Japan's Growing Reliance on Overseas Nurses and Care Workers

A Look at one of Asia's fastest-accelerating international healthcare recruitment markets

Introduction: A Country Running Out of People to Care for Its People

Japan is the world's most "super-aged" major economy, with more than 29% of its population already over 65, and roughly one in five people set to be 75 or older in 2025. That demographic reality, combined with one of the lowest birth rates among large economies, has created a structural problem Japan cannot train its way out of domestically: there simply aren't enough working-age Japanese citizens left to staff the hospitals, clinics, and long-term care facilities an aging population increasingly needs. The country currently has approximately 2.15 million nursing care workers — and is still projected to face a shortage of roughly 250,000 care workers by fiscal year 2026, widening to an estimated 570,000 by fiscal year 2040. Japan's response, after years of comparatively cautious and slow-moving immigration policy, has been a genuine and accelerating pivot toward international recruitment — one that's reshaping both its healthcare workforce and its broader immigration system at the same time.

The Trend: From a Trickle to a Structural Pillar

Japan's overseas healthcare recruitment story runs through roughly three distinct phases, and understanding that arc matters for anyone trying to read where the market is headed next.

Phase one (2008–2018): a small, symbolic beginning. Japan's first formal pathway for foreign healthcare workers began in 2008 through Economic Partnership Agreements (EPAs) with Indonesia, followed shortly after by the Philippines and Vietnam — bilateral trade agreements that included provisions allowing nurse and care worker candidates from those countries to work in Japan while studying toward Japan's demanding national licensing exams. This phase was defined by small numbers and a genuinely difficult retention story: of roughly 1,300 EPA nurse candidates who had entered Japan since the program began, only 136 foreign registered nurses remained in the country as of January 2019 — just over 10% of the original cohort — largely because the pass rate for foreign candidates on Japan's National Board Examination sat at around 16%, dramatically lower than the roughly 89% pass rate for Japanese examinees sitting the same exam in their native language. On the care-worker side specifically, cumulative EPA acceptances reached 4,302 individuals by fiscal year 2018, employed across roughly 800 facilities — meaningful, but nowhere near the scale Japan's demographics actually required.

Phase two (2017–2019): new legal pathways widen the door. Japan added nursing care to its Technical Intern Training program in 2017, opening a new (if also imperfect) route bringing interns primarily from Vietnam, Myanmar, and Indonesia for typically three-year placements, extendable to five. Then, in 2019, Japan introduced the Specified Skilled Worker (SSW) visa status — widely regarded as the turning point for the entire sector, because unlike the EPA route's slow, exam-gated pathway, SSW was explicitly designed as a faster, volume-oriented route for workers who pass a sector-specific skills test and a Japanese-language proficiency test, rather than Japan's full national licensing exam.

Phase three (2019–present): rapid, government-accelerated scale-up. The effect of the SSW visa has been dramatic and is still compounding. The number of foreign workers in elderly care specifically rose to 54,916 by June 2025 — a figure that would have been almost unimaginable under the EPA-only system a decade earlier — with workers concentrated from Myanmar, Indonesia, Nepal, and Vietnam. Zooming out to Japan's foreign workforce overall, the country recorded approximately 2.4 million foreign workers as of the end of October 2025, roughly double the level of a decade earlier and up about 8% year-on-year, spread across some 330,000 employing establishments — itself about 2.2 times the number of a decade earlier. Vietnam is now the single largest source nationality for foreign workers in Japan overall, followed by China, the Philippines, Nepal, and Indonesia.

Crucially, the government itself has shifted from a largely passive, employer-driven system to active, state-sponsored recruitment. Starting in fiscal year 2025, Japan's Health, Labour and Welfare Ministry began actively promoting nursing care staff recruitment specifically from Southeast Asia, subsidizing part of the recruitment costs Japanese care operators incur when hiring abroad, funding a new nursing-care education program inside Indonesia itself (a three-year program called Kaigo, training young people at local public nursing schools alongside their instructors, with experts dispatched from the ministry and the Japan International Cooperation Agency), and organizing briefings at Japanese language schools and dispatch agencies across Vietnam and Myanmar. In parallel, the 2024 legal amendments expanded the sectors covered by the Specified Skilled Worker program from 14 to 16, and Japan's Technical Intern Training program itself is being phased out entirely in favor of a redesigned Employment for Skill Development Program, with full implementation set for 2027 — a structural signal that Japan intends the "temporary training" framing of its older programs to give way to something closer to a genuine, longer-term international labor pathway.

