Human Resources
in Long-Term Care Services
- Japan’s Case -
MASAHIRO MORI NY Representative for
MHLW, Japan
Figures estimated in 2012
(Population estimated of Japan) Actual figure
(National Census)
0
20
40
60
80
100
120
140
1950 1960 1970 1980 1990 2000 2010 2015 2025 2035 2045 2055
61.3%
*1
26.0%
*1
1.42
(2014)
127.0mln (*1)
116.6 mln
36.8 mln
67.7 mln
12.0 mln
86.7mln
34.6mln
44.1 mln
7.9 mln
2014
In 2060, the total population will drop below 90 million
while the aging population ratio will exceed 40%.
Population (million)
Productive age (15 – 64 years
old) population ratio
Population of 15 - 64
years
Population of 14 years
old and below
Aging population
(65 years old and above)
ratio
Population of 65 years
old and above
Total fertility rate
Productive age
population ratio
50.9%
Aging
population
ratio
39.9%
Total
fertility
rate
1.35
Sources: Ministry of Internal Affairs and Communications National Census and Population Statistics, National Institute of Population and Social Security Research Future Population Projections for Japan
(January 2012 estimate): Moderate-range Projects for Births and Deaths (Each year’s population is as of October 1)
Ministry of Health, Labour and Welfare Population Survey Report
(*1) Source: Ministry of Internal Affairs and Communications, FY2014 “Population Estimates” (The 2010 Population Census shows Japan has a population of 128,060,000, a productive-age population ratio of
63.8%, and a population aging rate of 23.0%.) 1
(Source) Ministry of Internal Affairs and Communications National Census and Population Statistics, National Institute of Population and Social Security Research Future Population Projections for Japan
(January 2012 estimate): Moderate Projections for Births and Deaths (Each year’s population is as of October 1)
1990 (Actual figure) 2025 2060
People 75 years old and
above: 597 (5%)
People 65-74 years old:
892 (7%)
Total population:
123.61 million
Total population:
120.66 million
People 65-74 years old:
1,128 (13%)
People 20-64 years old:
4,105 (47%)
People 19 years old and
below: 1,104 (13%)
Total population:
86.74 million
75
65
Age
10,000 250
10,000 10,000
50 100 150 200 250 0
People 75 years old and above:
2,336 (27%)
People 20-64 years old:
7,590 (61%)
People 19 years old and
below: 3,249 (26%)
20
50 100 150 200 0 250
People 19 years old and
below: 1,849 (15%)
People 75 years old and above:
2,179 (18%)
People 65-74 years old:
1,479 (12%)
People 20-64 years old:
6,559 (54%)
150 200
In 2025, all baby boomers reach the age of 75.
0 50
2014 (Actual figure)
People 65-74 years old:
1,708 (13%)
People 75 years old and
above: 1,592 (13%)
Total population:
127.08 million
People 19 years old and
below: 2,224 (17%)
People 20-64 years old:
7,184 (56%)
50 100 0
Baby boomers
(born in 1947-49)
Second-generation
baby boomers
(born in 1971-74)
100 150 200 10,000
250
2
10(0.8%) 18 27 32 40 45 50 56(3.2%)
321 339 375 419 492 548 603 640 678 724 753 782 836 869
895 (50.7%)
4.8(8.7%) 59 72
88 104
125 141
155 166 190
210 230
264 286
306 (17.3%)
180 237 277
342
368
413 397
391 371
423 432
458
485 502
507 (28.7%)
2,180
2,580
3,030
3.480
3,870 4,110
4,350 4,410 4,550
4,690 4,870
5,080 5,330
5,640 5,860
0
1.000
2.000
3.000
4.000
5.000
6.000
0
500
1.000
1.500
2.000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
訪問系
通所系
入所系
小規模多機能型居宅介
護など
(32.7%)
(13.0%)
(53.5%)
(32.8%)
(58.5%)
(thousand)
549 635
724
849
964
1,086 1,141
1,196 1,233
1,363 1,427
1,509
1,630
People requiring care (thousand)
Source: MHLW
1,765
The number of employees for long-term care services has tripled
since long term care insurance system was implemented.
