As the nation’s population rapidly grays, ensuring there are enough nursing care workers to meet growing demand has become a pressing issue.

In 2025, 1 in 5 people will be aged over 75, and 1 in 5 seniors aged over 65 will have dementia, according to Health, Labor and Welfare Ministry estimates.

Given the urgency of the situation, Prime Minister Shinzo Abe’s administration released an action plan earlier this month outlining measures to secure enough nursing care workers for Japan.

Here are questions and answers about the current nursing care industry and the worker shortage:

Is the number of nursing care workers on the decline?

No. It has actually tripled to 1.71 million in 2013 from 550,000 in 2000, according to welfare ministry statistics.

The increase, however, has failed to keep pace with the rapidly growing demand, resulting in a nursing care industry with a chronic shortage of manpower.

The ratio of job openings to job-seekers in care services stood at 2.69 in April, while it was 1.12 for all industries, according to the ministry. The ratio means there were 269 positions available for every 100 job-seekers.

Considering Japan’s declining workforce, the labor shortage in the industry is expected to worsen over time.

According to the ministry’s estimate, Japan will need 2.53 million care workers in fiscal 2025, but the number will fall short of demand by 377,000.

Why is there a shortage of care workers?

The job is generally low-paying and physically demanding.

A government survey released last year said the average monthly wage of full-time care workers was around ¥220,000, roughly ¥110,000 lower than the all-industry average.

A care worker job can be physically and mentally tough. Such workers have to provide physical support to the elderly and be on alert throughout their working hours, especially when looking after senile dementia patients.

Care workers also cover overnight shifts about four to six times a month, when there are even fewer workers on hand, said Shinichi Nakatani, a care worker at Yushima no Sato, an intensive nursing home for the elderly in Tokyo’s Bunkyo Ward.

“Overnight shifts are nerve-wracking because you basically have to look after about 14 to 25 people all by yourself,” Nakatani said. “You never know what trouble or emergencies will occur during those hours. It’s psychologically draining.”

According to the welfare ministry, care workers who applied for worker compensation due to mental illness more than doubled in five years to 140 in fiscal 2014 from 66 in fiscal 2009, marking the largest increase among industrial sectors.

If demand is growing, why do wages remain low?

The government reduced the nursing care benefits — the subsidies for services provided by care facilities — because the ballooning costs were taking a toll on national finances.

The welfare ministry announced earlier this month that the cost of nursing care in fiscal 2014 more than doubled from ¥3.6 trillion in 2000 to a record ¥8.9 trillion. The rise reflected the increase in those receiving nursing care services.

The subsidies, coming from tax revenue and nursing care insurance premiums, cover 90 percent of the payments while those in need of such services pay the remaining 10 percent.

The government reviews the benefit rates once every three years. In the latest review, which took effect in April last year, the government lowered its overall payments by 2.27 percent while raising the basic salary for care workers by 1.65 percent — an average monthly hike of ¥12,000 per worker.

After the benefits were cut, 57.6 percent of nursing care companies said their earnings fell and over 40 percent were in the red, according to a survey conducted in October by the Japan Finance Corp. Research Institute.

Experts said such subsidy cuts will force care facilities to potentially cut wages, possibly by reducing overtime pay or paring bonuses.

How does the government plan to turn the situation around?

The government seeks to add 250,000 more nursing care workers to the system by improving their working conditions and increasing their average monthly pay by ¥10,000 from fiscal 2017. But the state has not made clear how it will finance this.

The government also plans to create new nursing care facilities to accommodate 500,000 more users by the beginning of 2020. This, however, has been questioned by industry experts who argue that in densely populated urban areas, the lack of workers is more acute than the shortage of facilities.

The increasing difficulty in finding enough workers has led more facilities to rely on temporary staff dispatched from agencies, and some have reduced services.

Are there other remedial measures in the pipeline?

To lessen the burden on staff, some nursing care facilities are starting to use robotics, including wearable units for elderly people and care workers.

The government is also eyeing an increase in non-Japanese nursing care workers by creating a new resident status category for those who graduated from schools in Japan and passed the national care worker license exam.

Japan has also accepted candidates from Indonesia, the Philippines and Vietnam under economic partnership agreements.

Under the EPA program, people who passed the national exam to qualify as nurses and caregivers can continue working in Japan. By the end of fiscal 2015, Japan had accepted 2,069, out of which 317 passed the exam.

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