Japan will lower specific immigration barriers this year to ease a projected shortage of professional care workers for the elderly. A health sociologist draws on extensive research to critique the government’s shortsighted, private-sector-driven approach to the problem, calling for greater efforts to support and export Japan’s advanced system of care work.
Opening the Door for Needed Help
Elder-care workers are in high demand in Japan, which has the highest percentage of elderly citizens of any country in the world. According to the Ministry of Health, Labor, and Welfare, Japan currently has about 1.8 million care workers qualified to provide care for the elderly. The ministry estimates that, barring some major change, the nation will need an additional 380,000 care workers by the year 2025, when the products of the postwar baby boom will be 75 or older.
With such warnings in mind, Japanese lawmakers took steps last fall aimed at facilitating the migration of foreign care workers to Japan. Specifically, they passed legislation that extends Japan’s Technical Intern Training Program to care work and revised Japanese immigration law by establishing the “care work,” or kaigo, visa as a new category of legal residence.
Japan’s Technical Intern Training Program, established for the ostensible purpose of transferring technical skills to developing countries, permits foreign nationals who would otherwise be ineligible for long-term residence or employment in Japan to work here as “trainees” under the supervision of agricultural and/or fishery cooperatives, factories, and small businesses. The recent change expands the program’s scope from such industries as agriculture, fishery, construction, and food processing to care with the primary aim of bringing the trainees into the Japanese labor force. The change of the immigration law, aimed at addressing the projected labor shortage, will allow foreign students who train at a Japanese care facility for two years and pass a national board examination to live and work in Japan indefinitely under the newly established kaigo residence status.
Japan has been accepting a limited number of nursing and care-work trainees from Southeast Asia since 2008 under economic partnership agreements with Indonesia, the Philippines, and Vietnam. As a researcher who has studied this program and its participants from the beginning, I am deeply disappointed with the Japanese government’s failure to deal with labor issues in Japan’s care industry from a long-term perspective. The latest plan, like the EPA program, is a myopic measure focusing narrowly on the goal of securing foreign workers to work in this sector. This explains the government’s failure to establish an independent body to oversee the private-sector-driven training program or to develop procedures to prevent the exploitation of care-work trainees by unscrupulous staffing agencies, a problem that has arisen often in the past.
The nursing and care professions involve a very high level of “emotional labor,” meaning the ability to manage one’s feelings and regulate one’s expression of emotion to ensure appropriate personal interaction. This is why one cannot address a labor shortage in the industry by mechanically increasing the number of foreign workers, the way manufacturers might expand their workforce to meet production targets.
We should note also that, as things stand, there is little cause for optimism concerning Japan’s capacity to attract and retain labor from other parts of Asia. Today, with Japan’s economic star in the descendant, particularly as compared with China and other rapidly industrializing countries in the region, we should be developing a long-term vision for substantive immigration reform aimed at ensuring Japan’s survival in the global community.
Why Foreign Care Workers Go Home
As previously mentioned, Japan already has a system for training and recruiting foreign nurses and care workers under bilateral EPAs with three countries in the region, Indonesia, the Philippines, and Vietnam. This program, launched in 2008 with great fanfare, offers important lessons for us going forward.
Under the EPA programs, qualified applicants receive Japanese language training, followed by professional training at a Japanese medical or care facility. If they pass the national board examination, they are then eligible to work in Japan indefinitely, renewing their residence status every three years. Candidates invest a great deal of time and effort to complete their training and earn their license, as do the facilities that take charge of their training. We must ask why, then, 16%–38% of those who passed the national board examination have returned home instead of staying on in Japan.
Many of the nurses and care workers who left Japan cite working conditions and long hours that made it impossible to balance work and family or proved injurious to their health. These are the same reasons Japanese nurses and care workers give for leaving the profession. In other words, Southeast Asian trainees are deterred by the same extreme conditions that drive Japanese women and men out of the profession. This tells us that the most important prerequisite for securing adequate care-work personnel in Japan, regardless of nationality, is to improve working conditions.
Japan’s Present, Indonesia’s Future
I should hasten to note that many of the EPA nurses and licensed care worker returnees I interviewed in Indonesia stressed the benefits of the program from their viewpoint. They were not referring simply to the money they earned and saved as paid trainees but also to the opportunity for direct contact with geriatric nursing and elder-care services in Japan. At present, none of the Southeast Asian countries with which Japan has EPA training agreements has a separate certification program for elder-care professionals, such as Japan’s national program for licensed care workers. Owing to differences in culture, demographics, life expectancy, and the sort of health issues people face, care for the elderly in those nations is primarily the family’s responsibility.
The EPA returnees with whom I spoke told me that nothing they had learned in nursing school at home had prepared them for their experience in Japan, where they were coached to treat patients as they would their own parents. “Japan’s long-term care insurance is a wonderful system,” an Indonesian nurse said. “Indonesia is going to face the same challenges of an aging society before long, and I’d like to be involved in designing a long-term care insurance system here.” An Indonesian care worker who had obtained the national license spoke glowingly of Japan’s home care as a promising model for Indonesia, where such services are close to nonexistent at present.
Comments like these were particularly frequent among trainees who had completed nursing school in Indonesia before coming to Japan. They raised the possibility that the experience of those trainees will help spearhead the incorporation of Japanese approaches to elder care in Indonesia into the new field of geriatric nursing. A nurse who obtained her national license in Japan told me that she wanted to set up a school devoted to preparing Indonesian candidates to undergo care training in Japan. Having had the opportunity to work on the front lines of Japan’s hyper-aging society, these returnees have seen what lies in store for Indonesia. Armed with knowledge of Japanese language, culture, and work habits, they are in an excellent position to pass on their know-how to the next generation of trainees.
Professor, Graduate School of Biomedical Sciences, Nagasaki University, specializing in the sociology of health and illness. Received her doctorate in health sciences from the University of Tokyo. Held faculty positions at Kyūshū University’s School of Health Sciences and Graduate School of Medicine before assuming her current post. Since 2007 has taken part in joint international research on the migration of Southeast Asian nurses and care workers to Japan under bilateral economic partnership agreements.