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Japan tentatively opens its doors to international care workers

Gabriele Vogt

/ 7 Minuten zu lesen

Japan’s population is ageing and the need for care workers is increasing. Facing demographic pressure, the country is now opening its borders to labor migration from abroad.

A Filipino caregiver leading day-care services users in exercising at a care home in Kesennuma, Japan. (© picture-alliance)

Japan’s shortage of qualified workers is particularly evident in the elder care sector. A growing demand for professional care has correlated with a decline in new workers entering the profession. Consequently, since the mid-2000s, Japan, which is one of the countries with the most restrictive immigration laws among liberal democracies, has been gradually opening its borders to international care workers. What are the societal and economic reasons behind this policy reform, and what role do international care workers play in Japan today?

Demographic change in full swing

In the three main demographic variables – fertility, mortality, mobility – Japan exhibits extreme values that favor aging and a decline in the overall population. By 2040, more than one in three people living in the country (34.8 percent) will be a senior citizen. These figures, combined with a growing acceptance of extra-familial care providers since the introduction of long-term care insurance in 2000, have resulted in increased demand for professional care workers. Japan would need to recruit 70,000 new care workers annually to adequately meet this demand.

At a glance: Demographic characteristics of Japan

The birth rate (fertility) in Japan stands at 1.30 children per woman, the life expectancy is 86.3 years for women and 79.6 years for men (born 2021).

The median age has increased from 40.7 to 49.1 years between 2000 and 2023. The number of deaths registered per year (mortality) is higher than the numbers of births in the same period. Since this so-called birth deficit is not compensated by immigration, Japan's population has been shrinking since 2010. In 2022, the population decreased by 800,000 persons – even though the number of foreign nationals living in the country increased by 289,500 persons.

In 2021, there were 2.76 million persons residing in Japan without Japanese citizenship; this represents only 2.2 percent of the total population (of more than 125 million) and is of little significance for the demographic development of the country.

By comparison, Germany:

In Germany, the birth rate, in 2022, stood at 1.46 children per woman. The life expectancy of women born in 2022 was 82.9 years, that of men 78.2 years. The population in Germany is also ageing. The median age rose from 39.0 to 44.9 years between 2000 and 2023. Germany's population would have shrunk without immigration since the early 1970s; since then, the annual number of deaths has exceeded the number of births. However, immigration has more than compensated for the birth deficit in most years and Germany's population has grown. At the end of 2022, 84.4 million persons were residing in Germany (2010: 81.8 million). Of these, 12.3 million were foreign nationals, which corresponded to 14.6 percent of the total population. Thus, immigration has a significant impact on Germany's demographic development.


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Labor shortages in the care sector and political strategies for tackling the issue

Even today, 61.3 percent of care professionals in Japan say that they are dissatisfied with their profession. The most common reasons given for this dissatisfaction include low wages and the physical and mental stress of the profession. But rather than addressing these issues, Japan is taking a two-pronged approach in another direction: encouraging older people to be more active, because people who remain healthy into old age require less care, and intensifying research and development in robotics for the elder care field. However, the cost of procuring these devices is still too high, and care workers remain extremely hesitant in their interactions with their “robotic colleagues.”

Bilateral agreements as the starting point for the immigration of international care professionals

The bilateral agreements that Japan signed with Indonesia (2008), the Philippines (2009), and Vietnam (2014) – known as the Economic Partnership Agreements (EPA) – mark the beginning of a new strategy for dealing with the growing demand for care professionals, as well as a paradigm shift in Japan’s immigration policies. It was the first time that the Japanese labor market opened up to migrant workers who were not considered “highly skilled” in the strictest sense. However, this path to legal migration, the design of which is similar to Germany’s Triple Win Program (TWP), has only attracted a small number of care workers to Japan to date. In January 2023, 3,257 so-called “EPA care workers” worked in Japan.

What is the Triple Win Program?

The Triple Win Program was launched in 2013 with the aim to recruit foreign care workers for the German labor market. It is intended to alleviate the shortage of care workers in Germany. The program is administered by the German Development Cooperation (Deutsche Gesellschaft für Internationale Zusammenarbeit, GIZ) and the International Placement Services (Zentrale Auslands- und Fachvermittlung, ZAV) of the German Federal Employment Agency (Bundesagentur für Arbeit, BA). The care workers come to Germany under the framework of placement agreements that have been concluded between the BA and the employment agencies in the countries of origin. To date, such agreements exist with Bosnia and Herzegovina, the Philippines, Tunisia, Indonesia, the Indian state of Kerala, with Jordan as well as with Vietnam, from where, however, only care worker trainees are recruited (as of August 2023). Those recruited via Triple Win are granted the right to stay and work in Germany for up to three years. If they succeed in having the vocational qualifications, previously acquired abroad, validated during this time, they may obtain a residence permit for skilled workers with vocational training and reside in Germany long-term. According to the German government 4,162 trained care workers had been recruited via Triple Win by May 2023. In total, around 1.8 million persons were employed in care professions in Germany at the end of 2022, including around 266,000 foreign nationals (approx. 15 percent).

