Comparison of data for the two periods between subjects matched for age group and gender evidently showed better health status and a slower decline in most of the health-related measures in 2017 compared to a decade ago. Accordingly flagship public residential care provision was restricted to those older people lacking financial means and family support and remained stigmatised, commonly associated with Obasuteyama (literally 'granny-dump mountain'), which suggested family neglect, failure of filial piety, abandonment and shame. The prospects for long-term care for growing ageing populations are daunting, but this does not mean that efforts on future planning are pointless. The growth of Japan's mutual-help networks under a time-banking system could be one way to supplement statutory provision in reducing the burden on family carers. Malnutrition and poor sanitary amenities often caused severe bedsores and those frail elderly who became wholly bedridden or fell into an acute condition, and families, simply gave up and accepted their fate.

During the Muromachi period, a period set within the Age of the Samurai, genpuku gradually spread from the samurai class to include men and women of lower ranks. Genpuku was traditionally considered a major rite, an important ritual affecting life course in which a child exchanged his childhood status for an adult status, and continues from the Nara (710–794 AD) into the Tokugawa period (1603–1868). According to the stereotype, Japan's tradition of strong family care for older people means that dedicated and responsible children look after dependent older parents within extended family living arrangements, with very few institutionalised elderly.

These arrangements finally removed supplementary and means-tested measures and, instead, featured mandatory contributions, uniform entitlements and elements of consumer choice. LTCI was popular and expanded much faster than official predictions: by 2005, LTCI expenditure totalled 6. It's best to be generally quiet, don't blow your nose in public, don't eat while walking on the street, don't count your change, and be sure to take off your shoes in places where everybody else does. Many concealed their abusive conduct, suffered strong guilt and shameful feelings, or blamed themselves rather than inadequate public care provision.

Japan's post-2000 comprehensive Long-Term Care Insurance system (LTCI) embodied a decisive shift from family care towards the socialisation of care as part of a social contract. The genpuku ceremony itself almost always took place in the evening on a predetermined "auspicious day," either at the residence of a Kakan (dignitary) or at the Shishinden (Kyoto Imperial Palace). Residential provision was stigmatised, with compulsory means- and needs-assessments of elderly applicants and their families, even as eligibility criteria were widened. Genpuku ( 元服) is a Japanese coming-of-age ceremony which dates back to Japan's classical Nara period (710–794 AD).

The Ceremony is also a good opportunity for the beauty industry, which dresses, makes up, and hairdos for the attendees. Long after the 1868 Meiji Restoration, Japan's post-feudal government remained extraordinarily centralised, authoritarian and paternalistic, emphasising familistic nationalism based upon worship of the Emperor as a living deity, with little concern for needy individuals.

The Yokohama City’s proposal determines that such components make the Ceremony lengthy and impoverish the content. With their families fully occupied with housework, agriculture or sericulture, such people were often left with just rice balls and water at home during the daytime, as were the chronic sick, frail or senile elderly. Specific ceremonial formats are built around specific constructions of class, rank, and time period.For example, adult status becomes effective on the 18th birthday, with some exceptions; both men and women can marry and are released from parental authority. Since many participants wear expensive kimonos for the Ceremony, the kimono industry promote kimonos. Therefore, although the school-age system, which determines the eligibility for participation, is the same everywhere, some municipalities hold the event on days other than the Coming of Age Day. With an average hospital stay of 103 days, many such patients were seemingly 'living' in hospitals, requiring social care but little or no medical treatment, a situation dubbed 'social hospitalisation'.