance in 2014 that aimed to encourage city governments to locate housing and public facilities in accordance with compact urban development principles. An early adopter of the compact city vision is Toyama City, Toyama Prefecture. Apart from the issues of declining and shrinking population common to many Japanese cities, Toyama has one of the lowest population densities among prefectural capitals (251 persons per square kilometer in 2015; Statistics Japan, n.d.). Challenges arising from urban sprawl, excessive dependence on private transportation, and declining public transportation use have contributed to higher maintenance costs for urban infrastructure and facilities. Beginning in 2003, with the Central District Revitalization Basic Plan and Public Transport Revitalization Plan, the Toyama City government embarked on a series of programs to revitalize the declining central urban area and improve public transportation 29 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER connections within and to the city center. The Comprehensive Ten-Year Plan (2007– 16) and Downtown Revitalization Plan (2007) put forward a vision of a compact city, based on efficient public transportation, comprising “a dense center and a series of dense hubs interconnected by strong public transport” (Arai 2019). The goal was to increase the well-being and quality of life of residents by reducing their dependence on private transportation and to capitalize on the city’s strengths by, for example, nurturing local industry. To achieve this vision, the city government has provided strong leadership and effected a comprehensive policy package that integrates land, housing, transportation, industry, and health care policies and actively engages with relevant stakeholders, such as private enterprises, nonprofit organizations, universities, and community-based organizations. Some notable policy tools include the following: • Designating residential encouragement zones, which are located within 500 meters of rail or tram stations or 300 meters of bus stops along high-use transportation corridors. The resulting enhancement of mobility and access to essential services and facilities can help older persons maintain independent lifestyles and, along with subsidies and assistance from the government, encourage the construction and purchase of housing within these areas. Additional assistance is provided to families who live together with older persons. • Revitalizing the city center through integrated development projects that invite private-sector and community participation. Mixed-use developments, such as the Grand Plaza and the Toyama Glass Art Museum complex, combine public spaces or amenities with commercial and business facilities, offering venues for community events and programming to foster a sense of engagement for older persons. • Providing accessible health and care facilities within the city center to meet the needs of older residents, for example, Sogawa Legato Square (box 2.4). • Improving public transportation through public-private partnerships, for example, the Portram and Centram Light Rail Transit projects (box 2.4). Tanya Jones / Shutterstock 30 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER BOX 2.4. SOGAWA LEGATO SQUARE AND PORTRAM LIGHT RAIL TRANSIT Sogawa Legato Square is a downtown community care center established in Toyama through public-private partnership to offer a comprehensive range of health and care services to older persons and the general population. Built on a site repurposed from a surplus elementary school, the center combines a regional comprehensive care institution, Machinaka General Care Centre, with private-sector facilities to improve the well-being of residents and encourage community interaction. The latter is facilitated through various provisions, including the following: • A sports club that provides opportunities for intergenerational interaction and encourages healthy, active lifestyles through sports • The Natural Cafe Kokando, operated by the city’s leading pharmaceutical company, which provides a place for residents of different generations to relax and socialize in an informal setting • The Kadokawa Preventive Care Centre, which offers accessible health- and community- oriented activities with a focus on preventive care, such as aquatic and fitness programs The Portram Light Rail Transit (LRT) connects the JR (Japan Railways) Toyama Station to Toyama Port (historically, a key transportation route through the city), replacing an older train line, while the Centram LRT is a city loop line that services the downtown area. Under the public-private partnership arrangement that operates them, the entire cost of providing and maintaining the railway facilities and train cars is borne by the city government with subsidies from the central government (Ministry of Land, Infrastructure, Transport, and Tourism), while the private sector is responsible for the LRT system. Several accommodations make the LRT system accessible to older persons and persons with limited mobility: • Tram cars have super-low floors, and stations have barrier-free features. • Supporting services such as feeder buses, park and ride schemes, and bicycle parking spaces further improve accessibility. • A concession scheme for persons aged 65 years or over encourages older residents to leave their homes and engage in more active and social lifestyles. Sources: Arai 2019; Toyama City website https://www.city.toyama.toyama.jp/index.html. While the ridership of the Portram LRT is relatively modest, the introduction of the LRT system has seen an increase in use by older passengers, particularly during the day. Between 2010 and 2012, the number of older women passengers on the Centram line increased 45 percent on weekdays (Runzo-Inada, n.d.). Older persons’s use of city facilities grew by 13 percent, while general admissions increased by more than 50,000 between 2011 and 2013. Starting in 2011, the city has offered free admission to its cultural and outdoor facilities, including the zoo, to grandparents who are accompanied by grandchildren. Data from the Odekake Pass (issued to citizens aged 65 years and older) suggest that the average number of steps taken by older persons post-LRT development is about 6,124 per day, an increase of 2,150 steps per person, which projects to a possible reduction of 75 million yen in annual medical costs (Toyama City 2018). Plans are underway to connect the Portram and Centram lines via an integrated transportation hub that also includes the city’s Shinkansen station. 31 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Toyama’s vision for a compact city has come to fruition in other ways, as well. The population living in the city center and the designated residential encouragement zones increased from 28 percent in 2005 to 38.6 percent by 2017 (Apolitical 2019). Within that period, the resident population aged 65 and older in the city expanded from 22.5 percent to 29 percent, while the population requiring nursing care has remained at 18.5 percent since 2014. The compact city strategy has contributed to the goal of keeping the older population active and healthy by improving the walkability of the city (Mori 2016; Arai 2019). Within the city center in particular, community care facilities, such as the Machinaka General Care Center and the Kadokawa Preventive Care Center, act as walking and mobility hubs. They have spawned small-scale, community-based initiatives, such as the “Walkable Zone Community Workshops,” which are city center walking tours for senior citizens organized by students, primarily from the University of Toyama. In addition to health benefits, these workshops provide opportunities for intergenerational social interaction and community bonding. To encourage wider participation from older persons, they also offer “walking carts,” enabling even the less mobile to participate. Toyama’s compact city has received national and international best practice recognition (OECD 2015a). Compact city development received renewed impetus in 2017 when the Science Council of Japan outlined a roadmap for achieving high quality of life in a super-aged society with healthy low-carbon development. The following were among the key recommendations: • Design healthy, low-carbon cities and traffic systems, for example, by developing and preserving compact city designs and establishing distribution systems to enable older persons, especially those with limited mobility, to obtain goods without traveling. • Increase the motivation for new, healthy, low-carbon lifestyles and behavioral changes, for example, by supporting healthy aging in ways that honor traditional Japanese lifestyles and encourage behavioral change to support low-carbon practices. • Accelerate development of low-carbon housing and buildings, health measures, and energy generation, for example, by promoting net-zero energy construction and building smart communities on city and block scales. 32 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Cindhyade / Shutterstock Improving Urban Walkability A growing number of Japanese cities have adopted measures to improve walkability, facilitate walking, and protect older persons from traffic accidents. Aside from compact cities like Toyama, encouraging walking as a mode of mobility within the neighborhood is a key initiative of the Smart Wellness Cities Network. This is an informal network of around 30 local cities united by their commitment to creating age-friendly or “wellness” cities. It is influenced by policies adopted by European cities, such as Freiburg, Germany, that encourage walking within city centers by restricting private vehicular traffic. The approach yields several benefits: • Creating a walkable urban environment can help improve the mobility of older persons and their access to necessary services and facilities. • Designing neighborhoods that encourage walking can facilitate incidental social interactions, which contribute to building social capital and enhance the well-being of older persons. • Encouraging walking serves to promote good health and active lifestyles. A 2011 survey showed that less than 10 minutes per day of moderate to vigorous physical activity, including walking, could lower the risk of older persons requiring care in the future (Suzuki 2020). Among the cities in the Smart Wellness Cities Network that have implemented measures to facilitate walking through neighborhood design are Takaishi City (Osaka), Gifu City (Gifu Prefecture), and Toyooka City (Hyogo Prefecture). In Gifu City, for instance, automatic rising bollards have been installed to restrict vehicle access. 