1,708
3
employee
Day care service
In- home service
facility service
Multi functional service
*) FY2010: the ratio is calculated without Iwate, Miyagi and Fukushima Prefecture due to Tohoku Earthquake and Tsunami
*) Source: “Statistics for Employment Stabilization” by Ministry of Health, Labour and Welfare, “Workforce Research” by Ministry of Internal and Communications
Job to application ratio
The job to application ratio in long term care service
sector is higher than all other industry average.
4
(times)
0
0,5
1
1,5
2
2,5
3
3,5
4
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015
Industry average
Long term care service
Source; MHLW and JILPT
Labor force is expected to decrease by 7.9M in 15years.
Assuming that the labor force rate increases with appropriate
economic growth, the decrease would be 1.8M.
10.4 9.8 10.2 8.9 9.8
40.7 39.3 40.8 35.4 37.8
12.3 11.4 12.8
11.3 14.1
(実績値) 経済成長と労働参加が
適切に進まないケース
経済成長と労働参加が
適切に進むケース
経済成長と労働参加が
適切に進まないケース
経済成長と労働参加が
適切に進むケース
2014年 2020年 2030年
Labor Force Simulation (2020 & 2030, Male & female total)
+2.8 million
+2.4 million
+0.9 million
30 – 59
yrs old
15 – 29
yrs old
60 yrs or
above
+1.5 million
+0.4 million
+1.4 million
60.5 million (-3.1 million)
63.8 million (+ 0.3 million)
55.6 million (-7.9 million)
61.7 million (- 1.8 million)
Increase by 3.4 million Increase by 6.1 million
63.5 million
(Actual)
2014 2020
(Scenario) Stagnant
economic growth and
labor force participation
(Scenario) Stagnant
economic growth and
labor force participation
2020 Scra
2030
(Scenario) Appropriate
economic growth and
labor force participation
(Scenario) Appropriate
economic growth and
labor force participation
5
5,1 4,8 4,2
10,0 10,3
9,9
11,0 10,6
9,6
7,5 8,6
9,6
0
2
4
6
8
10
12
2014 2020 2030
Mining/Construction Manufacturing Retail/whole sale Medical/Welfare
The number of employees in health and welfare sector will be
equivalent to that of retail and whole sale sector in 2030.
30% of nurses, 40% of certified care workers, and 60% of
nursery teachers do not work despite having professional
licenses.
(Million)
Source; MHLW 6
More than 1 million workers increase
is required by 2025.
Nurses; 1.6M in 2014
1.96 – 2.06M in 2025
Care Worker; 1.71M in 2013
2.31M in 2020
2.53M + α in 2025
7
Total Male Female
Average
age
Years of
employme
nt
Monthly
salary
Male
compositi
on
Average
age
Years of
employme
nt
Monthly
salary
Female
compositi
on
Average
age
Year of
employme
nt
Monthly
salary
(year) (JPY/000) (%) (year) (JPY/000) (%) (year) (JPY/000)
By Industry
Industry total 42.3 12.1 333.3 66.6 43.1 13.5 370.3 33.4 40.7 9.4 259.6
Medical/welfare 40.9 8.3 301.5 28.1 40.6 8.6 379.4 71.9 41.0 8.2 271.0
Social insurance/social
welfare/nursing care 41.7 7.6 246.5 29.6 40.6 7.8 277.6 70.4 42.2 7.5 233.4
Service 44.6 9.4 282.1 70.0 45.9 10.1 305.3 30.0 41.7 7.5 227.9
By
Occupation
Doctor 40.0 5.1 848.4 73.8 41.1 5.3 910.6 26.2 37.0 4.4 673.2
Nurse 38.2 7.8 329.2 9.3 35.2 6.7 335.3 90.7 38.5 7.9 328.6
Assistant nurse 48.3 10.9 277.4 9.1 41.5 10.0 292.0 90.9 49.0 10.9 275.9
Physical
therapist/Occupational
therapist
31.5 5.3 284.0 53.7 31.9 5.2 292.1 46.2 31.1 5.3 274.7
Nursery staff 35.0 7.6 219.2 5.3 30.9 5.8 238.2 94.7 35.2 7.7 218.2
Care manager 47.0 8.7 261.6 27.5 42.2 7.8 281.7 72.5 48.9 9.1 254.0
Home helper 45.3 6.6 225.1 22.2 37.5 4.3 237.7 77.8 47.6 7.2 221.5
Welfare service worker 39.7 6.0 223.5 34.4 37.3 5.9 238.8 65.6 41.0 6.1 215.5
Source: MHLW
Care worker wages are lower than the average of all
industries.
