JILPT Research Report No.168
Current Status and Issues of the Supply & Demand Structure of Nursing Care Workers:
For stable supply of care workers

May 30, 2014

Summary

Research Objective

Against the background of the aging population, operating a sustainable medical and nursing care insurance system, etc., building a system for service provision, and securing medical and nursing care workers who provide the service have become pressing issues. In particular, demand for care workers who actually perform nursing care services for the elderly is expanding; it is estimated that about 2.37-2.49 million care workers will be needed in 2025, vastly exceeding the 1.49 million in FY2012 (estimate).

Based on the above estimates and the current supply volume, this Research makes preliminary considerations for an empirical study on the efforts required in order to secure sufficient care workers in future.

Research Method

Research method used here are: Literature survey, organization of published statistics, secondary analysis of individual data obtained from questionnaire surveys for business establishments providing nursing care insurance service, nursing care staff, training facilities for certified care workers where training is conducted for former care workers who once left their jobs, and trainees.

Major Findings

Assuming that a certain additional number of care workers has been estimated as necessary, measures to secure them may be broadly classified as follows (in this Research, policies that could change the quality and quantity of required workers have not been considered).

  1. Increase the number of workers newly entering the nursing care profession.

    a) Expand the number of new graduates entering the profession.

    • a-1) Increase the number of students wishing to enter educational institutions which aim to train nursing care workers.
    • a-2) Increase the number of graduates entering employment as nursing care workers from educational institutions which aim to train nursing care workers.
    • a-3) Increase the number of individuals wishing to become nursing care workers out of students in educational institutions which do not aim to train care workers.

    b) Expand the number of workers switching from other professions and the number of persons entering the profession who were not employed.

  2. Encourage existing nursing care staff to continue their employment in the sector.

    c) Promote employee retention in the establishments that employ them.

    d) Support those who have left or changed jobs to select the profession again.

In this report, we look at the supply and demand of nursing care workers by prefecture (Chapters 1 and 2). According to such supply and demand analysis, population demographics, the subsequent increase in the number of care recipients, and service provision systems vary greatly between prefectures. Prefectures also differ in the development level of educational resources, with few in urban areas where increase in demand is anticipated.

Next, in connection with measure 1 b) above, systems for training displaced workers are examined and their roles and effects analyzed (Chapters 3 and 4). Trainees in two-year courses have a wide range of attributes and work experience, such as males in middle and older age; both the rate of entering employment as nursing care workers after completion of training and the rate of continued employment are high. The key will be to raise levels of satisfaction in the educational content (and particularly practical training) during the training period, and to make it possible for trainees to feel motivated by care work.

On measure 2 d), since raising the professional awareness of nursing care staff could have a beneficial effect, we examine whether the process of acquiring expertise has an impact on job satisfaction or willingness to continue in care work (Chapter 5), which shows that experience of receiving specialist education at school and experience of working in other professions do not have much impact on levels of willingness to continue in care work. At present, receiving specialist education, accumulating experience in the workplace and studying to acquire qualifications could increase dissatisfaction with the actual situation in the workplace. As for working styles, both job satisfaction and willingness to continue working are higher among part-time non-regular employees than among regular employees.

Next, on measures 2 c) and d), we examined efforts made by business establishments that were not considered in the above analysis, which include promoting settled employment of nursing care workers and employment management that contributes to workers retention in the nursing care sector even when changing employers (Chapters 6 and 7). In terms of the development of careers and jobs within companies and the impact on attitudes toward work, no significant correlation was seen between career development within companies and job satisfaction or the wish to continue employment. On the other hand, respondents who stated that they or their families would wish to use the services of their employer tended to have higher levels of satisfaction, with strong wishes to continue employment or wishes to continue in care work. Since around 40 % of displaced workers left their jobs during their first year of employment, we examined workers in their first year in the profession, to identify what hiring practices or management practices for settled employment may lead them to their positive attitudes toward work. Here, a stronger tendency to continue in employment was found among those who entered the profession because they felt an attraction or meaning in care work itself (rather than the company, working hours or place of work, etc.), those who had their instructors, and those who enjoyed individual personnel treatment in accordance with their respective ability and wishes.

Efforts to promote settled employment as stated in measure 2-c creates positive working environment, thus also should help to increase the numbers of human resources newly entering the profession as nursing care professionals (i.e. measure 1). Finally, we analyze the nature of business establishments in order to secure human resources (Chapter 8) focusing on "hiring", which has not been sufficiently discussed in the debate on securing human resources hitherto. According to this, efforts like i) raising the sense of solidarity in teams and workplaces through the improvement of stable human relationships, work and workplaces based on participation of the employees, and ii) eliminating anxiety or a sense of isolation by measures like promoting office visits by home care workers, contribute to the ease of hiring care staff by word of mouth by motivated care workers. A positive impact on securing the quality and quantity of human resources has also been confirmed when business establishments provide local community with their knowhow and human resources.

