Comsn Scandal Sheds Light on Problems of Nursing Care Insurance System

Profit-making Enterprises Cannot Ensure Stable Post-Retirement Life

 Unjust practices by Comsn, Inc., the largest nursing care service provider in Japan, have recently been revealed. (*) With the administrative punishment from the Ministry of Health and Labor, Comsn decided to withdraw from the nursing care business. This inflicted an extensive impact on 65,000 elderly patients and their families who have turned to Comsn’s services and 24,000 workers of the company. Indeed, malicious service providers should be duly punished. However, this incident is not merely a problem caused by a particular care provider. Let us explore deeper into the case, in order to find a way for a safe and stable “old age” life for all.

*What is Comsn Scandal?

Comsn, Inc., a nation-wide nursing care provider, made fraudulent applications for business licenses of their service offices, registering fictitious names as their home-care workers. Comsn tried to shirk away by reporting business closure of these offices before the government takes measures to cancel their licenses. Later, unfair billings for their nursing care services were also revealed. In June 2007, the Ministry of Health and Labor decided to reject Comsn’s applications for new business, or renewal of existing business. As a result, Comsn virtually closed 1655 of its 2081 service offices, and decided to withdraw from the home-visit nursing business. The parent company of Comsn is The Goodwill Group, Inc., which owns Crystal Group, which made the headlines for deceptive contracting works, and employment agencies to dispatch day-workers.

 Assistant General Secretary Hayashi Yasunori of Min-Iren (Japanese Federation of Democratic Medical Institutions), who is in charge of the nursing care and welfare division, points out the prime responsibility of the Ministry of Health and Labor, saying, “It should be held accountable for opening the way of public services for private corporations, whose prime mission is to make profit for providing dividend to their shareholders.” He says, “When the public nursing-care insurance system started in 2000, Comsn launched 1,200 service stations all at once, but within 2 months, closed 40% of them. The reason for the closure was that they were “unprofitable.” These profit-driven corporations completely lack the sense of responsibility for nursing old people in the community. Such profit-first nature of private corporations based on market principle is incompatible with the public nature required for nursing care.”

“Priority Given to Sales Over Users’ Needs”: Testimony of an ex-Comsn worker
 Ms. A, who used to work as the head of Comsn’s service station says, “I expected the news would come soon.” Having been a home-helper, she became a Comsn worker when the nursing care insurance system started. “Immediately I found myself having difficulty in working,” she says. All the reports from the top management are related only to the sales at each service station. The company’s president himself would visit top-ranking stations to reward them. Top priority was given to making profit only.
  In such an atmosphere, Ms. A was led to be more conscious of profit. When a request came from a new user for housework help, she declined to undertake the service, because “the remuneration for household work is, compared with that for physical nursing care service, is low. Before, I never refused our service to people in whatever condition, but since she started working in Comsn, priority shifted from patients’ needs to increased sales. Driven to compete for profits, my sense of right or wrong was becoming numb.” Shortly afterward, Ms. A left the company.
 The quality of nursing service, too, apparently deteriorated. Home-helpers try to make each of their visits at users’ homes as short as possible. “When the contracted time comes, a helper may leave, even when the preparation for meals is only half-way done. Worse, even when a user suddenly falls unconscious, or become choked with food in the face of a helper, she may leave the house at the given time, without calling an ambulance or reporting to her office manger for guidance. That’s the kind of nursing care provided by a business company. But nursing care cannot be a commercial product. The more I wonder how it should be improved, the more I want the system to go back to its previous form, where the government was responsible for providing nursing care to the patients”, Ms. A says.
 Apprehension about these problems arising from the privatization had been expressed even before the nursing care insurance system was launched. One expert commented, “Commercial companies pursue as their biggest organization target the ‘maximum profit’, whereas non-profit corporations try to achieve the ‘optimum profit’ ? only one word makes a huge difference.”
 Comsn was a symbol of private companies’ entry into nursing care industry. At the start of the nursing insurance system, Comsn said boastfully, “Nursing care is evolving from welfare to service.” But after 7 years have passed, Comsn has become a prime evidence of contradictions and problems of this system. With the entry of private businesses, there has been a competition over profit, but never an improvement in the quality of services. The Ministry of Health and Labor is now required to admit its mistake, in designing the current nursing care insurance system and conduct an overall review of it.
 Hayashi of Min-Iren says, “Another problem that surfaced through the scandal is an extremely harsh working condition of home helpers.” The following charts on those working for home-visit care illustrate their very unstable employment condition and low salary they receive.

