Visiting Nursing System In JapanThe Present and Future of
Visiting Nursing
2024
Visiting Nursing System In Japan

Japan Visiting Nursing Foundation
Vol. 001

We will share the present status of visiting nursing based on the data of visiting
nursing in Japan. We will also outline the future of visiting nursing in accordancewith the "Visiting Nursing Action Plan 2025," quoting reference materials.

1

Contents

I
01.
02.
03.
04.
05.
06.
07.
08.

Changes in medical expenses and long-term care benefits pertaining to visiting nursing stations
Changes in the number of visiting nursing offices under the long-term care insurance system
Shares by operators of visiting nursing stations
Composition of visiting nursing station offices by the scale of users
Shares by professions of staff at visiting nursing stations (comparison in FTE and actual number)
Breakdown of users of visiting nursing stations by disease/injury
Details of care for users of visiting nursing stations
Deaths and composition by the place of death

II

Visiting Nursing System In Japan01.

The Present Status of Visiting Nursing

The Future of Visiting Nursing

Overview of Visiting Nursing Action Plan 2025
Reference 1
Changes in Japanese population
Reference 2
Required nurses by scenario toward 2025 (provisional values)
Reference 3
Proposed lifetime training system for visiting nurses

Japan Visiting Nursing Foundation22

I-01.

Changes in medical expenses and long-term care benefits pertaining to visiting nursing stations
Medical expenses: health insurance, medical care system for latter-stage elderly people, publicly funded
health care, medical expenses not covered by health insuranceLong-term care benefits: visiting nursing expenses, care prevention visiting nursing expenses(100 million yen)

9000

1.25%

8000

1.18%

7000

1.17%

6000
1.08%
1.03%

4000

1.06%

1.11%
1.07%

1.10%

1.14%

1.06%

1.09%
1.09%

1.09%

2644
1854

1266

1.10%

1.07%

2000
1262

1.16%

1301

1383

1474

1568

Visiting Nursing System In Japan

479

518

605

665

740

808

956

2006

2007

2008

2009

2010

2011

2012

2013

Long-term care benefits

2026

2860

2023

2355

2017

2018

1256

1485

2014

2015

2016

3429
1.11%
1.08%
3097

1.15%
3724

1.10%
1.09%

1.05%
1.00%

2413

1742

1.16%

1.19%

1.08%

2204

1726
1086

Medical expenses

1.20%
1.16%

1.16%

1.00%

3000

0

1.18% 1.17%

1.09%
1.10%

5000

1000

1.21%

2727

3254

3929

0.95%
0.90%

Growth rate of medical expenses (vs. LY)

2019

2020

2021

Growth rate of long-term care benefits (vs. LY)[Source] Overview of National Medical Expenses / Status Survey of Long-term Care Benefits

Japan Visiting Nursing Foundation

3

This graph indicates changes in medical expenses and long-term care benefits
pertaining to visiting nursing stations. The total annual cost on visiting nursing isapprox. 765.3 billion yen (medical expenses: 392.9 billion yen, long-term carebenefits: 372.4 billion yen). Both medical expenses and long-term care benefits
are increasing. The growth rate of medical expenses is larger than that of longterm care benefits.

3

I-02.

Changes in the number of visiting nursing offices under the long-term care insurance system

18000
Visiting nursing stations

16000

Hospitals/clinics

Total

14287

12000
10000
8000

8845
8395

8780

8721 8645 8481

8235 7953

7786 7740

2000

8114

7809 6323
5537 5674 5884

5576 5517 5493
5126 5292 5417
4693 5002
3702 3843 3654
3429 3228
4000
2905 2718
2460 2249
6000

13444

12555

14000

9781
9088

8544
6807

7433

2066 1925 1791 1737

8158

10443
8839

11484
10938
9422

10000

12057

12985
12078

15285

14074

11128
10577

1655 1623 1604 1516 1484 1480 1427 1366 1302

1211

Visiting Nursing System In Japan0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
* The totals indicate the sums of figures in the graph.

Material: Prepared from the Ministry of Health, Labour and Welfare, "Statistics of Status Survey on Long-term
Care Benefits (the number of visiting nursing offices with billing in September every year)"Japan Visiting Nursing Foundation

4

The institutions that provide visiting nursing service under the long-term careinsurance system consist of visiting nursing stations, which are designatedvisiting nursing offices, and medical institutions (hospitals and clinics), which
are deemed designated offices. There are 15,285 offices in total.
The number of visiting nursing stations has almost doubled over the ten years
since 2010. On the other hand, medical institutions are slightly decreasing thanvisiting nursing stations.
More than 90% of visiting nursing services are provided by visiting nursing
stations.