33 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Yokohama City has also implemented measures to encourage residents to walk as a preventive care measure to improve public health. The Walking Point Program, introduced in 2004, aims to improve the health of residents while at the same time reducing carbon dioxide emissions from daily driving trips. The program operates on a point system that converts the number of steps walked to points that can be redeemed for rewards at participating local shops. More than 100,000 residents have registered since its inception. In conjunction with the Walking Point Program, Yokohama is also improving walking routes and pedestrian accessibility of public open spaces. In Tokyo, the metropolitan government sought to improve the accessibility of the urban environment by introducing a traffic safety campaign, “Prevention of Traffic Accidents for Children and the Elderly,” in 2016. Campaign messages advise older persons on how to stay safe in traffic and how they may receive various privileges by voluntarily returning their driver’s license to obtain a certificate of driving record. Tokyo also uses urban planning and design to promote walking and public mental health by, for example, developing “designated activity areas” and “healthy roads” (McCay et al. 2017). Developed under Tokyo’s long-term care policies, the former offers walking opportunities by making shops, services, home care, health facilities, and social facilities conveniently available in barrier- free daily activity areas, often around railway stations, while the latter seeks to widen roads to facilitate pedestrian traffic of different speeds while clustering the range of shops and services in an accessible way. Improving pedestrian safety of older persons by installing pedestrian crossing aid at traffic junction (left), raising public awareness using traffic safety campaign posters (center), and demarcating separate lanes for pedestrians and cyclists (right). Photo credit: Belinda Yuen 34 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Leveraging Technology Technology is integral to Japan’s Society 5.0 vision, and 229 smart city projects have been proposed in 157 areas, from robotics for healthy and active aging to smart city and economic development. In 2017, Fukuoka City, in collaboration with Accenture launched Fukuoka 100: Living Healthy for 100 years. The goal is to roll out 100 actions by 2025 to transform Fukuoka into a society that enables healthy, lifelong living in urban communities. A major feature of the plan is the use of advanced digital innovation with health, medical, and welfare systems and active citizen participation to enable citizens to lead healthy and independent lives. Japan is a leader in robot development and research. Among innovations that may be useful to older persons are companion robots, examples of which include the following: • Co-residence Robots (doukyo robot) are designed to help combat loneliness, ease the burden of nursing care for family members, and give peace of mind. • Talking pet robots include, for instance,  OHaNAS, a talking sheep-like robot with the ability to engage users in conversation, play word games,  and respond to touch in various ways. Released in 2015, OHaNAS had a dedicated accompanying app, “OHaNAS no Kimochi,” which has since been discontinued, although it can still be used as intended without updates.  • Robi Jr., a compact-sized communication robot, uses more than 2,000 phrases and is promoted with the slogan, “Motto nakayoshi” (get closer). These and other robots are for domestic use, and the challenge is to make them more mobile so older persons can leave their homes with an additional safety net. Some 5,000 nursing care institutions are testing the use of robots in elder care, and demand for them has been projected to increase an estimated 20 times between 2015 and 2025 (Economist 2017). In 2018, the Shintomi nursing home in Tokyo was using 20 different elder care robot models to care for its residents. Examples included Paro, a furry seal that cries softly when petted, and Pepper, a humanoid that waves while leading group exercise. The response from the residents has been positive, although the technology presents challenges with regard to high costs, safety, and user friendliness (Foster 2018). Manufacturers are also developing smart technologies to provide solutions to challenges faced by older persons in housing. The Sekisui House in Osaka provides smart health care with sensor technology to regulate room temperature and monitor the daily activities and health of inhabitants, while Nihon Kohden (a medical device corporation) has developed a system to monitor the daily activities of older persons. The system can detect in-home accidents and up to 20 different illnesses (Brucksch and Schultz 2018). Others have utilized artificial intelligence (AI) technology to offer virtual assistants, in the form of smart speakers, to older persons and people with disabilities who do not already have a helper in their daily living. Examples include Alexa, a smart speaker with videophone and voice-activated functionalities that can provide real-time information, such as weather and news, and smart control devices, such as home automation systems (Japan Times 35 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER 2020). Additionally, the smart speaker can be used to connect with friends and relatives and for family members to check on the well-being of older relatives, which has been especially helpful during the COVID-19 pandemic. On a larger spatial scale, Toyota has announced its plan to build a new “Woven City”—that is, a smart live-work-play city—to be built on a 175-acre former factory site at Higashi- Fuji, beginning in 2021 (Zeiba 2020). The smart city will test and prototype a wide range of technologies, including AI, personal mobility, mobility as a service, robotics, and smart home connected technology. Streets will be designed into a woven tapestry of three-by- three blocks of parks and buildings where infrastructure is provided underground. There will be three kinds of streets: • A primary street network for autonomous vehicles that can serve as mobile sites for health care, retail shops, and work • A street for personal transit options, like bicycles and scooters • A tree-lined street for pedestrians In Kashiwa, a smart city of 273 hectares called Kashiwa-no-ha is being developed through a public-, private-, and academic-sector partnership as Japan’s next-generation model for urban development. Designated in December 2011 as a Comprehensive Special Zone for Regional Revitalization and an Environmental Future City, Kashiwa-no-ha embodies three urban development concepts: • Creating an Environmental-Symbiotic City that is environment friendly and provides solutions for environmental and energy problems • Creating an Innovative City for New Industry with focus on fostering growth areas that would become sources of new economic vitality for Japan • Creating a Health and Long-Life City for people of all ages to enjoy aging as well as healthy and secure lives The focus of the Kashiwa-no-ha model is not just on economic development but also on urban livability and social improvement. It is designed as a smart city where the emphasis is on leveraging technology to further the well-being of residents, to provide for a better quality of life and healthier communities. City planning meetings with local residents are held monthly. The concept of healthy living and aging is central and is represented by “Ashita” (literally, “tomorrow,” and comprising three characters: “A” for akura—to walk; “shi” for shiyaberu—to talk; and “ta” for taberu—to eat) to denote the importance to older persons of walking and exercise, talking and socializing, and eating healthy meals. An Ashita center equipped with information and test equipment is located within the shopping center next to the Urban Design Center Kashiwa-no-ha. It is serviced by older persons themselves who are on hand to explain the use of the equipment to measure 36 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER blood pressure, gait, balance, flexibility, and so on. The information is uploaded to a computer and linked to individual medical records. The smart city received the LEED-ND1 Platinum certification in 2016. Ashita center at a shopping center in Kashiwa-no-ha. Photo credit: Belinda Yuen Some local governments have utilized digital technologies to promote health and help older persons lead active lives—for example, through economic activities. In Otsuki City (near Mount Fuji), for instance, where 35 percent of the local population are at least 65 years old, the city has collaborated with mobile phone operator NTT DoCoMo and Waseda University to implement a demonstration project to engage residents, including older persons, in e-agriculture—an activity that has enabled older persons to remain economically productive and socially active. Funded by the Ministry of Internal Affairs and Communications, the project connects the local farming industry, warehouse, and distribution outlets electronically with consumers residing in urban areas, including Tokyo. People living in Tokyo can also rent farming fields in Otsuki. Through the use of sensors, the internet, and digital cameras, they can monitor the fields remotely and communicate with local farmers on their daily maintenance. A further use of smart technology in Otsuki is an e-health application using digital networks to enable residents, including older persons, to monitor their health and send the data to medical care providers. Another such effort is based in Kamikatsu, a small rural town in Tokushima Prefecture where 86 percent of homes are connected to the internet and half the population of 1,500 are older. A cooperative project helps older local farmers sell Irodori leaves (grown in the local mountains and fields) for Japanese-style table settings. Through the project, farmers are able to receive orders, access market information, and contribute to the economic development of the town, which produces 90 percent of Irodori leaves in Japan. The average age of the participants, many of whom are women, is 75 years; the oldest is 92. Besides providing additional income, the program enables participants to perform moderate outdoor work and exercise their cognitive functions, improving both their physical and mental health (Osawa and Fujiwara 2019). Technological engagement for older persons in Japan is facilitated by increasing smart phone ownership (37 percent of people aged 50 or older owned a smart phone in 2018) and universal design of smart phones that target consumers aged 60 and older (AARP 2018). DoCoMo Raku-Raku smart phone caters to the aging user’s lifestyle and needs with larger fonts, icons with simplified steps, and preinstalled apps. E-commerce services, 37 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Chaay_Tee / Shutterstock such as Ito-Yokado and Rakuten, offer technology-savvy older persons the convenience of accessible online grocery shopping, while companies such as Fujitsu are developing ICT lifestyle products to aid mobility, including smart wheelchairs and walking sticks with built-in global positioning system (GPS) software, access to mobile data services, wireless networking (Wi-Fi), and health monitoring functions (BBC News 2013). Yet others have integrated IoT sensors into clothing. In 2016, for example, the Tokyo- based smart fabric company Mitsufuji developed and began manufacturing silver- metalized conductive fiber under its AGposs brand and wearable IoT products under its hamon smartwear brand. Stretchable and flexible, AGposs hamon smartwear can be used to monitor biometric information, such as breathing rate and heartrate, as well as environmental temperature, humidity, and acceleration and gyroscopic data. With a transmitter attached to the smart fabric and other devices, the data can be sent to mobile devices and cloud platforms. Another approach to IoT collection of data for better health involves the PRISM-J program supported by the Japan Diabetes Society (about 10 million Japanese citizens are living with Type 2 Diabetes). Physicians monitor patient conditions remotely through IoT using an app called Shichifukujin, collecting data from 2,000 patients between the ages of 20 and 75. 