Dialogue: Changing the Future of Nursing Care–Tackling Social Challenges the SOMPO Care Way

Dialogue: Changing the Future of Nursing Care ― Tackling Social Challenges the Sompo Care Way

Mr. Hideto Kawakita has been providing third-party comments on our annual CSR Communication Reports since 2001. In 2020, the year that marks the 20th anniversary of the introduction of the long-term care insurance system, the COVID-19 pandemic shone a new spotlight on the importance of the care industry to our society. In this latest dialogue with Mr. Kawakita, Satoshi Kasai discusses how the Sompo Group is tackling social challenges by bringing a new approach to long-term care and shares the challenges and expectations facing the Group. (Date of Dialogue: July 27, 2020)

Satoshi Kasai
Chief Executive Officer at Sompo Care Inc.
CEO of Nursing Care & Healthcare Business, Sompo Holdings, Inc.

（The affiliation, titles, etc. in a sentence are as at the time of dialogue）

Sompo Care's Work during COVID-19 Pandemic

Kasai: Although we have previous experience of dealing with infectious diseases such as influenza, nothing has made us as nervous as COVID-19 has. During the state of emergency, we paid our frontline staff a special daily bonus of 3,000 yen to show our gratitude to their commitment to continuing service in the face of the risk of infection. When we spoke to our frontline workers, it was clear that they were more concerned about the risk of passing infection to the long-term users of our services rather than their own safety and were making sacrifices in their day-to-day life to minimize the risk. The state of emergency may have ended, but Sompo Care's task force remains in operation across the country at the same high level of alert and is working to minimize the risk of infection, as well as handling contact tracing and isolation when positive cases emerge, and mobilizing support staff.
I feel that the COVID-19 pandemic has made the Japanese society realize how valuable social care work is. The government's decision to pay care workers the frontline workers’ bonus showed that care workers were appreciated and supported just as much as medical workers, which was a welcome boost to our morale. Our workforce is responding to this support with a renewed determination to step up to the plate. Care workers are committed to providing the best possible frontline service in a challenging situation, and it is paramount that we address problem of the difficult working conditions in the sector.
Due to the risk of coronavirus infection, we are currently asking the families of service users not to visit them. This led to some of the users to worry that their family has died. Recognizing the problem, we have started facilitating online virtual visits, which has been warmly welcomed. This initiative has had an added bonus of making visits easier for families who live far away and had not previously been able to visit as often as they would have liked. We intend to continue trying new initiatives like this, not only as we tackle novel coronavirus today but also beyond in the post-coronavirus future.

Kawakita: Have you been reviewing your business continuity plan (BCP) in the face of this pandemic? Are there any changes you have made to meet the challenge?

Kasai: We had plans to deal with pandemics of infectious diseases already, but the spread of COVID-19 has given us an opportunity to establish a detailed action workflow, which can serve as a manual, and I think this is a progress. Also, we must consider the possibility of natural disasters coinciding with an outbreak of an infectious disease. As we face the typhoon season, we are very concerned about the risk of flooding in the facilities located near rivers. It would not be easy to evacuate people to safety and support their needs while maintaining physical distancing. We see this as a challenge we still need to examine and address.

Kawakita: I asked before if you would be able to develop a version of Sompo Japan’s Disaster Risk Reduction Service for welfare facilities similar to the policy already offered to local governments. These facilities can get a small amount of compensation for the cost of evacuation if the Disaster Relief Act is applied, but in cases where the Act is not applied, they receive no financial reward for preparedness. If such an insurance policy is difficult to develop, due for example to the frequency of such damage occurring, would it be possible to introduce some sort of mutual aid scheme for care facilities and their supporters, perhaps in collaboration with Sompo Risk Management? For social welfare corporations, converting retained earnings into insurance coverage would also lead to more investment into their BCPs. It would be wonderful if the Sompo Group could use its expertise in providing a coverage for the preparedness of care providers.

Kasai: We are a joint-stock company rather than a social welfare corporation so the organizational framework is different, but the idea of using the retained earnings of social welfare corporations for insurance is very interesting.

Kawakita: The 2017 amendment of the Social Welfare Act sought to make retained earnings of social welfare corporations visible and encourage reinvestment for the benefit of the local community. Many social welfare corporations choose measures for community development such as mobility services and shopping assistance, but taking an insurance cover would be a good way to invest into the local community that also strengthens BCPs.

