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

Japan Visiting Nursing Foundation
Vol. 001

ContentsI
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

IIVisiting 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 Foundation2

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
5000

1.08%
1.03%

4000

1.09%
1.10%

1.11%

1.06%

1.07%

1.16%

1.16%
1.10%

1.14%

1.06%

1.09%
1.09%

1.09%

2644
1854
1383

1474

1568

Visiting Nursing System In Japan

1266

1301

479518

605

665

740

808

956

1086

2006

2007

2008

2009

2010

2011

2012

2013

Long-term care benefits

2204

1256

1485

1.16%

1.16%

1.19%

3429
1.08%
1.11%
1.08%
3097
2860

1742

1.15%
3724

1.10%
1.09%

1.05%
1.00%

2413

1726

1262

Medical expenses

2026

1.20%

1.10%

1.07%

2000

0

1.18% 1.17%

1.00%

3000

1000

1.21%

2023

2355

2727

3254

3929

0.95%
0.90%

2014

2015

2016

Growth rate of medical expenses (vs. LY)

2017

2018

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 Foundation3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
12555

14000
12000
10000
8000
6000
4000
2000

8845

8780

8721 8645 8481

8235 7953

8395
5126 5292
4693 5002
3702 3843 3654

5417 5576 5517 5493

3429 3228

2905 2718

7786 7740

8114

7809 6323
5537 5674 5884

2460 2249

9781
9088

8544
6807

7433

2066 1925 1791 1737

8158

10443
8839

11484
10938
9422

10000

13444
12985
12078

12057

15285

14074

11128
10577

1655 1623 1604 1516 1484 1480 1427 1366 1302

1211

Visiting Nursing System In Japan

02001 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 Foundation4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 Foundation5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

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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%

Heartdiseases
4.2%

Musculoskeletaldiseases
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 Foundation8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%

2. Care guidance to patients

47.5%

3. Rehabilitation (excluding breathing rehabilitation and swallowing training)

37.4%

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

34.3%

6. Maintenance/management of physical cleanliness

34.2%
21.6%

7. Dementia / mental illness

12.9%

8. Nutrition/diet guidance
9. Pressure ulcer prevention/care

12.9%

10. Enema/disimpaction

10.7%
8.7%

11. Emergency response

Visiting Nursing System In Japan

12. Intratracheal suction / other types of suction

5.8%

13. Urinary catheter

5.2%

14. Wound treatment

4.7%

15. Home oxygen therapy

4.6%
4.6%

16. Drip infusion / injection

96.7%

17. Gastrostomy / tube feeding

3.7%

18. Pain control with drugs / chemotherapy for cancer

1.7%

19. Terminal care

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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

30.0%

17.4%

400,000

20.0%

11.0%

200,000

1.4%

0

3.9%

1.8%

10.0%
0.0%

Visiting Nursing System In Japan

Hospitals

Clinics

Long-term carehealth facilities /nursing careclinics

Deaths1,011,326

21,69961,594

172,727

273,265

28,439

Share

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 Foundation10

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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
471
717
11284 36.3 37.1 37.6 37.9
12012
11194
1407 1627

12000
Total
population

10000

8000

6000

4000

(%)

Estimates

10467 284

9430

9921 224602

189 516
9008 164
434
8411 139
107 338
309

5017

366

699

776 892 1109 1301

1860 1936

1407

1517

1752

2261

Population aging rate (share ofpersons aged 65 years or older)7212
5517 6047 6744

7581 7883 8251 8590 8716

32.3 2227

1742 1687 1498
30.8
1435
29.0 29.6
1535

14.6
9.8 8.6

9.1
7.4

10.3

1701

23.0
8622 840920.2
8103
7735 7509
17.4
7421

12.1

7310 7076

38.4%

2238 34.8 10880

10469

2277

26.6 28.6

376

12.1 11.5
11.2 10.8

2155

45.0

6722

1668

6213 5832

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

2433

1455

10051
9615

2479

1299

2437
1207

38.79159

2316
1197

8700

2180
1187

Visiting Nursing System In Japan

0 to 14 years

15 to 64 years

65 to 74 years

75 years or older

35.0
30.0
25.0
20.0
15.0

5540 5307

5078 4809

4535

6.3
6.6
7.9
7.1
4.9 5.3 5.7
5.8
2.0
4.8 3.9 3.3 2.8 2.3 2.1
2843 2553 2515 2722 2751 2603
1.3
2.0 1.9
2249
3012
2001
2979
1847
1.8 1.6 1.5 1.4 1.4 1.4 1.4
1752 1680 15951503
797
14501363 1240 1169 1142 1103 1041 966 893
83601950 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

2000

40.0

10.0
5.00.0(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II-01.
Reference 2

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

Scenario 2

Scenario 3

Overtime work

≤ 10 hours≤ 12 hours

0 hour

Paid holidays≥ 5 days≥ 10 days≥ 20 days

2025
2.02 mil200

1.80 mil
1.66 mil

150

Scenario 1

1115

14
19

1.88 mil

1.90 mil14191420121215
2113511135

136

143

144153

2016

Values reported by prefectures(before applying coefficients)

Scenario 1

Scenario 2

Scenario 3

100

50Visiting Nursing System In Japan

0Hospitals + 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 Foundation13

II-01.
Reference 3

Proposed lifetime training system for visiting nurses[Advanced specialty (guidance/research)] Certified nursing education course Specialized nursing education course (graduateschool)<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 regionalcommunity) 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 visitingnursing

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