38 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER 2.3 Building Inclusive Cities to Enhance Age-Readiness Social inclusion, the process of improving senior participation in society, is embedded in the Japanese constitution and in Japan’s commitment to the Sustainable Development Goals (Das and Mehta 2019). As early as 1966, Japan designated a national public holiday to celebrate and honor older persons; it is the only country to do so (AARP 2018). The challenge of loneliness and isolation in old age, however, remains and is anticipated to intensify with the rise in numbers of older persons who are living alone. Most serious is the increase in solitary deaths (or “kodokushi”)—about 30,000 per year—many of which are not discovered until long after they occur (Fifield 2018). In response, several innovations have been introduced, primarily by local governments, as well as nonprofit or welfare organizations, to engage older persons in their communities and create a society that offers everyone (including older persons) the opportunity to lead “vibrant and active lives” (Tokyo Metropolitan Government 2016). These initiatives recognize the importance of motivation in life and underscore the perspective of older persons as positive contributors to society and the economy. Enabling Social Participation through Work Opportunities Many Japanese cities have instituted creative measures to support post-retirement employment as part of active aging and to emphasize the independence, participation, and choices of older persons. According to one study, older persons desire a very wide range of jobs they would like to try, including work that can be done at home or close to home, work that can be done lightheartedly, and work where they can make new friends as they get older (Hoshi et al. 2017). One novel approach to addressing this desire is the Silver Human Resource Centers, the first of which was set up in Tokyo in 1975. Founded on the principles of autonomy, independence, cooperation, and mutual assistance, a network of Silver Human Resource Centers (SHRCs) has been established nationwide with the support of the central and local governments to offer healthy persons aged 60 and older opportunities to utilize their knowledge, experience, and skills through flexible, short-term, temporary, or volunteer jobs that suit their lifestyles. These jobs are typically with local families, businesses, or public organizations within the community and involve light work, such as pruning plants or teaching. Although membership of the Silver Human Resource Centers has been inconsistent over time as a result of such factors as a change in the retirement age from 60 to 65 years, recession, and difficulties in providing older persons with the jobs they need, analysis suggests SHRC employment has generated increased well-being among its recipients (Hoshi et al. 2017; Weiss et al. 2005). Other organizations, including the Tokyo Foundation for Employment Services, have encouraged senior employment by offering a subsidy to small businesses that employ senior workers; the businesses must have a minimum of four workers, of whom at least half must be aged 55 or older (Gilhooly 2015). Toyama City established the Rakuno School in 2006 to provide agricultural training in a fun way that is accessible to newcomers to farming. The school helps participants start their own agricultural production and supports existing farmers who are facing a shortage of skilled farm labor. While the school is open to everyone with an interest in agriculture, many participants are older adults. 39 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER As mentioned in the discussion of the Toyoshikidai rebuilding project, above, Kashiwa has set up the Second Life Platform Project as a go-to point for job placement for those who desire to work, as well as for information on volunteer activities, lifelong learning, hobbies, health promotion activities, and seminars on social engagement. Another example is the nonprofit organization, Asaka Grandpa Project in Saitama Prefecture. Established in 2013, the project aims to improve the health of older men by recruiting and engaging them in childrearing support. The men are given training, consisting of thirty 90-minute lectures and practical experience over 13 days at nursery and elementary schools and afterschool children’s clubs. The “Asaka grandpas” then generally work at these schools and clubs once or twice a week and are encouraged to design activities that interest them and the children. The range of activities includes watching out for the safety of children playing at nursery schools on public open days, providing learning support, reading to children and engaging in other activities at elementary schools, accompanying children on field trips, playing games, and teaching the children to use carpentry tools. Feedback on the program has been positive, especially from the grandpas, who talk about “becoming energized by children,” “feeling very happy when children call my name on the street and their parents also thank me,” “having many occasions to go out, which helps me stay healthy,” and “meeting people of the same generation in the community” (Osawa and Fujiwara 2019). Supporting Lifelong Learning Government support for lifelong learning for older persons is provided mostly through funding for various programs that promote continuing education. Senior Citizens’ Colleges offer courses on health and recreation; the Silver Audit System enables older persons to audit college courses at local colleges; and the Senior Citizens’ Continuing Education Program helps older persons participate in a variety of courses through their local kouminkan—community centers administered by local governments that offer various programs to promote the health and well-being of citizens. Similar to the lifelong learning institutes founded as part of the international movement, University of the Third Age, the first senior college was established in 1954 at a private temple in Nagano Prefecture. It functioned primarily as a community meeting place while conducting community-based education for older persons. In 1969, the Hyogo Prefectural Board of Education established the Inamino College, which has its own campus (on a site 50,000 square meters in size), buildings, and teachers. The college offers a regular four-year graduate program, providing courses in history, health and welfare, and community activities, as well as a two-year community leader training program covering gardening, pottery, cultural studies, health and welfare, and general education for those aged 60 and over. In 1990, the Lifelong Learning Facilitation Act outlined the role of prefectures in promoting lifelong learning and lifelong learning centers. Following passage of the legislation, and with the increasing recognition that learning opportunities for older persons provide a good pathway for promoting health, many more (and larger) senior colleges were established. Although senior colleges may heighten life satisfaction for older persons, some have closed for financial reasons, while others have evolved beyond geographical and age boundaries (Hori and Cusack 2006; Hori 2010). 40 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER wdeon / Shutterstock Expanding Community-Based Activities At the local level, various community-based initiatives have developed to encourage the participation of residents, including older persons themselves, in addressing social isolation of older persons. In response to the incidence of solitary deaths, the local government Tokyo Adachi Ward implemented the Zero Tolerance to Isolation Project to create a community where residents would want to keep on living, regardless of how old they may become. Older persons can ask the local government to arrange for regular visits by community volunteers, while the local authority uses the citizens’ register to identify all single households with occupants aged at least 70 years who do not subscribe to a public health insurance program. Volunteers visit these households to assess their social connections. Those deemed socially isolated (defined as not having a ten-minute conversation with someone from outside the household more than once a week or being without someone to go to for help when in trouble) receive follow-up support, such as regular visits from volunteers (AARP 2018). Information about these households is shared with the police and fire services so they can help monitor and ensure occupant safety. Other cities, such as Nerima City, have engaged the help of volunteers from the community, as well as the postal service (Japan Post) and gas company employees, to provide “watchover” services, including monitoring older persons who live alone and alerting authorities to any abnormalities. Since 2015, Japan Post has collaborated with IBM and Apple to provide subscribers with free iPads to help connect older persons with services, health care, the community, and their families. The monthly subscription for one home visit per month from a postal employee is $20 and for one telephone call per month $10 (AARP 2018). During the home visit, the postal employee also helps the subscriber address technical issues with the apps. In Hikarigaoka neighborhood in Nerima City, residents have established a neighborhood watch service. A participating resident places a magnet that says “I am fine” on the front door each morning. Volunteers go around the neighborhood, look for these notes, and move them to the residents’ letterboxes. 41 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Senior citizens’ clubs have also been set up across the country, often with local government support and funding, to promote the health of members and encourage mutual support and community participation through activities such as volunteering. Around 100,000 such clubs operate nationwide, with a total membership of around 5.9 million. In Taketoyo, “salons” for older persons have been organized to provide exercise and social activities, such as poetry writing and recreational games. The municipal government provides the venue, financial assistance, and publicity for these salons. In Ueda City, the “dementia-friendly” Sanada initiative was created and has been led by people with dementia since 1993. Community action is directed toward transferring dementia care into the community, using group homes and a multifunctional care center where people with dementia host activities, including lunch clubs and dinner parties, with the support of friends and local residents. Central to this effort is raising the awareness of the community, for example, through seminars and training on how to communicate effectively with people with dementia. Tokyo launched the Heart Ring Movement to raise awareness and encourage compassion, thoughtfulness, kindness, and cooperation among the community, organizations, and persons with dementia. The goal is to change mindsets and reinforce positive attitudes toward community-dwelling people with dementia. Community gardens and the promotion of urban agriculture are another strategy by which community groups and local governments can engage and encourage social participation among the older population. The Toyama Community Garden Project provides plots of 50 square meters in parks and previously abandoned squares in the city center for residents to garden and to help bring nature into the city center. Initiated by neighborhood councils and local groups, the project gives participants, most of whom are older persons, opportunities to remain active and connect with others (Arai 2019). In Kashiwa, the University of Tokyo has been working with the city on a community urban agro-activity, Kashiniwa (rental garden), for vacant properties. Since 2010, a matching system organized by the city has connected owners of vacant properties with local people who want to use these places for community gardening. Many retirees and older persons have been involved in these projects. The program has transformed abandoned neighborhood lots into community gathering places, and, in the process, strengthened social ties and contributed to a healthy lifestyle among the older population (Machida 2019). Similar community-based urban community gardening projects, some on rooftops and in abandoned fields, have been increasing in number around Japan in recent years (Lewis 2017). Another notable example of a nongovernment-led initiative to promote the social inclusion of older persons is the Ibasho Cafe project in Ofunato, Iwate Prefecture. Initiated by nonprofit organizations in the wake of the 2011 Great Eastern Japan Earthquake, the Ibasho Cafe project leveraged community and private-sector resources to create a cafe that serves as a community hub. Its main strategy is the creation of an ibasho, “a place where all people feel they belong and are accepted” (Tanaka 2016). The Ibasho approach recognizes older persons as valuable assets to their communities and empowers them to be active participants and change agents in post-disaster community rebuilding. In the process, it addresses social isolation, builds social capital, and improves the community’s resilience to shocks and disasters (box 2.5). 