By Nao Yako / Yomiuri Shimbun Staff WriterIn November, the Health, Labor and Welfare Ministry made it mandatory for unlicensed day care centers (see below) to report to local governments incidents such as accidents resulting in the deaths of children. Unlicensed day care centers have fewer workers per child than the number stipulated by national approval standards for licensed facilities. As a number of fatal accidents have occurred at unlicensed day care centers, mandatory reporting is aimed at helping eliminate recurrences. To prevent future accidents, local governments need to strengthen oversight of childcare facilities and improve their environments.
“Obliging unlicensed day care centers to report serious accidents will lead to improved safety awareness and should have a deterrent effect,” a ministry official in charge of the issue said.
In 2015, the government made it mandatory for licensed day care centers to report to local governments any incidents that occur in their facilities involving children under their care that result in death, unconsciousness, or serious injury that takes over 30 days to recover from.
However, the government did not apply the new regulations to unlicensed day care centers, citing the fact that they do not receive government subsidies, among other reasons. Unlicensed facilities were called on to notify local governments of accidents but were not legally obliged to do so. On Nov. 10, the ministerial ordinance was amended to make the reporting of incidents also mandatory for unlicensed centers.
Fatal accidents occur more often in unlicensed facilities than in licensed ones.
In September 2015, a 3-month-old boy was found face down in a crib at an unlicensed facility in Kawaguchi, Saitama Prefecture. The baby was not breathing. He was taken to a hospital but died the next day.
“He was such an energetic boy ... He must have felt so alone, he must have suffered so much,” the boy’s 31-year-old grieving mother said.
She has demanded that the city investigate the accident, and is currently consulting with lawyers about what action could be taken in the future.
According to the city’s inspection report, childcare workers left the baby in the crib because he would not stop crying, while they fed the other children and cleared up after the meal.
National guidelines caution against leaving babies to sleep on their stomachs because this position increases the risk of sudden infant death syndrome.
According to surveys by the ministry and others, at least 187 fatal accidents happened from 2004 to 2016 at childcare facilities nationwide. Of all these accidents, 127, or about 70 percent, occurred at unlicensed day care centers. Fatal accidents have also occurred in 2017, including one at an unlicensed facility in Kagoshima.
As of 2016, there were about 7,000 unlicensed day care centers and 30,000 licensed centers operating in Japan. Despite the smaller number of facilities, accidents happen more often at unlicensed facilities.
The Tokyo-based Research Institute of Early Childhood Care and Education is run by people such as researchers and childcare providers. Institute head Yuichi Murayama said: “There are many good unlicensed centers that do provide finely tuned childcare. But generally, there is a wide gap in quality between licensed and unlicensed facilities.”
National standards for unlicensed centers are not as strict as those for licensed facilities: The required number of childcare workers is lower, and facilities are also allowed to hire uncertified staff. An unlicensed center can be established simply with the submission of a notification to local governments, whereas licensed centers must go through an approval process by local authorities.
Unlicensed facilities are not always required to take part in training organized by local governments or, due to a lack of staff, are unable to secure time to take advantage of training sessions. Staff at unlicensed centers also tend to be less informed on relevant policy, including national childcare guidelines.
“Central and local governments should improve standards [for unlicensed centers] and also help unlicensed facilities become licensed,” Murayama said.
It is important for central and local governments to thoroughly investigate reported accidents, publish relevant information and use it to prevent accidents from occurring again. Local governments are in charge of supervising facilities and therefore bear a significant responsibility to prevent accidents.
“The investigations conducted and guidance offered by authorities are not enough. They must get tougher, otherwise lousy facilities will slip through the net, and accidents will continue,” said Maki Fujii, 38, of the Infant Safety Alliance, a group of families who have suffered bereavements through incidents in such places as childcare centers.
According to the ministry’s guidelines, prefectural governments must conduct scheduled inspections of unlicensed centers, in principle once every year, to check operations at the facilities.
However, according to the ministry, only about 70 percent of all relevant facilities in the nation were actually inspected in fiscal 2015.
Unlicensed facilities that do not meet national standards accounted for as much as 39 percent of the total. However, most only received written guidance. No unlicensed centers were forced to suspend their operations or close down.
A local official in charge said: “Inspections mainly consist of checking documents and verbally asking questions. We assume that a facility meets standards if its records are in order.”
There has been a series of cases in which inadequate facilities passed inspections and were caught engaging in careless practices — such as letting babies sleep on their stomachs and completing every child’s nap-time records at the same time after the fact — only after accidents happened.
Masako Maeda, a professor at Konan University and an expert on social security, said: “Annual inspections of unlicensed centers are not enough. Authorities should tighten supervision by securing more staff and conducting snap inspections. Announcing the results of inspections and offering administrative guidance in an easy-to-understand format for parents should also help prevent accidents.”
It is not the case that all licensed centers are safe or that all unlicensed day care centers are not.
In urban areas where demand for childcare is high, unlicensed centers take on such responsibilities as accepting children on waiting lists for licensed centers and providing care at night or during holidays when licensed centers do not.
What is needed are childcare facilities to which parents can entrust their children without anxiety, whether these facilities are licensed or not.
Expanded use of equipment
A conspicuous number of childcare facilities are now using devices such as surveillance cameras and monitoring equipment that check the breathing of sleeping children, in an effort to prevent accidents such as sudden deaths in their facilities.
These monitoring devices work by sounding an alarm when a child’s body stops moving. Staff at childcare facilities using the devices say that they provide a sense of security because they enable extra checking. They also say the devices reduce their workload. This fiscal year, the Tokyo metropolitan and Kawaguchi city governments began offering subsidies for facilities that installed monitoring equipment.
The Health, Labor and Welfare Ministry is considering a system to provide subsidies to childcare facilities to cover the purchase costs of accident-prevention equipment such as monitoring devices. In fiscal 2015 and 2016, the ministry granted subsidies to facilities that planned to install surveillance cameras.
The cameras can be placed in day care centers so that children can be monitored even from offices and other locations. Footage from such cameras can also be used for verification purposes.
It is possible that such equipment will be more widely used at childcare facilities in the future. However, concerns have also been raised about over-reliance on equipment and the effectiveness of such devices.
Pediatrician Tatsuhiro Yamanaka, who is well versed in accidents at childcare facilities, said: “Central and local governments are not doing enough to verify how useful monitoring equipment is. Speeding up such verification should be given more priority than handing out subsidies to expand the use” of the devices.
■ Unlicensed day care centers
Childcare facilities that are not licensed by local governments must meet national standards set by the central government. These centers include facilities independently subsidized by local governments, facilities that operate without subsidies and “baby hotels” that offer late-night care or let children stay overnight. Unlicensed facilities are more common in urban areas where the high number of children on waiting lists for day care facilities is a serious problem. The new rules that mandate reporting of serious accidents also apply to such services as babysitting and “family support” activities in which people in the community are engaged in dropping and picking up children.