Today, Japan is one of the world's oldest societies. In FY2024, the number of people aged 65 and over will reach 36.25 million, accounting for 29.3% of the total population, the highest percentage ever recorded. In the future, it is said that everyone will live to nearly 100 years of age, the “100-year life age,” and all kinds of issues are emerging as society ages.

In particular, the nursing care industry, which is essential in an aging society, is facing serious problems such as a shortage of workers and a high turnover rate of employees. The current situation of not being able to secure sufficient human resources for the increasing number of elderly people who need nursing care significantly impacts the quality and sustainability of nursing care services. The current state of the nursing care industry is also having an impact on Japanese society as a whole, with its aging population.

Long-term care is an important industry that supports the creation of a safe living environment for the elderly in an aging Japanese society. In this article, we will introduce in detail the basic principles of nursing care, the challenges facing Japan's nursing care industry, and the current situation and prospects for the acceptance of foreign nursing care workers.

Basic Philosophy of Long-Term Care

The “Three Principles of Care” are the basic principles of caregiving, which were proposed in Denmark in 1982 and are still important indicators in the care industry today.

(1) Continuity of life

Support the person in need of care to continue as much as possible in his/her existing lifestyle without abruptly changing his/her familiar living environment or rhythm of life.

(2) Respect for self-determination

Supporting people who need nursing care to make their own decisions about how to live and how to live their lives and respecting those decisions.

(3) Utilization of residual abilities

Instead of having the people around them help with everything, they should use their existing abilities to the fullest and do by themselves what they can do by themselves.

Based on these basic principles, Japan's long-term care system and services have developed. However, with the aging of the population, the question of how to secure nursing care personnel and new forms of care is becoming increasingly important.

Challenges for Japan's Long-Term Care Industry

Shortage of Nursing Care Workers and High Turnover Rate

Japan's long-term care industry continues to face a serious labor shortage, especially in urban areas, where long-term care facilities are chronically short of staff. The main causes are, Low wages and heavy workload: Low salary levels and high physical and mental strain compared to other industries Unclear career paths: limited opportunities for promotion and few benefits of working longer High turnover: Approximately 40% of new caregivers leave within three years. These are some of the reasons for this.

Increased nursing care costs and financial pressures

With the aging of the population, the number of people using long-term care services is increasing, and the financial burden on the long-term care insurance system is growing. Increasing nursing care costs are affecting more than just the users of nursing care, as nursing care insurance premiums increase, compensation for nursing care is curtailed, and the burden on front-line workers increases, and public support alone is not sufficient to cope with the increased burden on family members.

Increasing Burden of Family Caregiving (Problem of Caregivers Leaving the Workforce)

In Japan, family members are often responsible for the care of the elderly, and the problem of difficulties in balancing work and caregiving is becoming more serious. In particular, the problems of caregiver turnover and caregiving for the aged are serious. Approximately 100,000 people a year quit their jobs to care for the elderly, and the number of cases of elderly people caring for elderly people is increasing, leaving many caregivers with mental and physical burdens.

Shortage of Nursing Homes and Variations in Quality

Although the number of long-term care facilities is increasing, the growing number of people on waiting lists and the uneven quality of services provided by the facilities are becoming an issue. There is a large waiting list for special nursing homes for the elderly (“tokubetsu koyo,” special hiring) (about 300,000 people nationwide). Many elderly people are unable to move into pay nursing homes due to high fees. There is a disparity in the quality of services among facilities. Supply is not keeping up with demand.

Current Status, Challenges, and Future Prospects for Foreign Nursing Care Workers

One way to address these serious problems in the nursing care industry is to accept foreign caregivers. In Japan, the acceptance of foreign caregivers is expanding against the backdrop of a shortage of caregivers. In particular, many foreigners, mainly from Asian countries, are working in the nursing care field through the EPA (Economic Partnership Agreement), technical training, and specified skills programs. Japan's programs for accepting foreign caregivers include the following.

Economic Partnership Agreement (EPA) Care Worker Candidates

EPA (Economic Partnership Agreement) is an international agreement between Japan and certain countries and is one of the systems that officially allows for the acceptance of foreign caregivers.

Acceptance is based on the acquisition of a caregiver qualification, and applicants must complete four years of training and work experience before taking the national examination. After obtaining the qualification, the applicant can work in Japan for a long period and, in some cases, can even live in Japan permanently. Unlike the Specified Technical Skills System, this system also has the advantage of facilitating career advancement.

However, while this system is the most important system for career development for foreigners in the Japanese nursing care industry, the high difficulty of the national examination and the low retention rate are major issues.

Specified Skills (Nursing Care)

Specified Skills is a system that began in 2019 and aims to solve the shortage of manpower. To obtain this qualification, you must pass the “Nursing Care Skills Evaluation Test” and the “Nursing Care Japanese Language Evaluation Test,” and if you pass the tests, you will be qualified to stay in Japan for up to five years. The specified skills have the following characteristics. A wide scope of work, allowing one person to work night shifts and assist with medication, can be included in placement criteria immediately after employment. Relatively little management as there is less reporting burden compared to technical training. In this way, trainees with advanced Japanese language ability and skills will be an immediate asset to the nursing care industry, which is suffering from a shortage of workers.

Technical internship system

The technical internship system is designed to enable human resources from developing countries to acquire skills in Japan and apply them to the development of their own countries. As a general rule, the period of stay in Japan is three years. Although the purpose of this system is to provide training and technology transfer, it is also used as part of the measures to address the shortage of human resources.

In the nursing care industry, in particular, “nursing care” was added to the technical internship program in 2017 against the backdrop of a serious shortage of human resources, and many foreign nursing care workers have come to work in Japan. In some areas, approximately 10% of the workforce is made up of foreign caregivers, contributing to alleviating the shortage of human resources. The target countries are mainly Vietnam, Indonesia, the Philippines, and Myanmar, and they are engaged in basic nursing care work such as assisting with meals and bathing. Unlike specified skills, the technical internship program does not permit one-person night shifts or assistance with medication.

The technical internship program, which can be accepted at a relatively low cost, not only solves the human resource shortage problem in the nursing care industry but also contributes to the internationalization of the nursing care industry by strengthening relations with the host country.

Nursing care visa (status of residence “nursing care”)

A nursing care visa is a visa for foreigners to obtain a Japanese “care worker” qualification and work in Japan on a long-term basis. The requirements for qualification are to obtain a Japanese “care worker” certificate and to graduate from a Japanese care worker training school (such as a vocational school). Advantages include permanent employment with more highly skilled human resources than technical internships and specified skills.

On the other hand, the qualifications for caregivers are not as high as those for technical training and specific skills. Also, there are some disadvantages, such as the requirement to obtain a care worker qualification (which takes at least 3 years) and the time and cost required to obtain the qualification. However, the number of residents has been increasing every year since the program started in September 2009. There is no doubt that they will play a key role in the future of the nursing care industry in Japan.

Conclusion

What did you think? In the nursing care industry, which is facing a serious shortage of human resources, foreign caregivers will be a key asset. The employment of foreign caregivers will greatly contribute to solving the shortage of human resources in the Japanese nursing care industry. In particular, the use of systems such as specified skills, technical internships, EPA, and nursing care visas will enable flexible employment from short-term to long-term.

While there are benefits in terms of reducing labor shortages, decreasing turnover, and increasing long-term workforce strength, it is also true that there are issues such as Japanese language skills, differences in culture and values, and uncertainty about career paths.

Solving these issues and creating a comfortable working environment for foreign caregivers so that they can settle in for the long term will support the nursing care jobs in Japan, which is suffering from a labor shortage, and support the aging society as a whole.