42 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER BOX 2.5. OFUNATO IBASHO CAFE Strategically located in the Massaki neighborhood of Ofunato, the Ofunato Ibasho Cafe was adjacent to temporary housing communities, making it accessible to those displaced by the earthquake who were perhaps most in need of community support. The effort was distinguished by older persons taking leadership roles in its development and management, directing the involvement of community members throughout the planning, development, and construction phases of the project. The cafe was built from an old farmhouse donated by the local Ozawa family, with support from the local government, Honeywell Hometown Solutions, Operation USA, and Tenjinkai (a local social welfare organization), and is formally owned by a group of older residents. The cafe offers an informal gathering place where visitors can enjoy traditional local meals and drinks, likewise, supported by donations. Local residents also bring home-cooked food and warm-up meals and prepare light meals together. The Ibasho Sozo Project, a nonprofit organization led by older persons from the community, has been formed to manage the cafe and ensure its continued sustainability. User surveys conducted following its opening in 2013 showed that most felt the cafe had succeeded in improving their social connections and everyday lives (Kiyota et al. 2015). Visiting the cafe brought joy and added meaning to their lives, as they were able to connect with existing friends, meet new ones, and contribute to the community through volunteering and activities. Participation in the cafe and the activities organized through it helped older persons regain confidence in their own efficacy. The creation of informal support networks was particularly beneficial to older persons who lived alone. One daily visitor, for example, was a 94-year-old woman. When she was absent from the cafe for two days, concerned community members visited her apartment and discovered she had broken her arm. Subsequently, other older persons took turns in accompanying her on daily walks to and from the cafe. Source: Kiyota et al. 2015. The older persons in charge of operating the cafe have since started an organic farm and farmer’s market that provide fresh food to nearby residents. Experience with the Ibasho Cafe project has motivated older patrons to organize activities to support people outside their own community, such as the disaster-recovery fund organized to support those affected by Typhoon Haiyan in the Philippines. But it is not just older persons who need social participation. Their caregivers, too, need support and respite care from the emotional and physical stress that often burdens them (Arai and Washio 1999; Morimoto et al. 2003). In Nagoya, a caregiver stepped forward to open a cafe for family caregivers, providing a place to share information about caregiving techniques (Marlow 2015). In addition, a volunteer nurse visits every other week to check people’s blood pressure and suggest questions they may wish to ask their doctors. 43 Conclusions and Recommendations 3 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Japan is the only country in the world where longevity is celebrated with a national holiday to honor and respect older persons. Japan is an early innovator in healthy living for older persons and offers a glimpse into the possibilities (as well as the challenges, such as the rising costs of health and social care) associated with meeting the needs of a super-aged society. Its experience highlights the importance of understanding the changing needs of older persons and utilizing preventive care, research, and social experimentation in healthy aging, based on scientifically sound and practical tools and technologies, when dealing with the trend of increasing longevity. A key lesson from the Japanese experience is that preventive care is best implemented through a multifaceted approach with policies regarding aging in place (for example, ensuring equal opportunity to age in place), the built environment (such as the provision of accessible homes and age-friendly neighborhoods) and communities (through, for instance, multi-stakeholder collaborations and integrated health and social care). The aim is to increase the number of older persons living independently and in good health, extend the lifespans of older persons, and reduce individual needs for medical and nursing care, as well as to harness the human capital of the older population. The notion of preventive care suggests healthy lifestyles do not start in old age and should be embraced early in life. The centerpiece is enabling older persons to do the things that matter to them. The following are some key actionable lessons emerging from the Japanese experience. Low-income people need equal opportunity to age in place. Housing access and costs are a fundamental aspect of daily living and can be a challenge for older persons, especially with increasing longevity. Japan has evolved policy tools to provide renters, especially those with low incomes, with an equal opportunity to age in place. These include two major lines of action: • Developing “hardware” concerns the development of supply at the local level, supported by central government financing through direct provision; examples include the Silver Housing projects, which provide barrier-free, public rental housing and the promotion of private-sector participation using a property registration system and incentives. • Putting into place “software” refers to creating a user-oriented ecosystem of services to support aging in place; examples of this are the Urban Renaissance Agency’s development of mixed communities, the offering of rental discounts to encourage family members to live close by, the availability of community medical and welfare centers, and the provision of calling and counseling services to provide community- based and in-home support services for older persons, including the frail and families with older members. 45 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Multiple partners can be activated to build age-ready neighborhoods. Although the government is an essential partner for effective age-friendly action in terms of setting a vision and providing legislative and institutional frameworks, infrastructure, and incentives, Japan’s experience demonstrates that a broad range of stakeholders, including the private sector, universities, nonprofit organizations, communities, and older persons themselves can participate in the process of enhancing the age-readiness of their environment. Meeting the challenge of aging infrastructure offers an opportunity to reorient urban redevelopment investment and engage the whole of society in creating age-friendly neighborhoods and promoting growth. Redevelopment that has been initiated by local governments, such as that in Kashiwa, Toyama, and Yokohama, demonstrates how to tap into partnerships with multiple stakeholders to revitalize aging residential neighborhoods and advance an evidence-based, age-friendly development agenda that encourages the adoption of healthy lifestyles, preventive health care, and wellness among older persons and everyone else. It is possible to have a holistic framework and a multi-action intervention plan. Kashiwa offers one example of a city that has evolved a pluralistic action plan in collaboration with various partners, including the university, the residents and community, and the public and private sectors, to respond to the diverse needs of older persons. Comprehensive, integrated solutions with regard to supportive care, social life, and the spatial living environment testify to a bold experiment in studying the multifaceted and knotted issue of aging to expand the response to it in scope and coverage. The resulting strategies have three dimensions: • Conducting community-engaged research into the experience of older persons • Redesigning the city to be more age friendly • Testing community and social innovations and model demonstration programs to offer care, social interaction, and active and healthy aging to older persons and the greater community Enhancements of the physical environment include new barrier-free housing, medical facilities, a community dining place, and public spaces designed with increased accessibility and walkability. The priorities are not only on age-friendly and adaptive buildings and infrastructure but also on programming and opportunities for social connection, autonomy, and independence among older persons and for awareness raising and mindset building among the community to support active, healthy aging, which is key to preventive care and extending the expectation for good health along with increasing longevity. Central to many of the age-friendly strategies is a multipronged approach that addresses at once the four issue areas most essential to staying ahead of the aging curve: 46 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER maroke / Shutterstock • Spatial—for example, barrier-free housing and transportation and a walkable environment • Social—community participation and cross-generational activities • Economic—post-retirement work • Health—accessible health care and home-based care The breadth of these issues will necessarily differ according to context and present different opportunities, challenges, and models for the age-ready city. Japan’s experience, however, draws attention to the importance of designing cities with the needs of the ever- expanding older population in mind, demonstrating that such prioritization can catalyze innovations. Among the priorities may be the following: • Reframing compact city policies to address better the challenges of shrinking and aging populations—for example, using density- and transit-oriented development to promote service proximity, walkability, and healthy lifestyles • Implementing universal design principles, residential encouragement zones, and