Monthly salary of nursing care professionals:

(Average: 172,400 yen; Average age: 43.5)
Less than 150,000 yen: 4.1%
150,000 – less than 200,000 yen 27.1%
200,000 – less than 250,000 yen 28.1%
250,000 – less than 300,000 yen 15.1%
300,000 – less than 350,000 yen 6.8%
350,000 – less than 400,000 yen 2.6%
More than 400,000 yen 0.2%
No answer 16.0%

Unstable employment of home-visit workers:

Permanent employees: 21.7%
Nonpermanent employees: 72.7%

Low Care Payment Causes Difficulties
 “Except for some major companies like Comsn, generally, home-visit nursing care is provided by local agencies, most of them small-sized. As the government tries to suppress the expenditure for nursing care and keeps remuneration for care very low, the wages for caregivers will not rise”, Hayashi says.
 After the revision of the care payment in 2005 and 2006, it was lowered by 2.4%. This was done on top of the 2.3% decrease in 2003. So, ever since the public nursing-care insurance system was introduced, the care payment has never been raised. Agencies management efforts, such as cuts in personnel and other costs, have reached the limits.
 Because of such poor working conditions, it is difficult to secure human resources. With the decrease of aspirants of nursing care workers, some nursing care schools suffer the shortage of applicants. 20% of workers in this industry leave their jobs in less than one year. There is no guarantee for time or money to train newcomers to become full-fledged professional home-helpers.
 “When new workers join, we want to escort them to users’ homes to help them learn. But as the remuneration is paid only to one person, we cannot escort them as we wish. Therefore, even when new helpers feel insecure, we are obliged to send them off to users, saying, ‘I’m sure you can do it alone.’”

“I want to continue the nursing care work, but….”
 A number of home-helpers, having acquired certain level of skill and knowledge, and feeling that their work is rewarding, often face with the dilemma: “I want to continue this work, but it is not possible.” Risa, age 33, a home-helper working at a non-profit corporation is one of them. She says, “I cannot say I will continue this work all my life.”
 Wanting to work to help other people, Lisa quit her job as an office worker and became a home-helper three years ago. Every day, she goes to her users’ homes directly from home and work there, and after all her works at several houses are finished, she comes home. She covers a wide range of work, from such household works as meal preparation, house cleaning, and laundry to physical nursing care service. Helping more than one person to take a bath in one day would tire her out completely. It is a very tough work.
 But she thinks her work is rewarding. Often she faces typical cases of “poor and lonely old people living in difficult conditions.” Sometimes she needs to start her nursing care with setting a human living environment, by removing rotten bed quilts or tatami mats under the patient’s body, cleaning the portable toilet filled with feces and other garbage, etc. There are many homes without air-conditioning or hot water. For the patients who have never taken a bath for months, she carefully cleans their feet, replacing hot water again and again. Some elderly persons with senile dementia live alone in their homes, though they cannot eat anything if they are not served to their mouths by a care-giver. Facing such difficult conditions of old people, Risa strongly feels that her work is the only support for their lives.
 Her hourly pay is 1,000 yen, which at first glance seems not so bad. However, the payment is made only for the hours spent at users’ homes. On contract, her working hour is 36 hours from Monday to Saturday, but with the time for transportation and waiting, her binding hour would naturally get longer. Her income divided by actual binding hours would be 600 yen, below the minimum wage.
 With only 150,000 yen or so disposable income, it is difficult to live independently from her parents. There is a chance to become a regular employee, but she cannot decide to go for it, as full-time, regular employment means more work and binding hours but possible income would not rise accordingly. She has tried to find a job with better working conditions, but has found none. “Our government treats the elderly people as “burdens”. No wonder our work to support those “burdensome” people would not be respected”, says Risa. She further says, “Nursing care workers and the old people who receive their care should join hands to raise their voices for the improvement of the current nursing care system. To that end, it is important to inform the public of the actual working conditions of us, care-givers.”

One day in the life of Home-helper Risa:


8:40am: Leaving home
9:00 Arriving at Mr. A’s home; Household help (house cleaning
10:30 Leaving Mr. A’s home
10:45 Break at a nearby community park to drink water
11:00 Arriving at Ms. B’s home; Household help (house cleaning, laundry, mealpreparation; change of clothes and preparation of the user to go to a day-care center)
12:30 pm: Leaving Ms. B’s home; Transfer to home
12:40 Arriving home; lunch
12:45 Leaving home again
13:00 Arriving at Mr. and Mrs. C’s home; Household help work (house cleaning);
(*1 hour for each user)
15:00 Leaving Mr. and Mrs. C’s home; Heading toward home
15:15 Arriving at home; Lunch and Rest
16:30 Leaving home again; Transfer to another user’s home
17:00 Arriving at Mr. D’s home; Household help and physical nursing care work (shopping;meal preparation, house cleaning, help in cleaning)
19:00 Leaving Mr. D’s home
19:30 Arriving home


* Hourly payment of 1,000 yen is paid only for the time to give actual services. Her earns 6,000 yen on this day but her binding time is 10 hours from 9 am to 19 pm, which makes her hourly wage as low as 600 yen.
* 180 yen of transfer-time payment is paid for each transfer between users’ homes, but if the waiting time is over 2 hours, it will not be paid.
* The motorbike Risa uses to make visits is her possession.
* 50 yen per 1 kilometer of travel distance is paid as compensation for transportation.

* * * * *

 “The structure of the current low care payment system makes it difficult to provide or continue the nursing care services to meet the needs of the users. This is the main cause to weaken the nursing care infrastructure of local communities”, Hayashi points out. He says, “The aging of the Japanese society will further accelerate. Nursing care payment should be raised. At the same time, in order to ease the already heavy burden on the users, the State government must use more tax money to the nursing care. Let us take the opportunity of the recent scandal to raise our voices and question, ‘for whose benefit and for what purpose the nursing care insurance system was introduced.’”