The Structure of Japan's Care Worker Crisis — The 'Invisible Roadmap' to 2040
Japan faces a projected shortage of 570,000 care workers by 2040. With a job-to-applicant ratio of 3.9x, the crisis is already underway.
TL;DR
- Japan faces a projected shortage of 570,000 care workers by 2040, with a job-to-applicant ratio of 3.9x signaling the crisis is already underway
- Hiring and turnover rates are nearly identical, creating a structure where experienced workers continuously leave
- The public pricing system of care reimbursement caps wages, making market-based solutions structurally insufficient
What Is Happening
Japan projects a 570,000 care worker shortage by 2040 amid rising demand.
Care workers will face a shortage of 570,000 by 2040—this is the estimate from the Ministry of Health, Labour and Welfare's "Required Number of Care Workers Based on the 9th Long-Term Care Insurance Business Plan" published in 2024. The workforce needs to grow from approximately 2.15 million to 2.72 million. The expansion required is 570,000 workers.
We need to examine the assumptions behind this figure. The shortage of 570,000 is calculated based on maintaining current care service delivery systems while assuming service demand will increase alongside population aging. In other words, it means "we cannot maintain services in 2040 if things continue as they are."
The job-to-applicant ratio reveals the urgency of this problem more clearly. The effective job-to-applicant ratio for care service positions averaged approximately 3.9 in fiscal year 2023. Considering that the average across all occupations hovers around 1.2, care work represents a typical sector facing "severe labor shortages."
縦線は求人倍率1.0倍（需給均衡点）。介護サービス職は均衡点の約3.9倍。
The turnover rate for care workers is 14.4% (Care Work Foundation). This may not appear particularly high at first glance, but the care industry's uniqueness lies in its relationship with the "hiring rate." The hiring rate is 14.2%, nearly identical—meaning the industry maintains a structure where as many people leave as enter. It's like opening a water tap while keeping the drain open simultaneously.
Background and Context
Historical factors and systemic issues contributing to the current care worker crisis.
Accelerating Aging and "Non-linear Growth in Care Demand"
Japan's elderly population will peak in the 2040s. The issue is not the "number of elderly people" itself, but the rate of increase in "elderly people requiring care."
There's a fact that late-stage elderly (75 and older) have roughly 6-7 times higher long-term care certification rates than early-stage elderly (65-74) (Ministry of Health, Labour and Welfare Long-Term Care Insurance Business Status Report). Japan reached a milestone in 2025 when all "baby boomers" turned 75 or older, and the number of people certified for long-term care is expected to accelerate rapidly going forward. While the growth in the "number" of elderly people is becoming gradual, the increase in "people requiring care" is projected to continue until the 2040s.
Institutional Constraints of Care Reimbursement
To discuss care worker wage issues, we cannot ignore the public pricing system called "care reimbursement." Care service prices are determined not by market mechanisms but by care reimbursement rates that the government revises every three years. Service providers must generate revenue and pay employee wages within the scope of care reimbursement. Even when labor shortages intensify job competition, if reimbursement rates don't increase, it's structurally difficult to generate resources for wage increases.
The 2024 care reimbursement revision expanded care worker remuneration subsidies (処遇改善加算), and corresponding facilities can expect certain wage improvements. However, because subsidy applications and calculations are complex, many cases exist where small-scale operators "cannot obtain subsidies." This creates a second problem of uneven access to remuneration improvements.
The Limits of Foreign Care Workers as a "Supplementary Measure"
Since the creation of the "Care" residence status in 2017, the acceptance of foreign care workers has expanded. Foreign care workers through EPA, Development Employment (formerly Technical Intern Training, transitioning due to 2024 legal revisions, supervised by the Immigration Services Agency), Specified Skills, and Care residence status have reached tens of thousands cumulatively, but remain only 1-2% compared to the total domestic care workforce (approximately 2.15 million).
Furthermore, there's the issue of retention rates. Language and cultural barriers, pressure to send money to families, low treatment—many foreign care workers return home after several years, and a common complaint among facility managers is that "we trained them but they didn't stay." While foreign workers are effective as a supplementary measure, they have limits in addressing structural shortages.
Reading the Structure
Analysis of underlying structural problems within Japan's care delivery system.
The care worker crisis has three layers.
First Layer—Quantitative Shortage: This is the widely recognized problem. The gap between the number of workers and the number needed. The figure of 570,000 toward 2040 shows this scale.
Second Layer—Qualitative Outflow: The reality that hiring and turnover rates are nearly identical appears to be in quantitative balance, but actually means "experienced workers continue to leave." As many new workers enter, veterans leave. Care "expertise" is difficult to accumulate.
Third Layer—Institutional Constraints: Care reimbursement functions as a public price ceiling, making wage improvements difficult through market mechanisms alone. This structurally sustains the outflow in the second layer.
Every three years during care reimbursement revisions, the phrase "treatment improvement" is repeated. But revision ranges are limited, and they don't answer the fundamental question of institutional design—"How should society evaluate the value of care?"
What the "invisible roadmap" to 2040 shows is not a problem of time, but a problem of structure. What should be written into the roadmap is not hiring numbers or capacity figures, but "redefining the social value of care."
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References
第9期介護保険事業計画に基づく介護職員の必要数について — 厚生労働省 老健局. 厚生労働省
介護労働実態調査（2023年度） — 公益財団法人 介護労働安定センター. 介護労働安定センター
職業安定業務統計（一般職業紹介状況） — 厚生労働省. 厚生労働省
令和6年度介護報酬改定について — 厚生労働省 老健局. 厚生労働省
