The current situation and Issue of accepting foreign workers in the nursing care and medical care industries: Opening up a new era of medical care, nursing care, and welfare

Zeroboard
Consulting Department
Sustainability Senior Expert
Nao Okayama

Interview with Shinichiro Ishizaka, Chairman of the Board of Directors of Kenseikai Medical Corporation, and Tetsuo Saito, Secretary General of Denmark Inn Shinjuku Nursing Home for the Elderly

As Japan faces an accelerating trend of declining birthrates and an aging population, there is a chronic labor shortage in the nursing care and medical care industries, making foreign workers indispensable. Through the Technical Intern Training Program and the Specified Skilled Worker Program, many foreigners come to Japan from Asian countries and work in facilities across the country.

On the other hand, human rights risks surrounding their employment, such as excessive work, lack of people to turn to for advice, and unfair treatment, have often been pointed out.

This time, we interviewed Ishizaka, chairman of Kenseikai Medical Corporation, which operates multiple nursing care and medical facilities mainly in the Kanto region, and Saito, secretary general of Denmark Inn Shinjuku, a nursing care facility for the elderly that is part of the Kenseikai group, and asked them about the current status of utilization of foreign staff and institutional Issue.

background

The declining birthrate and aging population in Japan, coupled with the need for foreign workers to help with labor shortages

Japan is experiencing a rapid decline in the birthrate and an aging population. According to the Cabinet Office, as of October 1, 2024, the aging rate reached a record high of 29.3%, with 12.5% ​​of the population aged 65-74 and 16.8% aged 75 or older, indicating a growing elderly population. (Source 1) Future projections predict that the declining birthrate and increasing elderly population will continue to accelerate, with the number of working-age people supporting one elderly person expected to fall from 12.1 people in 1950 to 2.0 people in 2024 and further to 1.3 people in 2070. [i]

　　　Source 1: Aging trends and future projections (Cabinet Office)[ii]

Meanwhile, the number of foreign workers in Japan is steadily increasing due to changes in Japan's demographic structure and labor shortages at companies. As of the end of October 2023, the number of foreign workers in Japan will reach a record high of approximately 2.05 million, accounting for approximately 3.4% of all employees.[iii]Until now, many foreign workers have used the Technical Intern Training Program to come to Japan.

Human rights violations in the technical intern training system and the transition to a development and employment system

The Technical Intern Training Program was established in 1993, and in 2017, the nursing care field was added to its scope. While the Technical Intern Training Program was originally established in the name of "international contribution," it has come to effectively serve as a means to address Japan's labor shortage. [i] Furthermore, the Japanese Technical Intern Training Program has come under increasing international criticism for its serious violations, including debt bondage (high recruitment fees), extremely low wages, verbal abuse, and poor working and living conditions, which are akin to forced labor and human trafficking. [ii]

In response to various Issue that were pointed out, such as the discrepancy between the objectives and the actual implementation, the “Specified Skilled Worker System” was established in 2019 as a system for accepting foreigners as workers under employment contracts. [iii] However, due to the different objectives and rules of the "Technical Intern Training Program" and the "Specified Skilled Worker Program," confusion arose in their implementation. In 2023, a panel of experts recommended integrating the two programs into a new "Training Employment Program" that would balance human resource development with human rights protection. [iv] In response, in June 2024, the Diet passed a new "Training Employment Program" as a revision to the existing Technical Intern Training Program. [v] The Training Employment Program is scheduled to be implemented within three years from the promulgation date of the revised law (June 21, 2024). [vi] Four new Industry have been added to the 12 Industry originally covered by the Specified Skilled Worker Program, including nursing care, construction, and food and beverage Manufacturing : automobile transportation, railways, forestry, and Industry . [vii] While all of Industry Industry labor shortages in Japan, the number of foreign residents with Issue skills, particularly in the nursing care field, has been steadily increasing in recent years. (Source 2)

Source 2: Trends in the number of foreign residents with specific skills in the nursing care field (Ministry of Health, Labor and Welfare)[xi]

Interview

Please tell me about the status of acceptance of foreign workers (specific technical intern trainees) at Kenseikai.

At Kenseikai, over 100 (more than 20%) of the 450 care workers are foreign staff (specific technical intern trainees). The site is running with a bare minimum of staff, and would not function without the foreign staff. The majority of staff come from countries such as Vietnam, Myanmar, India, and Bangladesh, and the number of staff from China, which previously made up the majority, is on the decline. The labor shortage in the care site is serious, and the number of businesses going bankrupt is increasing.

Please tell me about the system and Issue surrounding the acceptance of foreign workers under the Specified Skilled Worker System.

With the change in the name of the "Technical Intern Training Program" to the "Specified Skilled Worker Program," foreign workers in the nursing care field are now aiming to obtain a "Nursing Care Visa" instead of a "Specified Skilled Worker Visa." This significantly changes the way foreign workers are able to bring family members with them, which was previously prohibited under the "Specified Skilled Worker Visa." To obtain a "Nursing Care Visa," foreign workers, like Japanese nationals, must take the National Certified Care Worker Examination. If they fail to obtain the qualification within five years, their "Specified Skilled Worker Visa" will expire and they will be forced to return to their home country. However, the National Certified Care Worker Examination is difficult in both language and Contents, and few foreigners pass. Furthermore, the exam is only held once a year, creating significant challenges for nursing care and medical facilities. The percentage of certified care workers is crucial for facility management (less than 50% qualifies for the bonus [xii] ). An increase in uncertified workers risks reduced income and a decline in the quality of work.

