In a room at the Bunkyo Ward office in Tokyo, five former care workers are undergoing a refresher course conducted by the Tokyo Welfare Manpower Center.

"Please tell the patient in advance to 'raise your head' — otherwise he will be surprised," a lecturer says while showing a female trainee how to change the clothes of a person paralyzed on one side of his body.

The trainee had placed her hands at the head of the bed without saying anything.