various senior housing typologies to support aging in place • Building mixed-use spaces to enable cross-generational interaction • Providing integrated care to the general population to reduce the need for long-term care instead of focusing only on high-risk individuals • Developing salon-type community interventions to reduce long-term care needs. • Promoting community-based care and community engagement to help older persons remain active and involved in the daily life of the city rather than becoming a drain on resources 47 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Age-ready actions are not without challenges. The above possible actions are generally in areas where local governments are well placed to work with the community and stakeholders. The challenge for Japan is to replicate and mainstream these and other local innovations nationwide so the entire country, not just Kashiwa or Toyama or Yokohama, becomes age-ready. Another continuing challenge is how to create activities and care for older persons, along with providing appropriate adaptations in the built environment to support their changing lifestyles; this is especially pertinent at a time when older persons are living much longer than previous generations, while societal norms like retirement age have remained largely the same. Social isolation, loneliness, and solitary deaths are profound challenges that have accompanied the growing trend of living alone with aging. Several communities have opened exemplary pathways for people and businesses to volunteer (through, for example, a cafe for caregivers) or mobilize to develop innovative solutions. The question is how these innovations and experimentation can be effectively scaled up. No more delay on normalizing aging issues. The Japanese experience further testifies to the importance of building awareness and sensitizing the community to normalizing aging issues, including dementia, in the age-ready city. Many of the innovations discussed here involve the community and can probably be readily applied by other cities—even those with few resources—although careful planning is essential to ensure successful implementation. Collaboration with the community is a well-tested pathway for co-creating programs with older persons that are aligned with their needs and local conditions. More conventional ways of encouraging older persons to spend time outside and in social spaces may be adopted, such as the provision of supportive infrastructure— for instance, shuttle bus services and senior citizen centers. Other, more innovative projects have included the introduction in Toyama of community- based Walkable Zone Community Workshops for older persons, led by university students, with walking carts provided for the less mobile. Saitama Prefecture has introduced the Asaka Grandpa program to involve older men in childrearing support activities. The key idea is to bring younger and older persons together in shared activities and places. Other cities have creatively activated community volunteers and regular household services, like the postal service and gas companies, in neighborhood watch activities to keep watch over older persons, especially those living alone. Yet others have organized machizukuri (town-making community projects) to engage older persons in improving the livability of local neighborhoods. Community-based urban gardening projects in shrinking cities are transforming rooftops and abandoned properties into nature places. Kashiwa has even developed a system that connects owners of vacant properties with community members, including older persons, who are interested in using the land for community gardening. In the process, these projects create places where older persons and others can come together to improve their neighborhoods, transforming once abandoned, vacant plots into community places, connecting people with nature, and strengthening social connection. There is a large literature indicating that contact with nature can engender improved health and well-being, lower rates of type 2 diabetes, and slow the onset of dementia (Kabisch et al. 2017). 48 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER The Ibasho Cafe project in Ofunato is another notable demonstration of a community- based initiative that engages, enables, and empowers older persons by making them leaders in community rebuilding following a major disaster. It testifies to the importance of experience and knowledge in the aftermath of a disaster and the keenness of older persons to contribute theirs if given the opportunity; comments from Ofunato residents showed that, in the aftermath of the 2011 earthquake, older persons knew how to manage without electricity and running water when younger generations were at a loss. Japan illustrates the many opportunities available to capitalize on technological advancements in a transition toward an “e-aging” society, including the development of technologies that cater to older persons’s health care and caregivers’ needs. Japan is at the forefront of e-health provision, including robotics and telehealth systems that are particularly helpful for supporting older persons’s health care in rural and remote areas and, at present, for managing public health during the COVID-19 pandemic (Yang et al. 2020). These innovations have the added value of propelling economic growth in these sectors in light of the growth of the domestic home health care market (over $25 billion; Pacific Bridge Medical 2014), the overarching goal of reducing the financial burden of medical and long-term care, and the prospects for health care digitalization. The global home health care market, including devices, products, and services, was an estimated $215 billion in 2013 and growing at 8 percent per year (Pacific Bridge Medical 2014). Even with healthy aging and recognition of the importance of preventive care, health care will always remain a foundational aspect of the age-ready city, and the planning of long-term care is integral to it, especially with increasing longevity. Japan’s Long-Term Care Insurance System provides an example of meeting the fiscal challenge of aging populations, demonstrating how cities can evolve from traditional care by family to care by society. It also shows how governments can allocate resources to health care through an insurance program that makes long-term care and nursing services for older persons accessible in the home to support aging in place. It is particularly notable for providing only services (in contrast to European systems) and for giving users the flexibility to choose both services and providers to suit their individual needs and preferences. The system is not static but has evolved over time to include the introduction of preventive services and a “decentralized yet centralized” approach that takes account of local differences. Japan’s adaptation of the Long-Term Care Insurance System could offer further guidance for cities seeking to craft and adapt this scheme to suit their specific needs. 49 Annex Main Report Executive Summary SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Main messages 1. The world is becoming increasingly urban and older. This growing confluence of urbanization and aging is uneven, and cities and countries are at different points on the two trajectories. 2. Since aging is a dynamic yet linear and relatively predictable process, age-readiness can, with the requisite political will, technical expertise, and creative use of resources, be planned for and implemented. 3. Older persons constitute a growing market for goods and services related to health care, leisure, and information and communications technology (ICT). But they are a diverse group, differing not only by the countries and cities in which they live, but by income, wealth, gender, age, ethnicity, and disability status, among other attributes. The profile of older persons in a city or neighborhood affects the demand for city infrastructure and services and the manner in and extent to which they contribute to the economy and society. 4. Cities and towns are enablers that provide opportunities for older persons to lead full, productive, and dignified lives, but they also present insurmountable barriers unless their leaders make intentional investments in age-readiness. 5. Actions that lead to age-readiness are not just good for older persons; they create public goods with wide-ranging social and economic advantages that benefit, for instance, persons with disabilities, persons carrying heavy loads, or those who may be temporarily disabled by illness. 6. Cities can make progress toward age-readiness, especially in the built environment, with the help of actions in six areas: universal design, housing solutions, multigenerational spaces, physical mobility, technology, and efficient spatial forms. 51 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Introduction Cities and countries the world over are at the cusp of epochal global trends whose impacts are likely to be more intense and more far-reaching than those of similar trends in the past. The simultaneity of the demographic transition, deepening urbanization, a technological revolution, frequent shocks brought on by health and climate emergencies, mean that we will need to plan for an older and more urban future. Cities are often identified by their age profiles: they are reified as “young cities” or “old cities.” This is because city leaders are cognizant of the profiles of their constituencies, and the demographic profile of a city has a bearing on the demands on its leaders and on the policies and programs they put into place. Awareness of the demographic profile is not enough to spur action in response to demographic change, though. That awareness needs to be accompanied by concrete steps taken through policies and programs. Silver Hues: Building Age-Ready Cities is intended as a policy document that helps articulate the idea of “age-readiness” while building on the idea of “age-friendliness.” It highlights the varied trajectories of aging and urbanization and draws on the experiences of older and more urban countries to show how others can become “age-ready.” It is intended for cities and towns as they prepare for an older urban age, offering examples and options to help younger cities visualize age-readiness while focusing primarily on the built urban environment. Its main audience is intended to be policymakers, city leaders, and implementing agencies, but it is also expected be useful to researchers, nongovernmental organizations, the private sector, and communities. This report fills four gaps in the policy literature on aging: • The literature so far has focused on the dependency ratio and its impact on the economic growth of aging economies, on social protection, especially in terms of pensions and the health and care needs of aging countries. It has not paid attention to urban planning and governance in the wake of demographic changes. • The policy literature has focused on the implications of aging at the national, subnational, and regional levels but not at the city level. • Even such literature as exists on aging in urban areas comes mainly from countries in the Organisation for Economic Co-operation and Development (OECD) because rates of both aging and urbanization are high in these countries. There is little evidence from, or guidance for, cities that may be young currently but will see their populations aging in the coming decades. • Finally, the policy literature has not addressed the issue of the built urban environment and the ways in which it needs to adapt to be ready for an aging city. 52 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER While envisioned for cities that will see varying degrees of aging in the next few decades, this report is also grounded in the ambition of the Sustainable Development Goals to “leave no one behind,” and especially in SDG 11: “Make cities and human settlements inclusive, safe, resilient and sustainable” (UN/DESA, n.d.c). Furthermore, its publication coincides with the United Nations Decade of Healthy Aging (2021–2030) and is anchored in the World Bank’s overarching program on inclusive cities. Why Focus on “Age-Ready” Cities? The trajectory of aging varies by city and country. Some cities are old, others are getting older, and still others are young. Cities that are already aged have likely put in place infrastructure and services to cater to their populations. Those that are aging or can envision an older resident profile in their futures are often putting in place mechanisms to deal with the new profile; the benefits of an age-ready city are clear to them. But why should the younger cities and countries care about aging that will occur several decades later when they have other pressing problems to deal with today? We offer six reasons in this report. 