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2008年5月31日 (土)


05/31/2008 --The Asahi Shimbun, May 30(IHT/Asahi: May 31,2008)

EDITORIAL: Nursing care crisis


The Diet has enacted a surprisingly inane bill to tackle the challenge of securing a sufficient number of qualified nursing care workers. The bill has only one provision that is totally devoid of substance. All it says is "necessary measures should be taken, if deemed necessary, by April next year."




The shortage of caregivers in this aging society is becoming increasingly serious. Each year, about 20 percent of the 1 million people working in elderly care leave their profession.

The labor crunch in the care community is especially severe in urban areas where economic conditions have been improving over the past several years.



The number of offices of home care providers started falling around December last year due to staffing and financial difficulties following years of steady increase. The nursing care insurance system was introduced in 2000.


What is worrisome is that many of the vocational schools and university departments to train caregivers nationwide are failing to meet their intake quotas.


The number of students who enrolled in these institutions in April 2007 accounted for only 64 percent of the total of their quotas, which was 26,000, according to the Ministry of Health, Labor and Welfare. A total of 12 schools closed their courses for training care workers in fiscal 2007. The data clearly points to waning interest among young people in pursuing a career in nursing care work.


Care work means putting in a lot of hours, but care workers are paid only about 200,000 yen per month on average, or more than 100,000 yen less than what people in other industries earn. Low wages are clearly the primary factor behind the labor drain.

Job insecurity is another big problem for caregivers, with nearly half of them working as non-regular employees.


The costs of services provided under the state nursing care insurance program, including the wages paid to care workers, are covered by fees set by the government.


As the number of service recipients has been increasing year after year, the total amount of fees has also kept growing. To curb growth in the payments, the health ministry has lowered the fees twice.


The ranks of elderly people certified as requiring nursing care are projected to grow to over 6 million in 10 years from the current 4.1 million. That means at least 500,000 additional care workers will be needed. Unless the exodus of workers is stopped, the nursing care insurance program could collapse due to the shortage of labor.



Of the "necessary measures" stated by the law, wage increase should be given the highest priority. The government needs to raise the fees for care services and make sure that the hike will translate into higher paychecks for care workers.


The question is how to raise the money needed. Under the current system, 90 percent of the fees for nursing care services is covered by premiums collected from people, aged 40 or older, as well as taxpayer money, while the remaining 10 percent is paid by the service recipients themselves.  

Since it is difficult to raise either the premiums or the out-of-pocket payments by recipients, the only place to find new money to finance a fee hike is state coffers. That would require a shuffling of the state budget.


Japan's population is aging at a pace unprecedented in the history of mankind. The Japanese people are facing a big choice. Should the share of limited fiscal sources for public works projects to construct dams, control rivers and build roads be kept unchanged? Or should more of the total spending be allocated to programs for health and nursing care and education in a radical budget reform?


If a major budget reallocation is not enough to deal with the shortage of care workers, a tax hike will be inevitable.


To maintain the crucial nursing care system by keeping care workers in the profession, taxpayers may have to brace for an increase in their burden.


--The Asahi Shimbun, May 30(IHT/Asahi: May 31,2008)

朝日新聞 5月30日号 (英語版 2008年5月31日発行)


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