March 19, 2025
TOKYO – The number of nursing care workers nationwide fell to 2.126 million in fiscal 2023, down by 28,000 from the previous year to mark the first decline since the long-term care insurance system started in fiscal 2000, according to a Health, Labor and Welfare Ministry survey.
The ministry plans to financially support small-scale providers of home care services, which are suffering a serious manpower shortage, while encouraging them to expand their business through partnerships and reorganization to strengthen their management base and secure human resources.
The government will start later this month providing a subsidy of ¥1.5 million for businesses that have five or fewer employees or make fewer than 200 home visits a month, and ¥2 million for those in mountainous areas or remote islands. The money can be used for expenses related to reorganization, staff recruitment, joint training and the creation of group buying schemes for such items as masks and gloves.
Shortage of home caregivers
There is a particularly a serious personnel shortage among home caregivers who are dispatched to the homes of elderly clients. The government will beef up measures to prevent people in working-age generations from having to leave their jobs to look after their parents.
“It would be tough to live at home without caregivers’ help,” said a woman, 88, who looks after her wheelchair-using husband, 90, in Toshima Ward, Tokyo.
A caregiver dispatched from Carefriend Toshima helps him bathe twice a week and cleans the living room and bathroom once every two weeks.
The government announced last year that 2.72 million care workers would be needed in fiscal 2040 to ensure that everyone can continue living in familiar surroundings even when they need care. This target could be met if the number of care workers increased by 30,000 each year from fiscal 2022.
The reality, however, has been different. The number of care workers declined by 28,000 in fiscal 2023 from the previous year, and that of home caregivers declined by 8,500 to about 500,000, for a decrease of more than 20,000 from fiscal 2018.
The industry attracts few applicants. The jobs-to-applicants ratio for the business was 4.07 in fiscal 2023, exceeding the 1.17 average for all industries. The ratio for home caregivers is even more serious at 14.14 jobs per applicant.
“Young people are not coming into the industry,” the president of Carefriend Toshima said. “Those in their 70s and 80s who will soon retire are supporting the elderly now.”
Low wages
Behind the shortage is low wages for a heavy workload. A survey by Tokyo-based Nippon Careservice Craft Union found that the monthly salary of care workers are below the average for all industries by a margin of more than ¥60,000.
Retirements of older staff and a decline in the number of young applicants are factors behind the shortage of staff in the industry.
“Amid a talent war with other industries, the care industry is not maintaining its advantage in terms of pay and other aspects. The reality is harsh,” a senior health ministry official said.
Exacerbating the situation is a reduction in the unit price of home help services triggered by the government’s revision of nursing care fees in fiscal 2024.
Co-op Aichi, a consumer cooperative in Nagoya, saw profits from its home care business fall significantly in April-December 2024 compared to the same period a year earlier, from ¥20.49 million to ¥7.24 million.
With the cost of gasoline and utilities rising, a Co-op Aichi department manager said, “We can’t afford the costs of recruiting and securing staff.”
The cooperative is unable to make up for the shortage, resulting in staff being dispatched half as often as clients desire.
Many businesses are simply closing up shop. A record 784 nursing care providers either went bankrupt, suspended operations or dissolved in 2024, with providers of home help services accounting for 529, or two-thirds, according to Tokyo Shoko Research, Ltd.
The problem is not just that the elderly have trouble receiving the services they need. A government survey found 106,000 people left their jobs in 2022 due to difficulties in balancing work and caring for their parents, and half of them were in the prime working ages of their 40s and 50s. It estimates that economic losses associated with job losses or physical and mental burdens will be more than ¥9 trillion a year in 2030.