A critical shortage of home care workers is forcing providers to turn away clients while triggering widespread revenue losses across the sector, according to a survey conducted last month by the Nippon Careservice Craft Union (NCCU).

The survey, conducted from April 14 to 21, gathered responses from 1,066 individuals, including home care business operators and care managers. It found that 89.4% of facility managers had turned down service requests at least once since April 2024, citing insufficient staffing.

More than half — 55.2% — of home care business operators said the facilities they work for reported a year-on-year drop in revenue, and among those, 73.3% blamed the decrease on being unable to meet demand due to worker shortages.

Care managers have also been directly affected, with 68.3% saying they were unable to create adequate care plans due to a lack of available home helpers. The survey also found that 41.4% of care managers reported families stepping in to provide services in place of professional help, while 19.3% said no alternative support could be arranged, leaving some older individuals without any care at all.

The release of the survey follows a March 31 meeting of the health ministry’s long-term care insurance revision panel, where the government presented its own findings. The ministry reported that nearly 60% of providers saw a drop in income following an April 2024 revision to care service fees.

Ministry officials attributed the downturn to fewer service visits caused by regional demographic trends — such as declining populations of older adults in rural areas and increased competition, as well as the dispersion of service demand in urban centers.

But the NCCU, which represents care professionals nationwide, has pushed back against this narrative, saying the drop in services stems not from a lack of clients, but from an inability to meet demand due to chronic staffing shortages.

“The inability of insured individuals to access essential services undermines the very foundation of Japan’s long-term care system,” NCCU chair Akira Somekawa said in a statement accompanying the survey report. “This is a structural crisis that the government must address with urgency.”

The union is calling for an immediate midyear revision of long-term care fees, including a reversal of the 2024 rate cut for home visits. It is also advocating for emergency subsidies to support struggling providers and urgent improvements in compensation and working conditions to attract and retain care workers.

The NCCU plans to present its findings in upcoming sessions of the health ministry's Social Security Council’s long-term care insurance subcommittee, where it holds a seat. The union stated that it also intends to distribute the data to lawmakers in an effort to push for legislative reforms.