4

I-03.

Shares by operators of visiting nursing stations

Local governments
1.5%

Others0.5%
Specified non-profit organizations (NPOs)
1.3%

Medical corporations
20.8%

Commercial corporations(companies)
61.5%

Japanese Red Cross Society / social
insurance organizations / independentadministrative agencies
1.4%

Social welfare corporations
5.4%

Incorporated
associations/foundations
6.4%

Visiting Nursing System In Japan

Cooperative associations
1.3%

Material: Prepared from the Ministry of Health, Labour and Welfare "Long-term Care Service Facilities and Offices Survey 2022"

Japan Visiting Nursing Foundation

5

This indicates the shares by the operators of visiting nursing stations.
Visiting nursing stations shall be operated by corporations. Commercial
corporations (companies) account for the largest share at 61.5%,
followed by medical corporations at 20.8%, and incorporated
associations/foundations at 6.4%. The establishment of commercial
corporations became possible in 1999, one year before the start of longterm care insurance system in 2000, but they account for more than halfof all operators. There has been an increase in commercial corporations
established by nurses or public health nurses.

5I-04.

Composition of visiting nursing station offices by the scale of users
1 to 9 users
5.5%

100 or more users
20.9%

10 to 19 users
8.7%
20 to 29 users
10.7%

35.9%

30 to 39 users
11.0%
50 to 99 users
32.8%

40 to 49 users
10.4%

Visiting Nursing System In Japan(N) = 14,829 offices

Material: Prepared from the Ministry of Health, Labour and Welfare "Long-term Care Service Facilities and Offices Survey 2022"

Japan Visiting Nursing Foundation

6

By the scale of visiting nursing stations based on the number of users, stations
with fewer than 39 users account for 35.9%, indicating that many offices are
small.
On the other hand, visiting nursing stations with more than 100 users take up
20.9%.
For visiting nursing stations to become stable workplaces with good work-lifebalance, it is considered desirable that the station has 10 or more staff
members and 100 or more users.

6

Shares by professions of staff at visiting nursing stations(comparison in FTE and actual number)

I-05.

Actual number(N) =160,707

FTE (full-time equivalent)(N) =90,224
Public health
Other
professionnals, nurses, 1.1%
8.2%

Midwives, 0.1%

Public healthnurses, 1.0%

Midwives, 0.1%

Speech-languagehearing therapists,
1.9%

Speech-languagehearing therapists,
1.3%
Occupational
therapists, 6.4%

Occupational
therapists
6.3%

Physicaltherapists,
14.6%
Associate nurses,
4.5%

Other
professionnals,
8.6%

Physicaltherapists
14.7%
Nurses, 63.9%

Visiting Nursing System In Japan

Material: Prepared from the Ministry of Health, Labour and Welfare"Long-term Care Service Facilities and Offices Survey 2022"

Nurses,61.8%

Associate nurses,
5.6%

Material: Prepared from the Ministry of Health, Labour and Welfare"Long-term Care Service Facilities and Offices Survey 2022"

Japan Visiting Nursing Foundation

7

This indicates the shares of visiting nursing carers by profession at visiting
nursing stations (comparison in FTE [full-time equivalent] and actual number).
In FTE, nurses (including public health nurses and midwives) take up 63.9%,
and associate nurses account for 4.5%.
Among not-nurses, the share of physical therapists 14.6%, occupational
therapists at 6.4%, and speech-language-hearing therapists at 1.3%. The shareof physical therapists is the second larger after nurses.
In actual number, the share of nurses stood at 61.8%, associate nurses at
5.6%, physical therapists at 14.7%, occupational therapists at 6.3%, andspeech-language-hearing therapists at 1.9%. The share of physical therapists is
also the second larger after nurses in actual number.
* FTE: If weekly work hours at a visiting nursing stations is 40, a nurse whoworks for 40 hours is calculated as FTE 1. A nurse who works for 20 hours is
calculated as FTE 0.5.

7

I-06.

