Securing a Quality Personal Care Workforce

Skyrocketing Demands and High Turnover:  Securing a Quality Personal Care Workforce in Japan

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 personal care aides. By 2012, the number had increased to 1.49 million. By 2025, we are expected to need 2.37 to 2.49 million personal 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 personal care aides 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.

While the average turnover rate for all Japanese industries was 15 percent in 2012, it was 17 percent among personal care workers. Almost 60 percent of employers in the care sector (68 percent in home care) feel there is a worker shortage.

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

It is quite difficult to attract people to join the personal 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 personal 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 personal 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).

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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:

  1. Better staff development programs;
  2. 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
  3. 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 personal 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),


  •    Improve work conditions (e.g. increase the reimbursement rate and provide subsidies to improve the work conditions of direct-care workers).

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.
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Despite all these efforts, the fact remains that we still need many more personal 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.

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

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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3 Responses to Securing a Quality Personal Care Workforce

  1. Caryl Anne says:

    Great article! There is a need for more qualified personal care workers, but as mentioned, not many rise to the challenge. Thanks for sharing your information!


  2. Great article. I am a CNA. I know from experience that low pay and work schedules are a big problem. Quality of staff suffers because of pay and 24/7 coverage demands. Full time CNA’s leave because they can earn poor pay and work crazy hours doing a lot of other things. The future of Elderly care is going to get overwhelmed soon. The Baby Boomers are entering the system. Your ” Establish career pathways ” suggestion would help a lot.


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