Please tell me about the working environment, treatment, turnover rate, etc. of foreign workers.

Working hours for foreign staff comply with Japan's Labor Standards Act (7-8 hours per day). Night shifts are assigned to staff who have been working for a certain period of time. While long working hours for foreign workers are often cited as a human rights risk as they could lead to forced labor, many foreign staff members express a desire to work long hours to increase their income. However, our organization strictly complies with the law and does not require long working hours, but we also focus on human resource development so that staff can work night shifts as soon as possible (which will increase their take-home pay with allowances).

The average turnover rate at Kenseikai is 8-10%, but other medical and nursing care facilities in Japan have a turnover rate of 20-30%. As interpersonal issues are often the cause of employee turnover, Kenseikai is flexible in dealing with the job changes and transfers of foreign staff within the group. Please note that once a foreign staff member leaves their home country, it may be difficult for them to re-enter the country.

Kenseikai sees foreign workers as fellow workers who will coexist in Japan in the future, and provides generous support, including arranging housing (the corporation arranges and guarantees dormitories or rentals), lifestyle assistance, and Japanese language Education support. There is no difference in treatment between them and Japanese staff; in fact, the Education and support for foreigners is more comprehensive. Nursing care facilities are already becoming inoperable without foreign workers. We believe that it is essential for the future of medical and nursing care facilities that they first choose Japan, and that we become a facility of choice among them.

Please tell us about the management and institutional Issue facing the nursing care and medical care industries.

As mentioned above, it is difficult to obtain a care worker qualification, and retaining foreign staff is an Issue. The care industry is more conservative and closed off than other Industry, and we believe it is essential to bring in fresh ideas, such as external talent and New ideas. As the trend toward a declining birthrate and aging population accelerates, Kenseikai wants to explore new ways of coexisting with foreign workers.

[i] Cabinet Office, "2025 White Paper on Aging Society (Full Edition)"
https://www8.cao.go.jp/kourei/whitepaper/w-2025/zenbun/pdf/1s1s_01.pdf
[ii] Cabinet Office, "2025 White Paper on Aging Society (Full Version)"
https://www8.cao.go.jp/kourei/whitepaper/w-2025/zenbun/pdf/1s1s_01.pdf
[iii] Cabinet Office, "Current Situation and Issue of Foreign Workers in Japan"
https://www5.cao.go.jp/jj/wp/wp-je24/h02-03.html
[iv] Ministry of Justice and Ministry of Health, Labour and Welfare, "Expert Panel on the Technical Intern Training Program and the Specified Skilled Worker Program (Final Report)" (November 2023)
https://www.moj.go.jp/isa/content/001407013.pdf
[v] IHRB “Japan's Technical Intern Training Programme - Learning the Hard Way?” (2017)
https://www.ihrb.org/latest/commentary-japan-migrant-workers-titp
US Department of State “Country Reports on Human Rights Practices: Japan” (2023)
https://www.state.gov/reports/2023-country-reports-on-human-rights-practices/japan/
[vi] Ministry of Foreign Affairs, "Accepting New Foreign Human Resources: Specific Skilled Worker Status of Residence" https://www.mofa.go.jp/mofaj/ca/fna/ssw/jp/
[vii] Ministry of Justice and Ministry of Health, Labour and Welfare, "Expert Panel on the Technical Intern Training Program and the Specified Skilled Worker Program (Final Report)" (November 2023)
https://www.moj.go.jp/isa/content/001407013.pdf
[viii] I'm Japan, "The Technical Intern Training Program will be changed to the Development Employment Program" https://imm.or.jp/cms/jp_news/20240704notice1/
[ix] Immigration Services Agency, "Foster Employment Program/Specified Skilled Worker Program Q&A" https://www.moj.go.jp/isa/applications/faq/ikusei_qa_00002.html
[x] I'm Japan: "The Technical Intern Training Program will be changed to the Development Employment Program" https://imm.or.jp/cms/jp_news/20240704notice1/
[xi] Ministry of Health, Labor and Welfare, "Current status and future direction of accepting foreign care workers" https://www.mhlw.go.jp/content/12000000/001478533.pdf
[xii] Wiseman, “How does the nursing care premium work? Explaining the types of home care premiums and deductions” https://www.wiseman.co.jp/column/home-care/27503/
Nursing care fees are calculated using the formula "basic fee + surcharge - deduction," and nursing care surcharges and deductions are necessary items for calculating nursing care fees.
・Basic remuneration: Refers to the fee for providing care Service , and is determined based on the Contents , time, and level of care required by the user. ・Additions: Items calculated as a plus when providing Service that require more specialized knowledge, skills, or manpower than traditional care Service, such as "bathing assistance," "Service systems for moderately severely disabled people," and "individual functional training." ・Subtractions: When there are fewer staff than traditional Service or the standards are not met, a subtraction is calculated from the basic remuneration.