8
Source; MHLW andCare Worker Foundation
15,4 14,6 16,4 14,5 14,4 14,8 15,6 15,5
21,6
18,7 17,0 17,8
16,1 17,0 16,6 16,5
10
15
20
25
30
2007 2008 2009 2010 2011 2012 2013 2014
Comparison of Turnover Rate
Inustry average Care worker
(%)
15,9 14,2
15,5 14,3 14,2 14,8
16,3 17,3
27,4
22,6
25,2 25,8
21,0 23,3
21,7 20,6
10
15
20
25
30
2007 2008 2009 2010 2011 2012 2013 2014
Comparison of New Hiring Rate
Industry ave. Care workers
(%)
New hiring rate and turn over rate are relatively higher
than the average.
9
10
31,7%
25,0% 24,7% 23,5% 22,0%
18,9%
14,3% 13,2% 13,1% 12,2% 10,9%
5,3% 4,2% 3,7% 2,0% 0,9%
19,7%
0%
10%
20%
30%
40%
Ma
rriag
e, C
hild
birth
, Child
rea
r
dis
sa
tisfie
d w
ith w
ork
pla
ce
p
olic
ies
Rela
tion
sh
ip w
ith o
the
r wo
rke
rs
Lo
w s
ala
ry
Hea
lth p
rob
lem
(excl. b
acka
ch
e),
rea
ch
ed
retirin
g a
ge
Dis
sa
tisfie
d w
ith w
ork
h
ou
rs/h
olid
ay/w
ork
sh
ift
Ba
cka
ch
e
Cou
ld n
ot d
eve
lop
exp
teris
e fu
lly
Eld
erly
ca
re
La
ck o
f ca
ree
r de
ve
lop
me
nt
wa
nte
d to
exp
erie
nce
difffe
ren
t job
Relo
ca
tion
of fa
mily
me
mb
er
Ob
tain
ed
ce
rtifica
te/q
ua
lifica
tion
Restru
ctu
ring
, layo
ff, liqu
ida
tion
Pe
rso
na
l issu
e w
ith o
the
r fam
ily
me
mb
er
Esta
bis
he
d o
wn
bu
sin
ess
Oth
ers
Source; Social Welfare Promotion and National Examination Center
Marriage/Child rearing, Workplace policies, and
Relationship with other workers are the main reasons for
leaving their jobs.
High
turnover
Future career path is
not visionary
Target goal is Mt. Fuji shape which has broader
entrance as well as higher and more clear career
ladder.
Function
between
professional
and no
professional is
mixed up
Not labor
force with
licenses
Highly Professional
Basic Level
11
Limited entry Limited entry
12
Wage Increase (reimbursement price premium ($270))
No refund educational loan
Registry System for licensed care workers leaving the industry
Maternity Leave and Child Care Services
Wage increase is supported through long-term care
insurance system.
13
Improving expertise of care workers will bring
productivity increase
Care workers with training are allowed to conduct
sputum suction.
Nurses with training are allowed to conduct specified
medical treatment such as
Decubitus removal, Drain removal, Quantity adjustment of insulin injection
Visualize capability and expertise of care workers
Career Grade System for long term care services was introduced.
Higher Productivity will result in Higher wages
14
Non-professional workers such as retired, community
volunteer will be utilized for shopping/walking support,
cooking and cleaning.
Service revision for people with lower care needs.
(More preventive , More independent, More improvement)
Optimizing the allocation of human resources is
required
Professional Long Term Care Career Grades
Level Features
Professional
Level
7 Top Professional as representative of
each sector
6 Highly professional, originality of care
services 5
4 Excises leadership in a team
3 Independently providing services
without direction.
2 Providing services with direction.
1 Finished Basic Training
15
“Welfare service vision with response to
demand of new era” was released in Sep 2016.
16
Family issue is more complicated and more cross sectoral
System is working sector by sector
child welfare
long term care
welfare for disabled
welfare for low income family
Shrinking demographic will cause shortage of human resources and infrastructure in welfare services
• Comprehensive consultation system
• Multi generational and functional service center
• Comprehensive educational system for multi functional services
• Introduction of Innovation as well as improvement of service flow efficiency
17
Create community where individuals supports
everyone mutually.