Understanding the Care Service Environment and Future Challenges

Kasai: In terms of business environment, the care sector is a growing industry with a potential of an average 5% growth per year if you consider that the amount of care insurance payouts is expected to grow from the current ten trillion yen to around 15 trillion yen by 2025. Meanwhile, with the working population shrinking, it is clear that we are facing a shortage of care workers. The government is forecasting an increase, which is overoptimistic in my opinion. Even if the number goes up as the government expects, it would not be enough to meet the growing demand for care services without a 30% improvement in productivity. The financial viability of the care system also looks bleak.
Given this context, we are exploring new approaches in long-term care using productivity-improving technologies and data. Here are some of these initiatives:

Future Care Lab in Japan:

The Future Care Lab in Japan , a purpose-built facility for trialing and testing new care and welfare technologies, aims to use technology to support the independence of residents and maintain and improve their QOL as well as reducing the physical and mental burdens on care workers and providing a good working environment. We would like to improve both quality and productivity and translate these gains into better work conditions for care workers. The average annual income of care workers is currently around 3.3 million yen; we aim to increase this.
An example of such a new technology is the Nemuri SCAN, a sleep sensor mat that can monitor users' sleep remotely and collect vital signs data such as breathing and heart rate. Already introduced in around 30 facilities, the product is helping to reduce the workload of night watch staff. Users also benefit as fewer night watch patrols mean less disruption to their sleep. We plan to introduce the product in all of our long-term care facilities, which house about 18,000 users in total. We are also exploring the potential value of a real-data^*1 strategy like this. Once it is possible to collect a large amount of data at care facilities daily, we may then be able to learn new methods of analyzing personal data such as "medication vs. sleep" and "meals vs. sleep" in order to provide better service. We believe that this approach will show us a new vision of long-term care for the future.

1. Data relating to real-world activities of individuals and companies collected through sensors such as health information

Read-data Strategy:

Sompo Holdings has formed a collaborative partnership with Paramount Bed Holdings Co., Ltd., through which we seek to use real data to provide high added-value services and give everyone a bright future full of hope. We are building a platform to support unified data management by digitalizing all information associated with business activities, including real data aggregated from this partnership. This platform will enable Sompo Care to provide science-based care built on solid evidence rather than relying on staff's experience or intuition.
For example, where care services and interventions such as medication and food cause a change from state A to state B, we may be able to predict how the state of the person may change next by quantifying these services and interventions and analyzing the data.
If we understand what care plan was used to provide what sort of assistance and food and how the level of care requirement and cognitive symptoms changed as a result, then it will be possible to detect signs of change in the care user's condition or predict potential accidents so that preemptive interventions can be made.
This would also help with the government incentive to prevent the level of care needed from rising.

Data can only be useful if we can use it. We think that the expertise in analytics and know-how of Palantir Technologies Japan^*2 would be valuable in this area. We have conducted a three-week demonstration experiment with the company and gained many new insights. We are going to continue with this exercise.

*2Palantir Technologies Japan: A joint venture of Sompo Holdings and Palantir Technologies that operates big data analytics platforms. Palantir provides analytics platforms to government organizations and large corporations in 25 countries, including the US government.

Other Technologies:

There are many other technologies we are looking at. One example we are working on is the recording of food intake, which is currently done manually by staff but could be automated using a scale and a camera.
We have also introduced an app called Sketter, which matches care vacancies with job seekers. There are jobs that cannot be covered by care workers, and the app puts out job advertisements targeting people who have some spare time in their day-to-day life. This could be just a few hours to help during mealtimes when extra hands are needed. By recruiting local people with spare time, we would like to see our users supported not just by our care workers but people from the local community.

Solutions to Meet the Increasing Demand for Nursing Care

Kasai: The care business is a fragmented market consisting of around 60,000 companies across Japan. Unlike the insurance industry, there is no scope for productivity gains from mergers. From staff shortages to a lack of know-how in care facility management at companies moving into the sector from other industries, the challenges care service providers face are diverse. To address this issue, we have launched our solutions business called the Business Process Support (BPS) service which aims to share our care service management framework and know-how with other companies in order to improve the productivity of the industry as a whole. We want to help not only care service providers but also the users of care services by playing the role of a supporter of caregivers.

