Kerala's Japanese model for ageing population: What 'Kaigo Hoken' prioritises

The special department being established in Kerala exclusively for senior citizens is the first initiative of its kind in the country. The initiative aims to formulate new welfare schemes for the elderly and to ensure the coordinated and integrated implementation of existing programmes across various departments. 

The project is modelled on the Long Term Care Insurance (LTCI) programme implemented in Japan, widely regarded as one of the most effective elderly care systems in the world. During the announcement of the new department, Chief Minister V D Satheesan highlighted Japan’s pioneering approach to senior citizen welfare as a model worth emulating. But what exactly makes the Japanese system stand out as a global benchmark in elderly care?

A welfare model the world looks up to
Japan underwent a major demographic transformation in the 1990s, marked by steadily declining birth rates and a simultaneous rise in life expectancy, which together resulted in a rapidly ageing population. At the same time, the traditional joint family system began to shrink, leaving the responsibility of caring for elderly parents largely in the hands of women within households. This, in turn, triggered a steep rise in healthcare and caregiving costs.

Amid these changes, a realisation began to take shape in Japanese society: elderly care could no longer remain the responsibility of families alone but had to be treated as a collective social responsibility.

It was against this backdrop that Japan launched its nationwide Long Term Care Insurance programme, popularly known as Kaigo Hoken, in April 2000. Conceived as a solution to the country’s rising elderly population, changing family structures, and the increasing difficulty of relying solely on family members for care, the programme has since evolved into one of the world’s most systematic and admired models of elderly care.

The LTCI system functions as a mandatory public insurance scheme for all residents aged 40 and above. Its core objective is to ensure affordable, high-quality long-term care for senior citizens while easing the caregiving burden traditionally carried by families.

How the Japanese care model is implemented
The programme is being implemented by categorising beneficiaries into two groups. Those aged 65 and above fall under the first category, while individuals aged 40 to 64 fall under the second.

People in the first category are required to pay a special premium directly to the local government, whereas those in the second category contribute through their existing health insurance plans. The programme runs as a shared responsibility model between the government and citizens, funded equally through public taxation and mandatory insurance premiums.  

All individuals aged 65 and above are eligible for benefits, regardless of income. Those between 40 and 64 can also avail themselves of support if they require long-term care due to age-related conditions such as the early onset of dementia or terminal cancer.

Care needs certification
Japan has a special assessment system to determine the level of care required by elderly individuals. Both physical and mental health conditions are evaluated as part of the process.

A multidisciplinary team comprising doctors, nurses, psychologists and pharmacists prepares personalised care plans suited to each individual’s needs. Priority is given to addressing conditions such as dementia, physical frailty, falls and malnutrition.

Applicants must first submit a formal request for assessment, following which medical examinations and interviews are conducted. Based on the findings, individuals are certified according to the extent of assistance they require, ranging from minimal support to intensive long-term care.

Key benefits 
One of the biggest achievements of the programme has been the significant reduction in the caregiving burden borne by family members, especially women. It has also reduced the need for prolonged hospital admissions among the elderly. At the same time, the programme has led to a substantial expansion of employment opportunities in the caregiving and healthcare sectors.

'A vision for dignified ageing in Kerala'
Commenting on the initiative, Chief Minister V D Satheesan said this would be the first time in the country that a State is moving to establish an exclusive department dedicated to senior citizens. He added that the procedures for setting up the department are expected to be completed within two months.

“If we are to present ourselves before the world as a progressive society, Kerala must develop systems and policies that embrace the elderly with dignity, compassion and care. The objective is not merely to create another department with a secretary and a few officials. This Department for Senior Citizens is envisioned with transformative and far-reaching goals,” he said.

A hopeful new beginning for Kerala’s elderly
The demand for a dedicated department for senior citizen welfare has long been echoed by civil society and organisations working closely with the elderly in Kerala. At present, welfare schemes for senior citizens remain scattered across multiple departments, including Social Justice, Health, Local Self Government, Women and Child Development, Education, and Home Affairs. 

The proposed department aims to bring these initiatives under a single umbrella, ensuring better coordination and a more integrated approach to elderly welfare services. A key focus will be on creating a centralised system that delivers welfare services directly to the doorsteps of senior citizens, making support more accessible, efficient, and seamless.

Special emphasis will be placed on dignified ageing, improved healthcare services and community-based care. There is also growing optimism that the initiative will pave the way for new welfare programmes tailored to the needs of the elderly population. The government plans to complete the preliminary procedures for setting up the department within the next two months.

Longer lives, growing challenges
Kerala is among the fastest-ageing States in the country, with a significant share of its population now aged 60 and above. Rising life expectancy and declining birth rates have steadily increased the number of senior citizens in the State year after year.

Experts estimate that by next year, nearly one-fourth of Kerala’s population will be elderly. Alongside this demographic shift, the elderly community is increasingly facing challenges such as changing family structures, loneliness, health issues, financial insecurity and neglect. The proposed initiative aims to address these growing concerns through a more comprehensive and coordinated welfare system.

Kerala
Total Population: 36.2 million
Senior Citizens: 6.8 million
Japan
Total Population: 122.4 million
Senior Citizens: 44.6 million