The Structure of the Care Worker Crisis — An 'Invisible Roadmap' to 2040
Japan will face a shortage of 570,000 care workers by 2040, according to projections by the Ministry of Health, Labour and Welfare. With a job openings-to-applicants ratio of 3.9 and turnover and hiring rates nearly equal, what appears to be a quantitative problem intersects with systemic failures in institutional design. This column examines the crisis through a three-layer structural analysis.
What Is Happening
Japan will face a shortage of 570,000 care workers by 2040. This is the projection published in 2024 by the Ministry of Health, Labour and Welfare (厚生労働省) in its "Required Number of Care Workers Based on the 9th Long-term Care Insurance Business Plan." The current workforce of approximately 2.15 million must grow to 2.72 million — a gap of 570,000.
The assumptions behind this figure warrant careful examination. The projected shortage of 570,000 is predicated on maintaining the current care service delivery system while accommodating the anticipated rise in demand driven by population aging. In other words, it signals that the present trajectory will render Japan unable to sustain its care services by 2040.
The severity of the problem comes into sharper focus through the job openings-to-applicants ratio (有効求人倍率). For care service occupations, this ratio averaged approximately 3.9 in fiscal year 2023. Given that the all-occupation average hovered around 1.2, the care sector stands as a textbook case of acute labor shortage.
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 stands at 14.4% (Care Work Employment Survey, fiscal year 2023). At first glance, this may not appear exceptionally high. However, the distinctive feature of the care industry lies in the relationship between turnover and hiring. The hiring rate is 14.2% — virtually identical. Workers leave at roughly the same rate they enter. Even when the supply tap is opened wider, the drain remains equally open.
Background and Context
Accelerating Aging and the Nonlinear Growth in Care Demand
Japan's elderly population will peak in the 2040s. The critical issue is not the number of elderly persons per se, but the rate of increase in those requiring long-term care (要介護高齢者).
Adults aged 75 and over (後期高齢者) have a long-term care certification rate approximately six to seven times higher than those aged 65 to 74 (前期高齢者), according to the MHLW's Long-term Care Insurance Status Report. Japan reached a milestone in 2025, when the entire baby boom generation (団塊の世代) turned 75 or older. While the growth in the absolute number of elderly persons will gradually moderate, the number of individuals certified as requiring long-term care is projected to continue rising through the 2040s.
The Institutional Constraint of Care Service Fees
Any discussion of care worker compensation must account for the long-term care fee schedule (介護報酬), a publicly administered pricing mechanism. Prices for care services are not determined by market forces but are set by the national government and revised every three years. Care providers must generate revenue and pay staff wages within the bounds of these fee schedules. No matter how intense the competition for workers becomes, wage increases remain structurally constrained unless fee rates are raised.
The fiscal year 2024 fee revision expanded treatment improvement allowances (処遇改善加算), and compliant providers were expected to achieve some degree of wage improvement. Yet the application and calculation processes for these allowances are complex, and smaller providers in particular often find themselves unable to secure them. A secondary problem has emerged: an "equity gap" in treatment improvements.
The Limits of Foreign Care Workers as a Supplementary Strategy
Since the creation of the "care work" residence status (介護在留資格) in 2017, Japan has expanded its intake of foreign care workers. Across all pathways — the Economic Partnership Agreements, the new Work-based Training program (育成就労, successor to the Technical Intern Training Program following the 2024 legislative reform), Specified Skilled Worker visas, and the care work residence status — the cumulative number of foreign care workers has reached the tens of thousands. Relative to the total domestic care workforce of approximately 2.15 million, however, this represents only 1 to 2 percent.
Retention poses an additional challenge. Language and cultural barriers, the pressure of remittances to families, and low compensation all contribute to a pattern in which foreign care workers return to their home countries after only a few years. The refrain from the field — "we trained them, but they did not stay" — is common. Foreign workers serve as a valid supplementary measure, but they cannot resolve a structural deficit.
Reading the Structure
The care worker crisis operates on three layers.
Layer 1 — Quantitative Shortage: This is the most widely recognized dimension. It is the gap between the current workforce and the projected need, captured by the figure of 570,000 by 2040.
Layer 2 — Qualitative Attrition: The near-equivalence of hiring and turnover rates creates an illusion of equilibrium that masks a continuous outflow of experienced workers. For every new entrant, a veteran departs. Expertise in care work struggles to accumulate.
Layer 3 — Institutional Constraint: The publicly administered fee schedule functions as a de facto ceiling, making it structurally difficult for market mechanisms alone to drive wage improvements. This layer perpetuates the attrition described in Layer 2.
With every triennial fee revision, the phrase "treatment improvement" is repeated. Yet the scale of revision remains limited, failing to address the fundamental question embedded in institutional design: how should society value care work?
What the "invisible roadmap" to 2040 reveals is not a problem of time but of structure. The items that belong on that roadmap are not recruitment quotas or capacity targets, but a redefinition of the social value of care.
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References
Required Number of Care Workers Based on the 9th Long-term Care Insurance Business Plan
Long-term Care Bureau, Ministry of Health, Labour and Welfare. Ministry of Health, Labour and Welfare
Read source
Care Work Employment Survey (Fiscal Year 2023)
Care Work Foundation. Care Work Foundation
Read source
Employment Referral Statistics (General Employment Placement Conditions)
Ministry of Health, Labour and Welfare. Ministry of Health, Labour and Welfare
Read source
Fiscal Year 2024 Long-term Care Fee Revision
Long-term Care Bureau, Ministry of Health, Labour and Welfare. Ministry of Health, Labour and Welfare
Read source
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