Foreign Nurses and Care Workers in Japan: Reform Needed


To help deal with its rapidly aging population, Japan has been admitting nurses and care workers from other Asian countries since 2008. The program has run into a number of problems, and a sweeping overhaul is required.

Foreign Care Workers Decide to Head Home

Four years have passed since Japan started admitting nurses and care workers from Indonesia and the Philippines under the provisions of its economic partnership agreements with those two countries. People have noted some issues with this program, notably, the burden on institutions taking in the candidates and the difficulty of the national examinations they must pass in order to win qualification and remain in Japan. And this spring a new issue has emerged: Some of those who passed the exam to become certified care workers have nonetheless decided to return to their home countries.

Minister of Health, Labor, and Welfare Komiyama Yōko revealed the problem in a press conference on May 8. She reported that of the 36 foreign candidates who passed the exam for certification as care workers, 2 had already left and another 4 were planning to return to their home countries. This was the first group of successful candidates under the EPAs with Indonesia and the Philippines, since those taking the exam are required to have worked for three years as trainees. Komiyama explained that some of the successful candidates had to return home because of circumstances they did not foresee when they came to Japan, such as the need to care for family members. But the fact that one-sixth of those who completed their training and passed the exam decided to leave has come as a shock to those involved.

A Reality Quite Different from the Candidates’ Dreams

A more basic issue with the program for admitting nurses and care workers is the fact that so few of the candidates manage to pass the national examinations they are required to take. Of the 104 candidate nurses who came to Japan from Indonesia in 2008, only 24 passed the exam on one of the four opportunities they had to take it before the end of their originally granted three-year time frame. Another 27 were permitted to extend their stays for a year and take the exam this spring, but only 8 of them passed; the other 19 had to return to Indonesia.

Why is it that these young people who came to Japan dreaming to work here as nurses or care providers are having to return home with their hopes dashed or are deciding to leave even if they passed their exam? A number of factors may be cited.

The first factor is the height of the two major hurdles the candidates must clear, namely, the language barrier and the certification exam. Those hoping to become nurses had their first opportunity to take the exam in 2009. That year the pass rate was 0%, but in the following two years the figure crept up slightly, to 1.2% in 2010 and 4.0% in 2011, and this year it reached double digits at 11.3%. But it was nowhere near this year’s 90.1% pass rate for all candidates, including Japanese. The pass rate for foreign trainees seeking certification as care workers was a more substantial 37.9%, but even so it was not much over half the total pass rate of 63.9%.

Another factor I would cite is the gap between the candidates’ expectations and the reality of their experiences in Japan. Having had professional training and on-the-job experience in their home countries, the candidates are ready to start working as soon as they arrive. But since they do not yet have Japanese professional certification, they are treated as “assistants” in their workplaces. People who were employed as fully qualified nurses in their home countries, working alongside doctors and taking responsibility for portions of patients’ medical care, find themselves doing jobs in Japan that consist mainly of tending to patients’ hygienic needs and serving as nurses’ assistants. So after arriving in Japan, they must struggle to adjust to workplace practices and expectations different from what they are used to, and they must also do a tremendous amount of Japanese language study.

In terms of compensation, though, many candidates are favorably surprised at how much higher the salary levels are in Japan than in their own countries. Trainees who come to Japan to work in fields like agriculture and garment manufacturing sometimes have substantial portions of their pay illegally docked by others, but such problems are rare in the case of nursing and care work. So it is not surprising that some candidates decide to return home, where their families await them, after having assiduously built up their savings while working in Japan.

Efforts to Improve the Program

Those responsible on the Japanese side have not been neglecting the need to improve the program. For example, when the first group of candidates came to Japan from Indonesia, they had received no language training in advance, and there were no appropriate textbooks for them. But a program of pre-entry training was subsequently introduced, and it was extended to a six-month period for those who arrived this year. The aim is to teach the candidates reading and writing skills before they come to Japan and then to devote the six-month period of training after their arrival to having them acquire Japanese-language communication skills, learn about Japanese culture and customs, and become mentally prepared for the requirements of their workplaces, thereby reducing the burden both on the candidates after they start working and on the institutions that have accepted them.

In addition, the Ministry of Health, Labor, and Welfare has taken steps to make it less difficult for non-Japanese candidates to pass the national qualification exams. Last year the MHLW added furigana (pronunciation guides) to the more difficult kanji (Chinese characters) in the exams, and next year they are to be added to all the kanji; in addition, foreign candidates are to be given extra time to finish the exam. In Indonesia, meanwhile, the Japanese embassy has been extending assistance to Indonesian candidates who have returned from Japan after failing to pass the exam, such as by helping them find jobs with local Japanese affiliates; the aim is to keep the returnees from having bad feelings toward Japan.

The system of advance training is to be even more thorough for candidates from Vietnam, who are being recruited for the first time this year and who are expected to come to Japan starting next year. The candidates are to have a full year of Japanese language instruction in Vietnam so that they will be able to conduct everyday conversations before they arrive in Japan. The Japanese government is providing funds for this training from its budget for official development assistance. Vietnamese Prime Minister Nguyen Tan Dong, who visited Japan this April and signed a bilateral agreement on this program, noted that the Vietnamese language is the biggest hurdle for Japanese people working in Vietnam and that studying the Japanese language is similarly the toughest task for Vietnamese people seeking to work in Japan. He said he hoped that the candidates would receive good preparation for their exams before going to Japan.

It seems doubtful, however, that these efforts at improvement will be sufficient. To deal with the problem of care worker candidates returning to their home countries after passing the certification exam, the MHLW intends to check with candidates before they enter into an employment contract with an institution and confirm that they will continue working there if they pass the exam. But the candidates ought to have the freedom to choose their place of employment in Japan. The Japanese government’s role should be limited to providing encouragement for them to stay in Japan as care workers. From an international perspective, it is not acceptable to make the candidates leave Japan if they do not pass the exam and force them to keep working at a particular institution if they do pass.

Another difficult issue is the placement of candidates. In order to work in Japan, people need to be accepted by some institution. Institutions send people overseas to interview candidates before they come to Japan and they are naturally looking for the best human resources they can find. As a result, some of the candidates reportedly end up without offers from any institution and must give up the idea of going to Japan after having spent considerable time studying the Japanese language in the advance training program.

A More Fundamental Overhaul

Perhaps as a result of the circumstances described above, the number of candidates coming to Japan from Indonesia and the Philippines has been declining. Japan is not the only country with an aging population, and nurses and care workers have a much easier time finding jobs in places other than Japan, such as Europe, America, and Singapore. Nowadays people with specialized skills are increasingly able to move across borders. It would probably be a good idea to consider shifting from the current system to one under which people who know Japanese and have certain specialized knowledge would be allowed to enter Japan under short-term working visas.

Japan is a leading country in terms of population aging, and there is considerable demand in other Asian countries for opportunities to work and study on the front lines of Japanese healthcare. But we can already see signs that people in other countries are losing their willingness to accept invitations to come to Japan as care workers, however loudly Japan may declare it wants them. In order to keep the inflow from drying up, we need to undertake a bold overhaul of the present system.

(Originally written in Japanese on May 18, 2012. Title background photograph courtesy of Sankei Shimbun.)

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