1. The age-readiness of a city has universal benefits. Investments in age-readiness have universal and wide-ranging benefits that go beyond older age groups. This assertion does not detract from the fact that older persons may have distinct needs and can make unique contributions, but it maintains that accessible infrastructure, for instance, benefits diverse groups of individuals—caregivers pushing strollers, travelers wheeling heavy luggage, or persons who may be convalescing and need extra help in getting around. 2. A strong overlap exists between aging and disability. An estimated 15 percent of the population worldwide have disabilities, and over 46 percent of persons aged 60 years and over have one or more. Just as the gains of the disability rights movement have benefited older persons disproportionately, so too will investments that help older persons benefit persons with disabilities. This includes investments in accessible signage in public places and in better acoustics in public buildings, among other improvements. 3. There is some evidence that the benefits of accessibility to society outweigh the costs. While robust cost-benefit analyses are hard to come by, a study commissioned by the U.S. Department of Justice to assess economic effects of changes to the Americans with Disabilities Act (U.S. Department of Justice, n.d.) is instructive. It found that the changes were “expected to generate total benefits to society that are greater than their measurable costs under all studied scenarios” (ibid.). Furthermore, putting accessibility features in place during construction often has economic and social advantages over retrofitting. This is especially important in resource-poor environments less likely to have the wherewithal to retrofit expensive infrastructure once it is in place. 53 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER FIGURE E.1. WHY FOCUS ON AGE-READY CITIES? 1 The benefits of age- 2 readiness are universal. Overlap between disability and aging needs to be especially underscored. 3 There are economic and social benefits of 4 “building better before” over retrofitting or adding accessibility features afterwards. Older persons constitute a large and growing market for goods and services. $ RETROFITTING OR ADDING ACCESSIBILITY BUILDING FEATURES BETTER $ AFTERWARDS BEFORE 5 Intergenerational transfer of resources occurs in both directions—young to old and old to young. 6 Many cities pride themselves on their vision of being “cities for all.” 54 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER 4. Older persons constitute a large and growing market for goods and services. The existing literature associates a likely slowdown in economic growth with aging, but there is also increasing evidence that the impact of aging is contingent upon myriad factors, and generalized statements about its negative economic impacts do not always hold. Economies with high proportions of older persons are untapped and growing markets for such areas as health care, housing, ICT solutions, and leisure, and they present a huge opportunity for entrepreneurship and innovation. The terms “silver economy” and “longevity economy” signal the market potential of goods and services targeted to aging populations (Donovan 2020; Coughlin 2019; Coughlin and Lau 2006). 5. Intergenerational transfer of resources occurs in both directions—young to old and old to young. Older persons are portrayed in the policy and popular literature primarily as recipients of fiscal and social transfers, with their role within families highlighted in terms of their care needs. In fact, transfers occur in both directions, in economies with strong systems of social pensions, older persons who have accumulated assets over their lifetimes transfer both income and wealth to the next generation. The nonmonetary role of older persons is equally salient. Not only are they the providers of child care in many societies, enabling younger generations— especially women—to stay in the labor market; they are also a source of cohesion and cultural continuity in families and the society. 6. Many cities pride themselves on a vision of being “cities for all.” Vision statements of cities across the world emphasize the ideal of an “inclusive city.” Most countries and cities are cognizant of their age structures and are committed to catering to diverse age groups. In rapidly aging cities, older persons and their families can form a strong constituency that demands more policies and programs that benefit them. In societies with strong norms of filial piety and reverence for elders, governments are under additional pressure to address the needs of older persons. Both the ideal of caring for diverse population groups and the political imperative of inclusion make age-readiness a priority for most cities. They may, however, need to make tradeoffs between competing priorities, and political will and a robust social contract will determine success. 55 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER This report argues that the age-readiness of cities is contingent upon the extent to which they are adaptive, productive, and inclusive. • In being adaptive, a city transforms or repurposes some of its existing infrastructure and services to respond to the new challenge of aging. • In being productive, the city sharpens its competitive edge through incentives for innovation that will drive the development of new products and services catering to the growing demands of and for an aging population. • In being inclusive, the city “enhance[s] the ability, opportunity and dignity of individuals and groups disadvantaged on the basis of their identity, to take part in society” (World Bank 2013) by working toward inclusion in the spatial, social, and economic realms (World Bank 2015). The attributes of being adaptive, productive and inclusive however, are interdependent (as figure E.2 shows) and interventions that advance one aspect often have implications for the other two. FIGURE E.2. ATTRIBUTES OF AGE-READY CITIES Transforming or repurposing existing infrastructure ADAPTIVE Creating incentives Enhancing the ability, and developing opportunity and dignity partnerships to PRODUCTIVE INCLUSIVE of older persons to take attract private part in the economy investment and and society innovation 56 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Building Age-Ready Cities Why not begin with an activity as old as the human race: asking the advice of the oldest people you know? Because older people have one thing that the rest of us do not: they have lived their lives. —Karl Pillemer “Ask the Aged” This report argues that an adaptive, productive, and inclusive city can transform itself to become age-ready. One of the overarching messages is that actions taken toward age- readiness are not just good for older persons; they have wide-ranging benefits that can lead to a better city for all. The report highlights six thematic areas relating to age-readiness that draw from the WHO Age-Friendly Cities framework (WHO 2007, 9) but focus FIGURE E.3. SIX ACTION AREAS TO ENHANCE AGE-READINESS IN CITIES Age-readiness through improved Efficient spatial transportation Making forms technology work for age- readiness Creating multigenerational Universal “spaces” toward design toward age-readiness age-readiness Housing solutions for age-readiness Alexzel / Shutterstock 57 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER primarily on the built environment. They include, as figure E.3 shows, universal design, housing solutions, creating multigenerational spaces, enhancing the physical mobility of older persons, use of technology, and the possibility of efficient spatial forms. 1. Universal design toward age-readiness: The idea of universal design was first articulated by Ron Mace in 1997 (Mace 1998) and is upheld by seven principles: equitable use, flexibility in use, simple and intuitive design, perceptible information, tolerance for error, low physical effort, and size and space for approach and use (Connell et al. 1997). The experience of the user is central to good design. Entry points for universal design include, among others, the preparation of building codes and regulations and the encouragement of their application not only to the creation of new buildings and public spaces but also to the reconstruction and retrofitting of existing ones. 2. Housing solutions for age-readiness: Living arrangements of older persons vary across different circumstances, cities, and countries, ranging from independent living to living in institutional settings to co-residing with families. Some older persons have the means and the ability to choose between aging in place and moving to an institutional care setting. Others do not, or they may live in cities with limited options and have to deal with basic, affordable housing (Molinsky and Airgood- Obrycki 2018). These older persons often live in areas that present greater barriers to aging in place comfortably and safely because of poor-quality habitations and unsafe conditions and in areas that are prone to environmental and other hazards. Such areas may also lack services (Rodwin and Gusmano 2006; Smith 2009). Regardless, for cities to cater to their older residents, homes and other spaces need to be adapted to their physical and cognitive needs so they can lead independent, safe, and dignified lives. 3. Creating multigenerational “spaces”: Decision makers in families, neighborhoods, and societies often believe older persons are best kept safe by confining them rather than integrating them (Papke 2020). Not only do older persons prefer “multigenerational spaces,” however, but evidence increasingly indicates that segregation is deleterious to their well-being and to society as a whole. The loneliness and isolation experienced by older persons living in segregated facilities, for example, can be attenuated by providing mixed-generation spaces (see Kang 2021 for Korea). Opportunities exist to provide multigenerational spaces in housing and community facilities, and the city has a preeminent role in offering incentives for the creation of such spaces, as well as in directly supporting them. 4. Age-readiness through improved transportation: Being able to get around to meet basic needs, engage in employment and recreation, and obtain services is essential for the well-being of all individuals. Older persons, however, have different patterns of mobility from younger ones in terms of where they go, how far they travel, at what times, how frequently, for what purposes, and using which mode of transport (Loukaitou-Sideris and Wachs 2018). Understanding these patterns and behaviors is very important to predict the use of transportation, as well as for devising policies 58 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Sunil lodhwal / Shutterstock for fare setting and transportation vouchers, among others. It is also important for the design of, for example, public spaces like waiting areas, walking paths, accessible entrances, and signage. 