Long-term care insurance systemLong-term care services and benefits are distributed under the long-term care insurance (LTCI) system established in 2000. Half of the system’s budget is publicly funded by the central and local governments, while the other half is financed by the insurance premium. Every Japanese citizen above 40 years old must join the LTCI and pay these premiums. There are two categories, primary insured people aged 65 years and older and secondary insured people aged 40 to 64. Primary insured people are eligible to receive long-term care services with 70 to 90 percent of costs covered by the insurance depending on their income status. Secondary insured people can also access benefits when they suffer from disabilities caused by age-related illnesses such as cerebrovascular diseases.
Of the total primary insured people in the country, nearly 19 percent required nursing care or support in 2021. To compensate for the growing number of people requiring care, the LTCI fees for both age cohorts have steadily risen over the last decade. As of 2023, primary insured people paid a monthly average of around six thousand yen for premium.
Available services and shortage of caregiversLong-term care eligibility of primary insured people and the allocation of benefits are determined by the municipalities. There are seven care level categories from Support Level 1 -needing preventive care for long-term frailty - to Care Level 5 – assigned for bedridden conditions and neurodegenerative ailments. Services are divided into three categories, in-home care, care at nursing facilities, and community-based care. In-home care services are for recipients who live at home and receive services such as domestic help, bathing, and rehabilitation at home or day-care and short-stay facilities. Nursing institutions offer comprehensive services for in-house residents. Community-based care was established in 2006 to provide flexible services such as monthly flat-rate plans, in which local recipients can receive, for example, home-visit care with a night shift.
Generally, there is a shortage of both domestic and professional caregivers in Japan and the Japanese health ministry warned about this deficiency till 2025 and onward. A survey in 2020 revealed that the majority of households with care recipients were nuclear families or one-person households, indicating a high demand for external caregivers. The total number of certified care workers has significantly increased over the past decade.