Breakdown of users of visiting nursing stations by disease/injury

Cerebrovasculardiseases
12.9%
Dementia (including
Alzheimer's disease)
8.9%

Others
28.5%

Malignantneoplasm
8.5%

Heart
diseases
4.2%

Musculoskeletal
diseases
8.4%

Respiratory diseases
4.3%

Visiting Nursing System In Japan

Hypertensive diseases
4.4%
Injury, poisoning, etc.
4.4%

Schizophrenia
5.8%
Parkinson's disease
4.9%

Diabetes
5.0%

Material: Prepared from the Ministry of Health, Labour and Welfare"Long-term Care Service Facilities and Offices Survey 2019"Japan Visiting Nursing Foundation

8

By injury/disease of users of visiting nursing stations, cerebrovascular diseases
took up the largest share at 12.9%, followed by dementia (including
Alzheimer‘s disease) at 8.9%, malignant neoplasm at 8.5%, andmusculoskeletal diseases at 8.4%.

8I-07.

Details of care for users of visiting nursing stations* Users of visiting nursing stations: 848,014(Nursing pertaining to medical procedures is performed on 61.6% of total)

Multiple answers

1. Observation of condition

59.9%
47.5%

2. Care guidance to patients
3. Rehabilitation (excluding breathing rehabilitation and swallowing training)

37.4%
34.3%

4. Drug adherence management
5. Care guidance/support for family

34.2%

6. Maintenance/management of physical cleanliness

21.6%

7. Dementia / mental illness

12.9%
12.9%

8. Nutrition/diet guidance
9. Pressure ulcer prevention/care
10. Enema/disimpaction
11. Emergency response
12. Intratracheal suction / other types of suction
13. Urinary catheter
14. Wound treatment
15. Home oxygen therapy
Visiting Nursing System In Japan

16. Drip infusion / injection
17. Gastrostomy / tube feeding
18. Pain control with drugs / chemotherapy for cancer
19. Terminal care

96.7%

10.7%
8.7%
5.8%
5.2%
4.7%
4.6%
4.6%
3.7%
1.7%
1.7%
Material: Prepared from the Ministry of Health, Labour and Welfare"Long-term Care Service Facilities and Offices Survey 2019"Japan Visiting Nursing Foundation

9

Regarding the details of visiting nursing, observation of condition stood at
96.7%, followed by care guidance to patients at 59.9%, and rehabilitation at
47.5%. Emergency response stood at 8.7%, and terminal care at 1.7%.

9

I-08.

Deaths and composition by the place of deathN

1,200,000

Share

70.0%

64.5%

60.0%

1,000,000

1,569,050 deaths in total

800,000

50.0%
40.0%

600,000

20.0%

11.0%

200,000

1.4%

0Visiting Nursing System In Japan

Deaths
Share

30.0%

17.4%

400,000
3.9%

1.8%

10.0%
0.0%

Hospitals

Clinics

Long-term carehealth facilities /nursing careclinics

1,011,326

21,69961,594

172,727

273,265

28,439

64.5%

1.4%

3.9%

11.0%

17.4%

1.8%

Nursing homes

Patients' homes

Others* Shares were calculated based on the sums in the graph.
Prepared from Table 5, the deaths and composition by the place of death, the Ministry of Health,Labour and Welfare "Vital Statistics (2022)"

Japan Visiting Nursing Foundation

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This indicates deaths and composition by the place of death. Among the
1,569,050 deaths in total, the share of hospitals was the largest with 1,011,326
deaths (64.5%), followed by patients‘ homes with 273,265deaths (17.4%), andnursing homes with 172,727deaths (11.0%).
Recently, deaths at hospitals are slightly decreasing, while those at nursing
homes are slightly increasing.
At request from the patient, visiting nurses provide support for mental andphysical health over the terminal stage at home.

10II-01.