There is no distinction between supporter and
supported in such community.
This concept will lead us to Inclusive society.
18
Case 1
Case 2
19
Case 3
20
Example of Licenses
【Health Care】
Nurse
OT
PT
ST
ORT
Radiology Technologist
Clinical Laboratory
Technologist
Certified Social Worker
Certified Care Worker
PSW
Nursery Teacher
License
A
License
B
License
C
A
B
C
Common Curriculum
2 years
3 years
21
We are planning to create a common curriculum
between licenses
Complicated case
Efficient allocation
Mobility increase
New career ladder
【Welfare】
22
Number of Immigration by EPA(as of 2016/1/1)
Number of
Immigration
Accepted Candidates Qualification Obtained
Working Contract
terminated &
left Japan Total Working
Contract
terminated &
left Japan
Indonesia 966 528 224 214 135 79
Philippines 885 502 242 141 115 26
Vietnam 255 253 2 - - -
Total 2106 1283 468 355 250 105
(number of immigration)
Source: JICWELS
Long term care robot development promotion project
Idea
Development
Marketing Project for Development of Service Method
Practical Trial Supporting Project
Needs and Seed Matching Project
Monitoring Research
Campaign on outcome of trail use
Providing information on
proposal from on site
workers
Deployment of effective
utilization of the robot
23
Okayama city was designated as Special Zone for
Home Care Service Model Development
24
Sensor Mattress
PARO(Seal type
therapeutic robot)
Power Assist
Gloves
Kabo-can
(Communication Robot)
Rakunie
(Lamber Support Wear) One hand walking assist
Robots and various devices to support home care
PARO react human’s touch and voice, which
improves cognitive symptoms
JPY3,000/month (excl. tax)
Target user: People requiring care (level 1-5)
Sensor mattress monitors caretaker’s
daily life via tablet/mobile phone
JPY1,780/month (excl. tax)
Target user: People requiring care
(level 1-5)
Support grasping movement by air
pressure
JPY1,700/month (excl. tax)
Target user: People requiring care (level 1-
5), People requiring support (level 1-2)
Improve cognitive symptoms
through communication with
Kabo-can
JPY150 /month (excl. tax)
Target user: People requiring
care (level 1-5), people requiring
support (level 1-2)
Help care giver’s physical
burden
JPY600 /month (excl. tax)
Target user: People requiring
care (level 1-5), people
requiring support (level 1-2) and
care givers
Help the half-paralyzed to
stand and walk
JPY350 /month (excl. tax)
Target user: People
requiring care (level 1-2),
people requiring support
(level 1-2)
Source: Okayama City Government
Voice and screen display reminds you of
taking the medication. Digital light and voice reminds of you
medication time and details.
Barrier-free tatami helps wheelchair users to
move at home or nursing home.
JPY1,500/month (excl. tax) JPY850/month (excl. tax) JPY800/month (excl. tax)
This power walking robot assists you with
curve or slope. GPS tracking function
supports home care. JPY1,500/month (excl. tax)
Auto-wrapping defecation treatment using
thermocompression reduces care giver’s
burden. JPY1,000/month (excl. tax) JPY800/month (excl. tax)
Walking Assist
Medication Aids Robot
Walking Assist Robot RT.1
Medication Aids Robot
Toileting Aids
Auto-wrapping defecation treatment system
Medication Aids
Home medication aids
Take medicine !
Everyday Life Support
Tatami customized for care takers
Barrier-free Slope
Walking Assist
ACSIVE
It doesn't require the use of electricity nor
motor, but is powered by a cam spring
mechanism.
24 Source: Okayama City Government
-25
-20
-15
-10
-5
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14
DBD points
DBD has dropped
dramatically
after 6 month use of PARO
23.2点 month
26 Source; Okayama city
Ms. A case Age 90, Female
• Care need 5 (highest)
• Dementia Independency Ⅳ (Second highest)
• Abusive to care workers
• Strong demand to be spoiled by her son
Outstanding improvement was seen in 13 month use of PARO
• DBM 20 → 16
• NM scale 17 → 21
• Zarit 40 → 13
27 Source: Okayama City Government