Japan has the world’s oldest population, with an average age of 47 and a life expectancy of more than 81 years. More than 28 percent of its residents are over the age of 65, ahead of Italy in second place with 23 percent, and compared with 16 percent of Americans.

It could have been sitting on a coronavirus disaster, with the pandemic hitting seniors particularly hard, especially those in group facilities.

But Japan has recorded 1,225 deaths from covid-19, the disease caused by the coronavirus, compared with about 180,000 in the United States. In Japan, 14 percent of the deaths have been in elder-care facilities. That is compared with more than 40 percent in the United States, despite a lower proportion of U.S. seniors living in nursing homes.

Fewer than 1 percent of Americans live in nursing facilities, compared with 1.7 percent in Japan.

In Japanese tradition, the job of caring for the elderly would fall on the eldest son’s wife, and there was social stigma around the idea of placing relatives in a nursing home.

That changed after the introduction of long-term care insurance in 2000, with a tax levied on everyone over the age of 40 to pay for elderly care. But there is still a level of expectation within society that elderly people should not be neglected, and that care homes should be carefully regulated.

In the United States, even before the coronavirus pandemic, about 4 in 10 nursing homes were cited for infection control violations, according to a report from the Government Accountability Office, and around 380,000 residents died of infections each year, according to the Centers for Disease Control and Prevention.

Read more in the Washington Post.