Overview of Visiting Nursing Action Plan 2025

I. Quantitative expansion of visiting nursing

1. Establish visiting nursing offices nationwide
 Improve imbalanced presence among regions
 Establish a system for service 24/7
 Expand the scale
2. Retain a stable number of visiting nurses
 Objective; 150,000 visiting nurses
 Recruit newly graduate nurses
 Improve treatment and work-life balance (WLB)
3. Mutual development of nurses between medical institutions and visiting
nursing stations
 Establish human resource development system Opportunities for human resource exchange

II. Functional expansion of visiting nursing

Visiting Nursing System In Japan

1. Increase the places for visiting nursing
 Visiting nursing to long-term care facilities, group homes, schools, etc.
2. Functional expansion of visiting nursing offices
 Establish at least one visiting nursing station with expanded functions in eachsecondary medical zone
 Enhance outpatient day care
 Implement preventive activities for residents
3. Enhance nurse-led comprehensive community care
4. Improve the efficiency of visiting nursing operations
 ICT-based information sharing with other professionals
 Improve the efficiency of operations

III. Quality improvement of visiting nursing

1. Develop specialists who have a viewpoint to support health maintenance andrecovery, living, and a calm terminal stage of life Enhanced care
Terminal care at home, palliative care, support for dementia, mental illness, and children with severe
mental/physical disorders, etc.

2. Collaborate with other professionals exercising nursing specialty
 Provide occasions for learning and thinking with other professionals
3. Upgrade the management skills of managers at visiting nursing stations
 Enhanced training for managers
4. Strengthen basic nursing education
 Cooperation with educational institutions
 Upgrade exercise guidance for home nursing studies

IV. Response to regional comprehensive care

1. Dissemination of visiting nursing to the general public Information provision concerning the functions and roles of visiting nursing
2. Establish a regional comprehensive care system
 Establish a regional network Participate in municipal services and meetings
3. Strengthen the function of visiting nursing stations to provide comprehensive
support for regional living
4. Policy proposals from the standpoint of visiting nursing Participation in the planning process Policy proposals that match regional characteristics

Japan Visiting Nursing Foundation

11

The Visiting Nursing Action Plan summarizes action plans for achieving the
Visiting Nursing Vision 2025 by the Japan Nursing Association, the National
Association for Visiting Nurse Service, and the Japan Visiting Nursing
Foundation.
The Action Plan consists of "I. Quantitative expansion of visiting nursing," "II.
Functional expansion of visiting nursing," "III. Quality improvement of visiting
nursing," and "IV. Response to regional comprehensive care."11

II-01.
Reference 1

Aging of Japanese population and future estimates(10,000 persons)Actual figures

14000

12615
12361
12806
12693
12105
12777
12709
12557
12495
11706
11664
12326
597
900
1160
717
11284 36.3 37.1 37.6 37.9
12012
11194 366 471
1407 1627

12000
Total
population

10000

8000

6000

4000

2000
Visiting Nursing System In Japan0(%)

Estimates

9430

10467 284
9921 224602

189 516
9008
8411 139 164 434
376
107 338309

5017

5517 6047 6744

Population aging rate (share of
persons aged 65 years or older)7212

12.1 11.5
11.2 10.8

892 1109 1301
699 7761407

7581 7883 8251 8590

1860 19361517

9.8 8.6

9.1
7.4

10.3

2261

32.3 2227

1742 1687 1498
30.8
1435
29.0 29.6
26.6 28.6
1535

1701

23.0

10880
10469

2277

1668

8716 8622

20.2
8409 8103
7735 7509
17.4
7421

14.6

5.7 6.3

2155

1752

2238 34.8

12.1

7310 7076

6722

6213 5832

Rate of population aged 15 to 64
years who support population
aged 65 years or older

6.6
7.9
7.1
4.9 5.3
5.8
4.8 3.9 3.3 2.8 2.3 2.1
2843 2553 2515 2722 2751 2603
2249 2001 1847
3012
2979
1752 1680 1595 1503

2.0

2433

1455

10051
9615

2479

1299

2437
1207

45.0

38.4%

38.7
9159

2316
1197

8700

2180
1187

35.0
30.0
25.0
20.0
15.0

5540 5307

5078 4809

4535

1.5 1.4 1.4 1.4 1.4 1.3
1.8 1.67971450 1363 1240 1169 1142 1103 1041 966 893
836
2.0

40.0

1.9

10.0
5.0
0.0

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2022 2025 2030 2035 2040 2045 2050 2055 2060 2065 2070
0 to 14 years

15 to 64 years

65 to 74 years

75 years or older(Year)

Source: Prepared by the Foundation based on Chapter 1, the status of aging population (Figure 1-1-1),
the Cabinet Office "White Paper on Aging Society 2023 (Overview)"

