Carers' Policies in Japan

Japan introduced Long-Term Care Insurance (LTCI) in 2000 to adapt to rapid population ageing and increasing pressures on family caregiving. LTCI is a mandatory social insurance delivering in-kind home, community, and facility care via care managers with regulated co-payments, substituting formal support for unpaid hours and reducing carers’ time constraints and burden. Early implementation delivered clear gains: universal entitlements, graded benefits, and professional care management expanded access to in-kind services, easing daily care time and enabling many carers, especially women, to remain in or return to paid work. However, due to the fiscal burden, the latter reform increased the level of co-payments, narrowed benefits, and devolved prevention responsibilities to municipalities; these measures have shifted the caregiving responsibility back to family carers. However, support services for carers in the areas of financial assistance, respite care, counselling, and training are limited and uneven. To promote the well-being of informal carers, the Japanese government needs to offer them comprehensive service entitlements at the national level, rather than relying on the present discretion of municipalities.