For a dementia-ready society that allows sufferers to live their way

We have been working on dementia care across the Group since October 2018. We endeavor to raise awareness and understanding of dementia in society, and in addition to our nursing care business, we are providing an insurance product that pays out upon diagnosis of mild cognitive impairment (MCI). We are also planning a program called SOMPO Smile Program for Brain & Physical Health, which is currently scheduled for an in-house demonstration experiment. The theory on which the program is based has been scientifically proven to be effective on dementia. The program has Professor Miia Kivipelto from Sweden's Karolinska Institute, a leading researcher of lifestyle interventions for elderly people to prevent cognitive decline, on board as an advisor, and contains diverse elements based on evidence, including exercise, nutrition counseling, social participation and cognitive training. We are currently conducting demonstration tests to see what can be done to maintain and sustain users' motivations.

These are some of the initiatives Sompo Care is currently working on as our contribution to the care industry.

Kawakita: Thank you very much for your presentation. I am particularly impressed by the fact that you are looking from the viewpoint of "how can we impact the care industry?" The idea of offering a platform for the care industry is good as it is a role Sompo Care can play that is important as well as unique. I would like to see you use this opportunity to start providing a consultation service on BCPs for the industry. Also, I think you should try and persuade the industry to adopt Nemuri SCAN as an industry standard.

From what you told me, I am getting a strong feeling that you have moved up to the phase of becoming a platform provider for the industry. When doing so, I think you should start from a defined hypothesis that sets out what effect your platform is expected to bring ― in other words, how you are going to solve the challenges the industry is facing. For example, remote rural areas and urban areas have different issues at different degree of severity. It is important to understand these regional differences and define a clear hypothesis that explains the sort of environment in which the offered service is likely to be used most.

In platform development, the important thing is scale rather than initial profitability. If you are going to adopt a subscription model, the key is to ask paying users to take part in joint beta testing and then share the outcome of the research. Please also consider setting up opportunities for networking and exchanges of ideas such as progress presentations and top-level seminars.
As for the online visit tool, we will start seeing different apps for specific targets such as users, their families and the care facilities. If the existing platform for your users to communicate with their families can also be used to share long-term changes in the state of their health based on continuously collected vital signs and other data, that would create added value. I would advise a cautious look into these possibilities.

Better Communication

Kawakita: Also, it would be wonderful if you could start telling the world about these initiatives, not just in Japanese. Perhaps setting up a conference may be a little too ambitious, but you could certainly start issuing research briefs on the work of the Future Care Lab in Japan for overseas readership. Sending out information in English can open up markets in sophisticated countries focusing on this field.

Kasai: You are absolutely right. We are using the Sompo Group network to learn and exchange information about how the care service business works in the US, Denmark and UK. We will continue with this exercise.
We are also partnering up with Japan’s Ministry of Health, Labour and Welfare for a joint research to explore the possibility of collecting data that can be used to support the long-term care insurance system.
In terms of issues we need to look into in the future, we would like to see the establishment of a clear standard for care services. There are no defined service standards in Japan, so each care provider must negotiate with each user individually to come to an agreement. We would like our users to understand that care services cannot do everything, and we are trying to learn from practices in other countries.

Kawakita: Regrettably, there are not yet many researchers in the field of welfare studies who make use of data. Some say that welfare is a matter for the heart, but it is impossible to evaluate skills and quality without data. It would be wonderful if you can disseminate its research outcomes to the wider society and realize the company's full potential.

Kasai: Yes, and indeed we are proactively sending out information on our work relating to the COVID-19 challenge using the channels of the industry bodies. It is our intention to communicate openly through industry bodies how we respond when someone is tested positive in our facilities and how we are handling PCR testing, for example. We are also using YouTube to publish our exercise videos for people who are facing the risk of physical deconditioning due to being housebound. From now on, whenever we think something is useful, we will actively send out the information.

Kawakita: BCPs may be optimized for the environment of each company, but they are also something that should be optimized for the society at large. I would like to see you proactively share your know-how with the wider industry. Today's conversation has been a fantastic learning exercise for me. Thank you.

• Sompo Care Smile Exercise Videos (in Japanese)

Other Initiatives

Here are some of Sompo Holdings Group's other initiatives for the aging society.

• Initiatives and Services to Help Japan Achieve Its Healthy Longevity Goals
• Sompo Welfare Foundation