Japan Visiting Nursing Foundation

12

The total population of Japan is 124.95 million as of October 1, 2022.
The population aged 65 years or older is 36.24 million. The share of population
aged 65 years or older in the total population ("population aging rate") is
29.0%.
The population aged 65 to 74 years is 16.87 million (13.5% in total population),and the population aged 75 years or older is 19.36 million (15.5% in total
population), larger than the population aged 65 to 74 years.
In 2065, one in approx. 2.6 persons will be aged 65 years or older, and one inapprox. 4.0 persons will be aged 75 years or older.
In the aging society with a declining birthrate, one person aged 65 years orolder will be supported by 1.3 persons aged 15 to <65 years in 2025.
The population aged 66 years or older (the height of the bar graph) continues
to keep a large proportion from 2020 to 2065.
It is important that the population aged 65 to 75 years will stay in the
supporting population, in order to minimize the burden on persons aged 15 to<65 years.

12II-01.
Reference 2

Required nurses by scenario toward 2025 (provisional values)(10,000 persons)250

Scenario 2≤ 10 hours≤ 12 hours

Scenario 3
0 hour

Paid holidays≥ 5 days≥ 10 days≥ 20 days

2025
2.02 mil200

1.80 mil
1.66 mil

150

Scenario 1
Overtime work

11
15

14
19

1.88 mil

1.90 mil

14
19

14
20

15
21

13

12

12

136

143

144

153

Values reported by prefectures(before applying coefficients)

Scenario 1

Scenario 2

Scenario 3

5

11

135

2016

100

50
Visiting Nursing System In Japan0

Hospitals + medical clinics with beds + psychiatry wards + medical clinics without beds

Visiting nursing offices

Long-term care services, etc.

Schools

Material: Prepared by the Foundation based on the Ministry of Health, Labour and Welfare, "Interim Summary of Review Meeting on Supply and Demand of Healthcare Professionals /Subcommittee on Supply and Demand of Nurses (Overview)"
Japan Visiting Nursing Foundation

13

According to the estimated supply and demand of nurses at visiting nursing
offices published by the Ministry of Health, Labour and Welfare, 120,000 nurses
are considered necessary by 2025, assuming each nurse work overtime up to
10 hours per month, and take five paid holidays per year.
If each nurse takes ≥20 paid holidays from the viewpoint of work-life balance,
130,000 nurses are considered necessary.

13II-01.
Reference 3

Proposed lifetime training system for visiting nurses[Advanced specialty (guidance/research)] Certified nursing education course Specialized nursing education course (graduate
school)<Training occasions common to all ladder levels>
 OJT
 OFF-JT[Management and administration of visiting nursing stations]* Training for visiting nursing station managers
 Entrepreneurship training• This part corresponds to the career ladder, and is therefore distinguished with thedotted line and different colors.

Content of training[Specialty]

 Training on regional comprehensive care (viewpoint for regional
community) Training on knowledge and skills required for visiting nursing service
 Training on knowledge and skills by medical procedure Training on knowledge and skills by target, etc.

[Specified acts] Respiratory procedures
 Fistula management procedures Injury management procedures
 Medication procedures regarding blood
sugar control[Visiting nursing basics]

 Visiting nursing basic program  Visiting nurse development seminar(Visiting nursing e-learning)

Capable of guidance and research for visiting nursing
Capable of guidance and management for visiting nursing
Goal of training

Upgrade specialty in visiting nursing

Visiting Nursing System In JapanWork in visiting nursing / understand the basics
Approximate positions

Yet to be employed / staff

Staff

Staff / managers

Staff / managers

Staff / managers

Approximate
experience in visiting
nursing

Yet to be employed in visiting
nursing to 6 months

6 months to 1 year

1 to 3 years

3 years or longer

3 years or longer (manager)

Ladder (level)

I (Novice)

II (Beginner)

III (Intermediate)

IV (Advanced)

V (Advanced)

Japan Visiting Nursing Foundation

14

To recruit and retain visiting nurses, it is considered necessary to establish alifetime training system that enables visiting nurses to upgrade their career, by
providing opportunities for training according to their fields of interest in
combination with ladder levels.
Through such a system, it will become possible to perform wage appraisal
based on the career ladder, and to promote the evaluation of visiting nursing bynurses who have completed specialized training.
Visiting nurses will be able to contribute to society throughout their life as
valuable social resources in regional comprehensive care, while accumulating
experience as visiting nurses and changing their workplaces and roles bycompleting different training courses in a timely manner.

14