Policy Implications

  1. The Ministry of Health, Labour and Welfare publishes short-term forecasts on the securing of care workers, but closer examination is required in estimating the care worker supply structure. In particular, the basis for estimating the number of workers entering the profession from new graduates, job changers and people not in employment needs to be confirmed. This will also be important in considering the order of priority of measures to secure care workers.
  2. It is necessary to estimate care worker supply and demand in each prefecture, ascertain the supply structure and development level of educational resources, and quantify the supply and demand gap while studying countermeasures. In the municipalities, similarly, it is hoped that greater concern will be displayed over care worker supply and demand, and measures to secure them.
  3. In particular, prefecture-led efforts are important, and it is thought that promoting management processes designed to study and practice measures for securing human resources and to monitor and review the outcomes will be effective.
  4. As regards new graduates entering employment, in light of the decrease in the younger population, efforts must be made to increase the number of applicants to educational institutions that train care workers. At the same time, efforts should be made to consider the educational content that will encourage commitment to work, in order to sustain the wish to enter employment as nursing care workers after enrollment, as well as the scale of courses (trainee intake), etc., from the perspective of increasing educational effects.
  5. As well as identifying employment management that contributes to securing human resources and promoting settled employment in nursing care businesses, it is also needed to study the factors that increase specialist professional awareness and thus contribute to workers selecting nursing care positions even after changing jobs. This will be influenced by the management of businesses and workplaces, in addition to the processes of acquiring expertise.
  6. In order to study the issues above mentioned, not only single point surveys, panel surveys that track the same individuals will also be indispensable.
  7. Career enhancement is being promoted in the nursing care sector. At present, however, specialist education, acquisition of qualifications and career development in the workplace are not necessarily enhancing job satisfaction. It is important to study ways of developing careers based on individual communication with employees coupled with efforts designed to improve the quality of care services at the level of individual establishments as a whole, while utilizing a career ranking system for nursing care professionals, etc.
  8. There is still room for further efforts so that new graduates, job changers and persons not in employment include nursing care professions in their choice of job. Since nursing care workers are highly varied in their age of entry into the profession, previous employment experience, and their attitudes to work, more detailed information needs to be provided on the content of the work and its significance.
  9. In order to build a system of comprehensive community care, nursing care businesses are expected to play the role of assisting mutual support and organization of residents in local communities. It will be effective to share the findings that business operation that is open to the local community can also contribute to the securing of human resources, as well as to accumulate case studies and subject them to further study.

Policy Contribution

This Research could provide a basic material for consideration of measures to secure care workers.

Moreover, the content of this Research was made to practical use in reports and statements for the Working Group for Long Term Care Benefits of the Advisory Council on Social Security, the Comprehensive Community Care Research Group, the Survey Research Project on Promoting the Securing of Human Resources in Nursing Care, and the Study Committee on the Current Status of Nursing Care Work of the Nursing Care Work Stability Center, among others.

Contents

  1. Chapter 1  Population demographics by prefecture / Nursing care demand / Current status of nursing care workers —Towards an estimate of care worker numbers by prefecture—
  2. Chapter 2  Supply routes of nursing care staffs and educational resources
  3. Chapter 3  Role of displaced worker training in the education of nursing care workers
  4. Chapter 4  Outcome of education and training in the displaced worker training system
  5. Chapter 5  Career types and job continuation of care workers —With focus on the process of acquiring expertise
  6. Chapter 6  Career formation and job expansion of care workers —Focusing on the situation inside companies
  7. Chapter 7  Hiring and retention management going beyond the "1st year" barrier
  8. Chapter 8  Shortage of care workers and difficulty in hiring
  9. Appendix   Data and questionnaire forms used in secondary analysis for this report.

Research Categories

Project Research "Survey Research on vocational capability development systems in response to economic and social changes"

Subtheme "Survey Research on directions for capability development and career formation inside and outside company"

Research Period

FY2012-2013

Authors

Hiroki SATO
Professor, Institute of Social Science, University of Tokyo
Satoko HOTTA
Researcher, Japan Institute for Labour Policy and Training
Masahiro KAWAGOE
Director, Department of Theoretical Social Security Research, National Institute of Population and Social Security Research
Toru SUWA
Professor, Department of Social Welfare, College of Humanities and Sciences, Nihon University
Yukiko KANAZAKI
Research Director, Japan Institute for Labour Policy and Training
Satoshi MIWA
Associate Professor, Graduate School of Education, Tohoku University
Reiko KOSUGI
Senior Fellow, Japan Institute for Labour Policy and Training
Yukie HORI
Senior Researcher, Japan Institute for Labour Policy and Training

Related Information

  • JILPT Research Report > No.168 Current Status and Issues of the Supply & Demand Structure of Nursing Care Workers