Foreign Care Workers Surpass 100,000 as Nursing Homes Face Staff Shortages 

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"Chew slowly," said Kristin Barus (24) in Japanese, as she helped an elderly man with his meal at Dai-ni Shin-Yokohama Parkside Home, a special nursing home operated by the Yokohama-based social welfare corporation Senrikai. Bals, an Indonesian care worker, is now in her third year in Japan. Her Japanese has a slight accent, but she is clearly understood. The man accepted the tea she offered him and drank it with a calm, reassured expression.

Of the facility's 62 staff members, 40 are foreign nationals. "Without them, we simply could not keep this facility running," said director Yuko Makino.

"I love speaking Japanese, but kanji is hard," Bals said.

Her interest in Japanese culture led her to study the language as her second foreign language at nursing school in Indonesia. She came to Japan to work in a country with higher wages.

Now, she is preparing for the national certified care worker exam in January, as she hopes to keep living in Japan.

Filling the Labor Gap 

According to the Ministry of Health, Labor and Welfare, the number of people certified as needing long-term care or support continues to rise, reaching about 7.2 million in fiscal 2024. As of October 2024, Japan had around 2.12 million care workers, but the government estimates a shortage of about 250,000 in fiscal 2026.

"Care work still suffers from an image of low pay and tough working conditions," Makino said. "In reality, the gap with other industries is not that large, but that perception is hard to overcome."

"The people we want to hire simply aren't coming from the Japanese workforce," she added.

Foreign workers like Bals are helping to fill the gap. According to the Ministry of Health, Labor and Welfare, about 108,000 foreign nationals were working in welfare-related fields, including nursing care, as of the end of October 2025. That is 3.6 times more than five years earlier.

Four Pathways Into Japan

Japan has four separate pathways for accepting foreign care workers. They include programs under Economic Partnership Agreements (EPAs) with certain countries; the "nursing care" residence status; the Technical Intern Training Program; and the specified skilled worker program.

For a single occupation, it is an unusually elaborate framework. Behind it lies a constant balancing act between the care industry's demand for workers and the profession's special requirements. Unlike many other jobs, care work involves close interaction with people, making Japanese-language ability essential.

To preserve the quality of care, the government generally requires foreign workers who come to Japan under EPA arrangements to pass the national certification exam for care workers during their stay.

Under the Technical Intern Training Program, nursing care is the only field with its own separate Japanese-language requirements. Under the specified skilled worker system, applicants must demonstrate Japanese proficiency equivalent to N4, the second-lowest level on a five-tier scale; be required in fields such as construction and agriculture; and pass a separate nursing care Japanese evaluation test that checks whether they understand the terms used on the job.

But under the technical intern program, the language requirement proved a major hurdle, and the number of workers did not rise as much as initially hoped. The government later eased the rules, allowing workers to remain in Japan for up to two additional years even if they fail the Japanese test upon arrival, provided they show a willingness to continue studying.

Japanese Only on the Job

Care facilities are also experimenting with ways to help foreign staff integrate. As the number of foreign workers rises, conversations among them in their native languages can become more common. At Dai-ni Shin-Yokohama Parkside Home, the rule is simple: Japanese only while on duty.

The facility also uses a step-by-step training program. In the first year, workers focus on everyday conversation. In the second, they learn specialist nursing care terms. In the third, they work through past questions from the national certified care worker exam.

At a long-term care health facility in Osaka operated by the medical corporation Keieikai, Vietnamese and other foreign care workers have been actively hired since Japan began accepting them under the EPA framework. 

Some residents were initially uncomfortable receiving care from foreign staff. Over time, however, those concerns faded, and the foreign workers became part of the same team as their Japanese colleagues.

Some still struggle with the Kansai dialect, which is not taught at Japanese-language schools. But Nguyen Thi Hau, 32, a Vietnamese staff member now in her eighth year at the facility, said, "You pick it up naturally as you work."

Maintaining Care Standards

The number of foreign staff at Keieikai facilities has grown to around 80. The organization is also working to secure capable workers by hiring international students studying for the national certified care worker qualification as part-time care assistants.

"With a national qualification, they are ready to contribute immediately," said Makoto Mitsuyama, chairman of Keieikai. "If we cannot keep these facilities running without relying on foreign workers, then we have to do everything possible to maintain the quality of care."

Still, many care providers are small or midsize operators, and some lack the resources to provide Japanese-language training for foreign staff.

Tomoya Suzuki, an associate senior researcher at the NLI Research Institute, said operators need to take a more proactive approach. "Care providers should work together to organize training programs, while also seeking support from local governments and NPOs," he said.

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(Read the article in Japanese.)

Author: Momoka Nagare, Saori Fujii, The Sankei Shimbun

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