According to a study conducted by the Competence Center for Securing Skilled Workers (Kompetenzzentrum Fachkräftesicherung, KOFA), in 2020/21, Germany experienced a shortage of more than 17,000 skilled workers in elderly care and 14,000 skilled workers in healthcare and nursing. As the number of persons in need of care keeps rising due to the demographic transition in Germany, the need for care workers will expand in the years to come. Already in 2018, the German Economic Institute (Institut der deutschen Wirtschaft, IW) estimated that by 2023 Germany would face a shortage of at least 135,000 skilled workers in elderly care alone.


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  3. Syda, Susanne; Robert Köppen and Helen Hickmann (2021), Pflegeberufe besonders vom Fachkräftemangel betroffen (Care professions particularly suffer from shortage of skilled workers), KOFA Kompakt 10/2021, Externer Link: (accessed on August 24, 2023).

  4. Informationsdienst des Instituts der deutschen Wirtschaft (iwd) (2018), Pfleger, bitte kommen! (Care workers, please come!), October 10, Externer Link: (accessed on August 24, 2023).

The numerous uncertainties that the EPA immigration route entails for both the international care workers and their employers in Japan are the primary reason for these low numbers. Among these uncertainties, the national exam that the care workers have to take in Japanese after a maximum of four years working in Japan, despite already having been educated in their home countries, is a particular challenge. Only after passing this exam, the care facility managers may consider the international care workers as certified personnel with long-term prospects in the staffing roster. This lack of recognition of qualifications obtained outside of Japan is a systemic barrier that was put in place by the Ministry of Labor, which campaigned for it in the interests of domestic care workers. In that sense, the EPA immigration route was so unattractive right from the start that it never even managed to attract the maximum number of 1,000 international care workers per year allotted for each partner country.

New immigration routes for international care workers in the Abe era

Beyond the EPA immigration route, policy reforms enacted during Prime Minister Shinzō Abe’s (2006-07, 2012-20) second term created new opportunities for the migration of international care workers. These reforms were part of the prime minister’s “Abenomics” campaign of labor market restructuring intended to revitalize the economy and counteract the shortage of skilled workers.

In 2017, the migration system for international interns was restructured – since then, it has also included care workers. Although 17,066 interns were employed in the care sector in January 2023, many care facility managers are still reluctant to hire candidates via this immigration route. Under the banner of knowledge transfer, this system is considered a building block of international development work, however, it is actually used to smuggle temporary workers into the Japanese labor market, in some cases with flagrant disregard for labor laws and human rights.

Care professions are also listed as a target group alongside other sectors impacted by the shortage of skilled labor in the Specified Skilled Workers (SSW) program of 2019. Within the first five years that the program was in operation, 60,000 international care professionals were supposed to be given the opportunity to receive on-the-job training in Japan, with the prospect of eventually qualifying for the work-related kaigo (care worker) residence permit, which was introduced in 2016. This residence permit would have afforded them the possibility to live and work in Japan long term. As of June 2022, 5,339 people have received the new residence permit, some of whom transferred over from the EPA immigration path. This was the first time that the opportunity for vertical mobility was embedded in Japan’s immigration system. It increases the chances that workers who have integrated into the Japanese labor market and society over the course of years will also stay long-term in the country.

The country’s nursing schools, which are largely privately owned, start the process one step earlier: They recruit trainees from neighboring countries, given the declining domestic demand for these traineeships and the corresponding economic pressure the schools face as a result. While just three percent of newly registered trainees came from abroad in 2016, that percentage rose to its highest level ever – 34 percent, or 2,395 people – by 2020. In 2022, that figure was 28 percent. The decline reflects the impact of Japan closing its borders to non-Japanese people, which was a core aspect of its efforts to contain the coronavirus pandemic for two and a half years, and which completely cut the country off in terms of international mobility.


A look at the immigration of care workers to Japan reveals a major gap between the demographic and economic necessity of expanding the pool of care workers on the one hand and the immigration policies that are only moderately effective in responding to this demand on the other. Nearly two decades since the implementation of the EPA migration route, its minimal effectiveness is now obvious to all stakeholders in politics and business. Newer initiatives focus on recruiting less qualified personnel and nursing students. This diversification of the country’s paths to migration certainly seems necessary. However, the international immigration of care workers in this fashion cannot be the only strategy to effectively counteract the current labor shortage in the care sector.

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Prof. Dr. Gabriele Vogt is Chair of Japanese Studies and Director of the Department of Asian Studies at the Ludwig-Maximilians-Universität in Munich (LMU Munich). Among her research interests are demographic change, labor market and international migration, as well as local-level politics and political participation in Japan. Her monograph “Population Aging and International Health-Caregiver Migration to Japan” (Springer) was published in 2018.