The Numbers, in Context

It's worth being precise about scale, because the raw growth figures can obscure how far Japan still has to go relative to its own targets and needs. As of the end of 2023, 28,400 foreign nationals had entered Japan under Specified Skilled Worker status specifically to work in the nursing care industry — just over half of the government's own target for the program at that point. Even with the more recent jump to 54,916 workers in elderly care by mid-2025 across all visa categories combined, foreign care workers collectively still represent only roughly 1–2% of Japan's total domestic care workforce of approximately 2.15 million — a reminder that, despite genuinely rapid percentage growth, Japan's overseas hiring remains a small fraction of the total workforce relative to the scale of the shortage it's meant to address. A 2023 survey by the Tokyo-based Care Work Foundation found that 60% of care facilities nationally, including special nursing homes (tokuyo), reported an active staff shortage — yet only about 10% of facilities had taken the step of accepting foreign workers at all, suggesting the growth curve so far reflects a relatively small number of facilities scaling up hard, rather than broad-based adoption across the sector.

Which Sectors Are Hiring, and Where

Elderly and long-term care (kaigo) is, by a wide margin, the largest and fastest-growing category. This isn't incidental — it's a direct function of Japan's demographic structure, where the fastest-growing care need is chronic, long-term support for an expanding elderly population rather than acute hospital-based treatment. Special nursing homes (tokuyo) and roken (long-term care health facilities) have historically been the largest accepting institution types under the EPA scheme, and remain central under the newer SSW pathway.

Hospital-based nursing (kango-shi) is a smaller, more exam-gated pathway, and has grown more slowly. Because Japan requires foreign nurse candidates to eventually pass its full National Board Examination — a high-stakes, Japanese-language clinical licensing exam — to practise as a registered nurse, this pathway carries a materially higher barrier to entry and a correspondingly lower retention rate historically than the care-worker pathways, which do not require the same level of clinical licensure. A nationwide survey of Japanese hospitals examining EPA nurse recruitment intentions found that many hospitals remained cautious about, or simply hadn't yet engaged with, foreign nurse recruitment at all, reflecting both the exam-pass-rate challenge and broader institutional unfamiliarity with managing an internationally recruited clinical staff.

Geographically, both rural, labor-scarce regions and larger metropolitan care networks are active hirers, for different reasons. Facilities in regions where Japanese applicants have effectively stopped applying at all — a pattern increasingly common outside Japan's largest cities — have become some of the most committed adopters of foreign staff out of operational necessity rather than strategic choice. A representative example: a special nursing home in Oizumi, Gunma Prefecture, now employs 35 care workers, twelve of them from Myanmar, the Philippines, and Bolivia, compared with just a single foreign worker eight years earlier — a shift facility management described as having kept the home operating at all, after a deliberate push to strengthen foreign recruitment roughly three years prior.

What Japan Is Actually Looking For

Japanese language proficiency is the single biggest gatekeeping factor across every pathway, and the specific bar varies meaningfully by role and by how much direct patient or client communication the position involves. JLPT (Japanese Language Proficiency Test) N4 is the government-set floor for Specified Skilled Worker eligibility in nursing care, but in practice, most employers actively prefer candidates at N3 or even N2, particularly for any role involving direct, sustained communication with elderly clients and their families — care work depends heavily on nuanced verbal communication in a way that many other shortage-sector jobs in Japan (construction, manufacturing) simply don't. This has produced a measurable, source-country-linked pattern: Vietnamese care worker and nurse candidates, who typically receive around 12 months of pre-departure Japanese language training before arrival, have consistently shown stronger language outcomes and fewer workplace communication problems than earlier cohorts of Indonesian or Filipino candidates who, particularly in the EPA program's earliest years, received little to no equivalent pre-departure language preparation.

For the nursing (not care-worker) track specifically, passing Japan's National Board Examination remains the ultimate requirement, and Japan expects EPA nurse candidates to pass it within three years of arrival or leave the country — a genuinely demanding standard given the historically low pass rate for foreign candidates relative to domestic examinees, and one of the clearest areas where better-structured language and exam preparation support, delivered before rather than only after arrival, has been identified in workforce research as the single biggest lever for improving both pass rates and retention.

For the care-worker (kaigo) track, a sector-specific skills exam plus the language test is the core requirement, with formal certification as a Certified Care Worker available as an eventual, higher-status endpoint for those who complete additional training and pass Japan's national certified care worker examination — a credential that unlocks the more stable, longer-term "Nursing Care" residence status rather than the comparatively more constrained Specified Skilled Worker status.

