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GUEST COMMENTARY: Securing a Quality Direct-Care Workforce in Japan

March 27, 2014

A guest commentary by Yoshiko Yamada, Researcher, Japan Aging Research Center.

Skyrocketing Demands and High Turnover

It is no secret that the whole world is aging, and Japan is no exception. Indeed, Japan is the most aged country in the world and will continue to be so. The number of older people aged 65+ will increase from 31 million (24 percent of the total population) in 2012 to 37 million (30 percent) in 2025, when baby-boomers become the “old-old.”

Along with the aging population, the demand for direct-care workers is also skyrocketing. In 2000, when national long-term care insurance took effect in Japan, there were 550,000 direct-care workers. By 2012, the number had increased to 1.49 million. By 2025, we are expected to need 2.37 to 2.49 million direct-care workers. Recruiting nearly 1 million additional workers in the next decade is a serious challenge for Japan.

In Japan, like the U.S., most direct-care workers are women but the average age of the workers is higher: 45 overall and 52 in home care. Many are in their 60s and even 70s, contributing to higher than average turnover rates. 

While the average turnover rate for all Japanese industries was 15 percent in 2012, it was 17 percent among direct-care workers. These figures don’t account for wide variation, with some employers having turnover rates as high as 30 percent.

The data suggests that we are having challenges both attracting new workers and retaining existing workers. No wonder almost 60 percent of employers in the care sector (68 percent in home care) feel there is a worker shortage.

A Serious Worker Shortage

The challenges Japan is facing in attracting and retaining direct-care workers are similar to the U.S. 

It is quite difficult to attract people to join the direct-care workforce. The public image of this job is that the work is hard and the pay is low. These perceptions make sense. The average monthly wage of full-time care workers in Japan is indeed lower than other industries: $2,400 for the entire long-term care industry and $2,050 for the home care industry compared to $3,200 for all industries. The most commonly given reason for work dissatisfaction among direct-care workers is “low pay relative to the work involved” (43 percent). 

Since long-term care services in Japan are mostly funded by national long-term care insurance, the reimbursement rate is set nationally. Therefore, national policies need to be changed to improve the wage and certain work conditions.

Organizational Improvements

There are other things that can be done at an organizational level to make the job more attractive. According to a national survey of long-term care provider organizations, while about one fifth of employers have turnover rates higher than 30 percent, about half of employers have rates lower than 10 percent.

Considering the reimbursement rate under the national system is the same, these differences seem to derive from organizational characteristics. For example, a national survey of direct-care workers shows that common reasons for leaving a previous care work position include “relationship issues at work” (25 percent) and “dissatisfaction with philosophy and/or administration of the organization” (24 percent).

Moreover, according to Satoko Hotta, a researcher with the Japan Institute for Labour Policy and Training, the organizations with minimal or no problems with worker shortages share several characteristics, including:

  • better staff development programs;
  • having workers stop by the office at least once a day to improve information sharing, facilitate better collaboration with other workers, and prevent isolation (among home care agencies); and
  • being community-oriented (e.g. participating in local events, collaborating with other organizations in the community, etc.).

National Measures to Overcome the Challenges

A number of measures have been taken to deal with worker shortages in Japan, including a wage increase, but more needs to be done. The national government has been taking this issue quite seriously, and the Long-Term Care Insurance Working Group in Social Security Council has set up four pillars in efforts to attract and retain workers:

  • improve the image of the job (e.g. by distributing comics and books on direct-care workers to high school students and making November 11th Caregiving Day to raise awareness of caregiving),
  • establish career pathways (e.g., from home helpers to certified care workers and to advanced certification, systematizing pay and training systems),
  • improve the work environment (e.g., develop care robots and assistive devices), and
  • improve work conditions (e.g. increase the reimbursement rate and provide subsidies to improve the work conditions of direct-care workers).

The Care Work Foundation, a national organization to support direct-care workers, has introduced on its website over 800 successful examples of home care and institutional care organizations improving the work conditions of these workers. Viewers can search the examples by keywords (e.g. recruitment, wages, communication, etc.).

Efforts are also made at an organizational level. For example, some organizations raise the base salary when the worker gets an additional qualification and/or responsibilities. Other organizations focus on recruitment at colleges and vocational schools to attract young workers through efforts such as accepting interns and attending job fairs for college students.

Despite all these efforts, the fact remains that we still need many more direct-care workers. Securing a quality care workforce is not only a big challenge in Japan and the U.S. but also across the globe. There must be a lot of strategies that we can learn from each other to address this critical issue.

Data source on the direct-care workforce in Japan (in Japanese):

Ministry of Health, Labour and Welfare (September 4, 2013). Securing Care Workforce. Working document #3 for the 47th Long-Term Care Insurance Working Group, Social Security Council (pdf)

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