5. Making technology work for age-readiness: Technology is a boon, as has been amply demonstrated during the pandemic; it can ease the lives of everyone, and older persons are no exception. It also supports their caregivers and service providers, enables them to live independently longer, and enhances social connections and access to services, with huge impacts on their overall well-being. Yet technology can also be a bane, intensifying gaps in access between those who are conversant with and can afford it and those who are not and cannot. In addition, older persons tend to be less digitally literate than their younger counterparts, which makes them more susceptible to cybercrime. 6. Efficient spatial forms: Spatially concentrating resources and services can facilitate accessibility (particularly for those with limited mobility) and reduce the environmental footprint, and it is often cost effective, particularly in aging and shrinking cities. Transit- oriented development is one approach to achieving such efficient spatial forms. Even in the context of the pandemic, where city planners are revisiting the idea of compact cities, the benefits of urban forms that promote walkability, accessibility, and mixed land use spaces can be wide ranging. An age-ready city is, at its core, an inclusive city. In taking action towards age-readiness, cities move closer towards a goal that most of them espouse—building a city for all. Yet, older persons, like others, are not identified only by their age. They also have other characteristics—gender, disability status, location, income, marital status, and living arrangements, to name a few. As mentioned earlier, they contribute to society and the economy and often have political and social influence on the manner and extent to which city politicians deploy policies. All these possibilities can become reality only if cities take intentional action to ensure that older persons have the ability, opportunity and dignity to lead fulfilling lives. The issue of violence against, and ill-treatment of, older persons 59 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER deserves special mention because evidence indicates that such violence and victimization is pervasive and likely increasing, especially in light of the restrictions and vulnerabilities imposed by COVID-19 (Elman et al. 2020; Pillemer et al. 2016; WHO 2020b). Citizen voice and participation are essential to building age-ready cities. This includes the participation of not just older persons but anyone who is invested in the age-readiness of the city. Such participation is essential for a city to secure public support for investments in age-readiness, which has universal benefits. It is part of building a wider social contract and consensus around the idea of an age-ready city. How Can Cities Advance toward Age-Readiness? It is relatively easy to point to areas in which cities and other tiers of governments can intervene to bring about age-readiness. It is more difficult to suggest how this can be done. This report proposes six stylized steps to that end as figure E.4 illustrates. • First, build a long-term vision. Often, building age-readiness is a matter not of making large financial investments but of recognizing its importance and centrality to future actions. Vision statements are statements of intent and ambition on the part of the government. • Second, invest in data and analysis. Overall, city-level data are scarce, especially in non-OECD countries. An essential condition for evidence-based policy action, then, is the production of robust data and upstream analysis that identify city-level demographic trends and define the issues at hand, as well as the core needs of an age-ready city. FIGURE E.4. SIX STEPS TOWARD AGE-READINESS 1 2 3 Undertake comprehensive Build a Invest in consultations, not just long-term data and with older persons vision analysis but with all city stakeholders 4 5 6 Put into place Mainstream Design implementation age-readiness in appropriate arrangements and monitoring and actions revamp institutions evaluation systems as needed 60 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER • Third, undertake comprehensive consultations, not just with older persons but with all stakeholders in the city. Such consultations are important in devising a social contract that ensures all residents are invested in the vision of an age-ready city. Consultations are also important to detect any resistance and understand its source. Consultations would benefit the design, sequencing, and implementation of any reform actions. • Fourth, design actions toward age-readiness. How will a city mainstream aging issues into its overall policy framework? Will it design special programs? Will it focus on mainstreaming aging issues into existing programs? How will it adapt buildings and other infrastructure for universal accessibility? Will it need to retrofit infrastructure? What will be the role of the public and private sectors, of communities, academia, civil society, and external bilateral or multilateral institutions? These are questions the city will need to consider as it designs the actions it will take. • Fifth, put into place implementation arrangements and revamp municipal-level institutions to respond to the need for age-readiness, because the proof of policy actions is in their effective implementation. Such implementation takes place through existing systems, augmented systems, or reformed systems. It includes provision of services, contracting, management, and quality control and enforcement mechanisms. Overall, gearing institutions toward changing populations makes the institutions more responsive to their needs but can be politically, bureaucratically, and financially challenging. • Sixth, mainstream age-readiness in monitoring and evaluation systems. This is best achieved when cities are at early stages of aging, so that monitoring systems can be built into investments that seek to build age-readiness. Cities can also make use of community monitoring mechanisms that engage older persons to buttress the top-down monitoring systems. To summarize, Silver Hues: Building Age-Ready Cities illustrates the rationale for, and chalks out the contours of, age-readiness. It argues that planning for an aging city makes both economic and social sense. It profiles older persons as a diverse, growing cohort whose members are active agents in their social and political environments. It also shows that the availability, affordability, and accessibility of infrastructure and services can aid its transformation toward age-readiness. As more of its residents become aged, the city will, inexorably, have to address the challenges of an altered demographic reality, which makes early planning and implementation essential. In this context, COVID-19 presents an opportunity and an imperative to reimagine the city. Concomitantly, it presents a unique chance to integrate age-readiness into the new imagination. This may include expanding walkable spaces, improving street accessibility features, rethinking the design and layout of nursing homes, devising intergenerational housing solutions that benefit both older persons and young, integrating older persons into built and social environments, making greater investments in the care sector, addressing the gender dimensions of caregiving for older persons, and investing in technology solutions, among others. It is important, however, as cities pivot to a new reality after the pandemic that they keep age-readiness in mind. 61 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Endnotes 1 Although implemented since 1966, housing for the aged only became a priority in 1991. 2 Japanese housing also includes single-family homes and multiple-unit buildings that are owned by individuals or corporations and rented as apartments to tenants or owned by the occupants. A unique feature of Japanese housing is the scrap-and-build approach, by which homes gradually depreciate over a lifespan of 20 years (wooden buildings) to 30 years (concrete buildings). The reasons are several, including the low-quality construction that was used to meet demand quickly during the postwar years; repeated building code revisions to improve earthquake resilience; and poor maintenance cycles because owners lack incentive to make homes marketable for resale. See Ronald 2009 for further discussion. 3 This independent administrative agency established under the Act on the Urban Renaissance Agency, Independent Administrative Agency, is under the supervision of the Ministry of Land, In- frastructure, Transport, and Tourism. Its principal business encompasses urban renewal, new town development, disaster restoration, and rental housing, including housing for older persons. 62 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER References AARP. 2018. The Aging Readiness and Competitiveness Report: Japan. Washington DC: AARP. Abe, S. 2015. “What the United Nations Means for Japan.” Address by Prime Minister Shinzo Abe at the Symposium of the 70th Anniversary of the United Nations. United Nations University, Tokyo, March 16. https://www.mofa.go.jp/fp/unp_a/page3e_000310.html. AIA (American Institute of Architects). 2016. Design for Aging Review 13: 25th Anniversary: AIA Design for Aging. Mulgrave, Australia: Images Publishing Group. Apolitical. 2019. “Japan Wants to Help the Elderly by Making Cities More Dense.” April 8, 2019. https:// apolitical.co/en/solution_article/japan-wants-to-help-the-elderly-by-making-cities-more- dense. Arai, Y. 2019. Development Knowledge of Toyama City. Tokyo: World Bank. http://documents1.worldbank. org/curated/en/684691569561769406/pdf/Development-Knowledge-of-Toyama-City.pdf. Arai, Y., and M. Washio. 1999. “Burden Felt by Family Caring for the Elderly Members Needing Care in Southern Japan.” Ageing and Mental Health 3 (2): 158–64. BBC News. 2013. “Fujitsu Makes ‘Smart Walking Stick’ to Help Elderly.” February 28, 2013. Belles Demeures Magazine. 2019. “Sun City, the Premium Residence for the Seniors of Tashikawa, in Japan.” July 18, 2019, AIA 2016. Bloom, D. E., M. Kuhn, and K. Prettner. 2018. “Health and Economic Growth.” IZA Institute of Labor Economics Discussion Paper Series, no. 11939. Bonn: IZA Institute of Labor Economics. Brucksch, S., and F. Schultz. 2018. Ageing in Japan. Domestic Healthcare Technologies. Tokyo: German Institute for Japanese Studies Tokyo. Das, M. B., and S. K. Mehta. 2019. Building Visionary Cities: Social Inclusion in Japan. Tokyo: World Bank Group. De Roo, G., and D. Miller, eds. 2000. Compact Cities and Sustainable Urban Development: A Critical Assessment of Policies and Plans from an International Perspective. Aldershot, UK: Ashgate. Economist. 