Beyond formal credentials, employers consistently cite genuine, sustained commitment to Japanese-language improvement, not just meeting the entry threshold, as a differentiator in employment outcomes — candidates who pass at N4 and continue actively improving their Japanese after arrival are reported to have meaningfully better long-term employment outcomes than those who plateau at the minimum qualifying level, a pattern facility managers and workforce researchers both point to directly.

What This Means for International Recruitment Strategy

• Japan's shift from passive to actively state-subsidized recruitment is a genuine strategic opening. A government now funding in-country training programs, subsidizing employer recruitment costs, and running structured briefings inside source countries represents a meaningfully lower-friction environment for organized, ethical international recruitment partnerships than existed even five years ago.

• Pre-departure language training is the highest-leverage investment for candidate success, based on the clear, source-country-linked gap between Vietnamese candidates' stronger outcomes (with roughly a year of pre-departure preparation) and the more difficult early experience of Indonesian and Filipino cohorts who received comparatively little.

• The care-worker (kaigo) pathway remains the larger, faster-growing, and comparatively more accessible route relative to hospital-based nursing specifically, given the National Board Examination's demanding pass-rate history — meaning candidates and organizations prioritizing volume and speed of placement should weight the care sector heavily, while candidates specifically pursuing full RN scope of practice in Japan should budget for a genuinely longer, exam-intensive pathway.

• Facility-level adoption is still shallow relative to the scale of need — with roughly 60% of care facilities reporting shortages but only about 10% having brought on foreign staff at all — suggesting substantial future growth potential concentrated less in facilities already hiring internationally and more in the large majority that haven't started yet, often for reasons of institutional unfamiliarity rather than lack of need.

• The 2027 transition away from Technical Intern Training toward the new Employment for Skill Development Program is worth tracking closely, since it signals Japan's own policy direction is moving toward treating international care and nursing labor as a durable structural pillar rather than a temporary stopgap — a shift that should, over time, further ease some of the retention and status-instability problems that have historically limited how long foreign healthcare workers actually stay in the Japanese system.

Conclusion

Japan's overseas nursing and care-worker recruitment has moved, within less than two decades, from a small, largely symbolic EPA program with a genuinely poor retention track record to a rapidly scaling, government-subsidized pillar of national workforce policy — driven by demographics Japan simply cannot reverse through any domestic policy lever available to it. The numbers are still modest relative to the true scale of the shortage: foreign workers remain only 1–2% of Japan's total care workforce even after several years of accelerated growth, and the country continues to fall meaningfully short of its own recruitment targets. But the direction of travel — active state-sponsored recruitment abroad, expanding visa categories, a phase-out of the older, more exploitative training-visa framework, and a projected shortage that only grows larger through 2040 — points toward Japan becoming one of the largest and most consistently active destination markets for internationally recruited nurses and care workers in Asia over the coming decade, provided the language-preparation and retention lessons of the program's earlier, harder years are genuinely applied going forward.

Sources

• Ministry of Health, Labour and Welfare (Japan), "Notification Status of the Employment of Foreign Nationals" (data as of end of October 2025, released January 2026)

• Straits Times / Asia News Network, "Japan to actively recruit nursing care staff from Southeast Asia" (2024–2025)

• Unseen Japan, "Why Foreign Workers Have Become Essential to Japan's Elderly Care System" (2026)

• ISVD, "The Structure of Japan's Care Worker Crisis — The 'Invisible Roadmap' to 2040" (2026)

• Yourbright, "Key Points on Systems, Operations, and Retention Support to Check When Hiring Specified Skilled Workers in Nursing Care" (2026)

• Note.com (Kobayashi Osamu), "Trends in Foreign Workers in the Nursing Care Sector" (2025)

• MHLW (Japan), care worker acceptance summary PDF (EPA and Technical Intern Training figures, FY2018–2019)

• MailMate, "High Demand Jobs in Japan for Foreigners 2026 Guide"

• Akiya Japan, "Japan's Skills Gap: The Industries That Need You (and How to Qualify)" (2026)

• "Factors Associated With the Recruitment of Foreign Nurses in Japan: A Nationwide Survey of Hospitals," Human Resources for Health, BioMed Central / Springer Nature

• "A Study of Factors Related to Retention of Foreign Nursing Care Workers Who Came to Japan Under the EPA Scheme," PMC (2023–2024 survey data)

• National University of Singapore, East Asian Institute Background Brief, "Japan's Evolving Policy on Foreign Care Workers"