2017. “Japan Is Embracing Nursing-Care Robots.” November 23, 2017. Evans, N. 2002. “Machi-zukuri as a New Paradigm in Japanese Urban Planning: Reality or Myth?” Japan Forum 14 (3): 443–64. Fifield, A. 2018. “Cleaning Up after the Dead.” Washington Post. January 24, 2018. Foster, M. 2018. “Aging Japan: Robots May Have Role in Future of Elder Care.” Reuters. March 28, 2018. Geospatial Information Authority of Japan. 2019. December 26 (in Japanese). https://www.gsi.go.jp/ ENGLISH/page_e30233.html. Accessed May 25, 2020. Gilhooly, R. 2015. “Growing Old, Gracefully: Senior Citizens in the Workplace.” Japan Times. December 19, 2015. JapanGov. 2018. Abenomics: For Future Growth, for Future Generations, and for a Future Japan. Government of Japan. https://www.japan.go.jp/abenomics/index.html. Accessed June 14, 2020. 63 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Heine, S. 2008. Zen Skin, Zen Marrow: Will the Real Zen Buddhism Please Stand up? Oxford: Oxford University Press. Hiraoka, K. 2006. “Long-Term Care Insurance in Japan.” In Handbook of Asian Aging, edited by H. Yoon and J. Hendricks, 355–381. New York: CRC Press. Hirayama, Y. 2010. “The Role of Home Ownership in Japan’s Aged Society.” Journal of Housing and the Built Environment 25: 175–91. Hori, S. 2010. “A Study on the Change of Functions of a Senior College: A Comparative Study in Nishinomiya City Senior College in 10 Years.” Japanese Journal of Gerontology 32 (3): 338–47. Hori, S., and S. Cusack. 2006. “Third Age Education in Canada and Japan: Attitudes toward Aging and Participation in Learning.” Educational Gerontology 32 (6): 463–81. Hoshi, I., S. Yamaguchi, and N. Takada. 2017. “Changes in Elderly Employment and New Roles of ‘Silver’ Human Resources Centers.” NRI Papers No. 214. Tokyo: Nomura Research Institute. Japan Health Policy NOW. n.d. “Long-Term Care Insurance.” http://japanhpn.org/en/longtermcare/. Japan Times. 2019. “Rising Numbers of Elderly People Are Living Alone.” May 3, 2019. ———. 2020a. “AI Speakers Play Growing Role in Daily Life of Japan’s Seniors and Disabled.” September 29, 2020. ———. 2020b. “Elderly Care Providers in Japan Closing to Ride Out Virus Crisis.” April 25, 2020. Jenks, M., E. Burton, and K. Williams, eds.1996. The Compact City: A Sustainable Urban Form? London: Spon Press. Kabisch, N., H. Korn, J. Stadler, and A. Bonn, eds. 2017. Nature-Based Solutions to Climate Change Adaptation in Urban Areas. Cham, Switzerland: Springer. Kiyota, E., Y. Tanaka, M. Arnold, and D. Aldrich. 2015. Elders Leading the Way to Resilience. Washington, DC: World Bank. Kobayashi, M. 2015. “Housing and Demographics: Experiences in Japan.” Housing and Finance International, Winter, 32–38. https://www.jhf.go.jp/files/300304336.pdf. Kose, S. 2019. “Ageing in Place: Japan’s Struggle towards Its Realization.” In Urban Environments for Healthy Ageing: A Global Perspective, edited by A. Lane. London: Routledge. Lewis, T., ed. 2017. Green Asia: Ecocultures, Sustainable Lifestyles and Ethical Consumption. London: Routledge. Machida, D. 2019. “Relationship between Community or Home Gardening and Health of the Elderly: A Web-Based Cross-Sectional Survey in Japan.” International Journal of Environmental Research and Public Health 16: 1389. https://doi.org/10.3390/ijerph16081389. Mackellar, L., T. Ermolieva, D. Horlacher, and L. Mayhew. 2004. The Economic Impacts of Population Ageing in Japan. Cheltenham: Edward Elgar. Makigami, K., and J. Pynoos. 2002. “The Evolution of Home Modification Programs in Japan.” Aging International 27 (3): 95–112. Marlow, I. 2015. “Japan’s Bold Steps,” Globe and Mail, November 13, 2015. 64 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Matsuda, S., and M. Yamamoto. 2001. “Long-Term Care Insurance and Integrated Care for the Aged in Japan.” International Journal of Integrated Care 1(3). https://doi.org/10.5334/ijic.39. McCay, L., E. Suzuki, and A. Chang. 2017. “Urban Design and Mental Health in Tokyo: A City Case Study.” Journal of Urban Design and Mental Health 3 (4). https://www.urbandesignmentalhealth.com/ journal-3---tokyo-case-study.html Ministry of Health, Labour, and Welfare. 2008. Vital Statistics of Japan. Tokyo: Ministry of Health, Labour, and Welfare, Japan. Ministry of Land, Infrastructure, and Transport. 2003. The 2003 Survey of Housing Demand. Tokyo: Ministry of Land, Infrastructure, and Transport, Japan. ———. 2005. General Principles of Universal Design Policy. Tokyo: Ministry of Land, Infrastructure, and Transport, Japan. Mori, M. 2016. “Aiming for a Sustainable City that Creates Added Value and Is Full of Social Capital.” Presentation to a working group for the International Forum on the “Future City” Initiative, Yokohama, Japan, August 30, 2016. Morikawa, M. 2014. “Towards Community-Based Integrated Care: Trends and Issues in Japan’s Long- Term Care Policy.” International Journal of Integrated Care 14 (1). https://doi.org/10.5334/ ijic.1066. Morimoto, T., A. S. Schreiner, and H. Asano. 2003. “Caregiver Burden and Health-Related Quality of Life among Japanese Stroke Caregivers.” Age and Ageing 32:218–23. Murakami, K., R. Gilroy, and J. Atterton. 2009. “Planning for the Ageing Countryside in Japan: The Potential Impact of Multi-Habitation.” Planning Practice and Research 24 (3): 285–99. Muramatsu, N., and H. Akiyama. 2011. “Japan: Super-Aging Society Preparing for the Future.” Gerontologist 51 (4): 425–32. Nikkei Weekly. 2010. “Boomers Wield Financial Clout.” January 11, 2010. Nippon.com. 2019. “The Aging of Japan’s “New Town” Public Housing Complexes.” Nippon.com. https://www.nippon.com/en/japan-data/h00475/the-aging-of-japan’s-new-town-public- housing-complexes.html. Accessed October 9, 2020. OECD (Organisation for Economic Co-operation and Development). 2015a. Ageing in Cities: Policy Highlights. Paris: OECD. ———. 2015b. Health at a Glance 2015: OECD Indicators. Paris: OECD. ———. 2019. Government at a Glance 2019. Paris: OECD. ———. 2020. How’s Life in Japan? Paris: OECD. Ogawa, N., and R. D. Retherford. 1997. “Shifting Costs of Caring for the Elderly Back to Families in Japan: Will It Work?” Population and Development Review 23 (1): 59–94. Ogura, S., and R. Suzuki. 2001. “Concentration and Persistence of Health Care Costs for the Aged.” In Aging Issues in the United States and Japan, edited by S. Ogura, T. Tachibanaki, and D. Wise, 187–222. Chicago: University of Chicago Press. 65 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER Ohara, K. 2006. “New Trials of the Elderly Living in Japan: Community-Based Care Facilities.” ENHR International Conference, Ljubljana, Slovenia, July 2–5, 2006. Olivares-Tirado, P., and N. Tamiya. 2014. Trends and Factors in Japan’s Long-Term Care Insurance System. Cham, Switzerland: Springer. Osawa, E., and Y. Fujiwara. 2019. “Case of Active Ageing in Japan.” In Holistic and Comrehensive Strategies for Asian Ageing Society from the Perspective of “Active Ageing,” edited by H. Miura. Toyota Foundation. Pacific Bridge Medical. 2014. “The Expanding Home Healthcare Market in Asia,” May 14, 2014. https:// www.pacificbridgemedical.com/publication/the-expanding-home-healthcare-market-in- asia/. Ronald, R. 2009. “Privatization, Commodification and Transformation in Japanese Housing: Ephemeral House—Eternal Home.” International Journal of Consumer Studies 33: 558–65. Runzo-Inada, J. n.d. “Toyama’s Compact City Strategy.” City of Toyama, Japan. Shimizutani, S. 2006. “Japan’s Long-Term Care Insurance Program: An Overview.” Revue Suisse D’economie et de Statistique 142 (1): 23–28. Sorensen, A., and C. Funck. 2009. Living Cities in Japan: Citizens’ Movements, Machizukuri and Local Environments. London: Routledge. Statistics Japan. n.d. Prefecture Comparisons. https://stats-japan.com/t/kiji/13400. Accessed December 6, 2020. Statistics Bureau of Japan. 2015. 2015 Population Census. Summary of the Results and Statistical Tables. Tokyo: Ministry of Internal Affairs and Communications, Japan. ———. 2018. Statistical Handbook of Japan 2018. Tokyo: Ministry of Internal Affairs and Communications, Japan. Suzuki, N. 2020. “Japan’s Seniors Trapped between Infection and Frailty as Pandemic Drags On.” Japan Times, May 4, 2020. Takeo, Y., and H. Dormido. 2019. “Japan’s Population Problem Is Straining Its Economy. The World’s Watching for a Solution.” Bloomberg, September 20, 2019. https://www.bloomberg.com/ graphics/2019-japan-economy-aging-population/. Accessed June 14, 2020. Tamiya, N., H. Noguchi, A. Nishi, M. R. Reich, N. Ikegami, H. Hashimato, K. Shibuya, I. Kawachi, and J. C. Campbell. 2011. “Population Ageing and Wellbeing: Lessons from Japan’s Long-Term Care Insurance Policy.” Lancet 378:1183–92. Tanaka, Y. 2016. “Ibasho House: A Common Place in an Aging Local Community.” Nippon.com, August 30, 2016. https://www.nippon.com/en/features/c02802/. Accessed June 24, 2020. Taniyama, T. 2009. “Housing Policy to Support the Lives of the Elderly.” Journal of National Institute of Public Health, 58 (2), 78–83. Taylor, A. 2018. “Japan Sets a New Record Number for People over 100 Years Old—and Almost All Are Women.” Washington Post, September 14, 2018. Tokyo Metropolitan Government. 2016. New Tokyo. New Tomorrow. The Action Plan for 2020. Tokyo Metropolitan Government. 66 SILVER HUES: BUILDING AGE-READY CITIES JAPAN BACKGROUND PAPER ———. n.d. Tokyo’s History, Geography, and Population. Tokyo Metropolitan Government. https://www. metro.tokyo.lg.jp/ENGLISH/ABOUT/HISTORY/history03.htm. Accessed June 13, 2020. Toyama City. 2018. Toyama City: The Sustainable Development Goals Report 2018. Toyama City, Japan. UN (United Nations). 2015. World Population Ageing. New York: United Nations Department of Economic and Social Affairs, Population Division. UNDP (United Nations Development Programme). 2019. Human Development Report 2019. New York: UNDP. University of Tokyo, Urban Renaissance Agency, and City of Kashiwa. 2018. Kashiwa-Toyoshikidai Projects for Enabling Age-friendly Communities: Achievements and Future Challenges. http://www. glafs.u-tokyo.ac.jp/wp-content/uploads/2018/07/35222084446b30b77df3f23690141037. pdf. Accessed August 22, 2020. Urban Renaissance Agency. n.d. UR Profile. https://www.ur-net.go.jp/profile/english/pdf/profile_en_all. pdf. Accessed October 9, 2020. Watanabe, S., S. Kodama, H. and Hanabusa. 2018. “Longevity and Elderly Care: Lessons from Japan.” Global Health Journal 2 (4): 5–10. Weiss, R. S., S. A. Bass, H. K. Heimovitz, and M. Oka. 2005. “Japan’s Silver Human Resource Centers and Participant Well-Being.” Journal of Cross-Cultural Gerontology 20:47–66. World Bank. n.d. Economic indicators. https://data.worldbank.org/indicator/NY.GDP.MKTP. CD?locations=JP. Accessed May 28, 2020. Xu, H., and Y. Zhou. 2019. “Public Housing Provision and Housing Vacancies in Japan.” Journal of the Japanese and International Economics 53: 101038. https://doi.org/10.1016/j.jjie.2019.101038. Yang, G. Z., B. J. Nelson, R. R. Murphy, H. Choset, H. Christensen, S. H. Collins, P. Dario, K. Goldberg, K. Ikuta, N. Jacobstein, D. Kragic, R. H. Taylor, and M. McNutt. 2020. “Combating COVID-19: The Role of Robotics in Managing Public Health and Infectious Disease.” Science Robotics 5 (40). https:/ /robotics.sciencemag.org/content/5/40/eabb5589. Yoshimura, K. 2010. “University of Tokyo Transforming Kashiwa into City for the Elderly.” Japan Times, April 2, 2010. https:/ /www.japantimes.co.jp/news/2010/04/02/national/university-of- tokyo-transforming-kashiwa-into-city-for-the-elderly/#.XuTcTC2Q1j5. Zeiba, D. 2020. “BIG’s First Project in Japan Is a High-Tech Mobility Incubator for Toyota.” Architects Newspaper, January 7, 2020. 67