Elderly Care and Long-Term Care Insurance in Japan

Japan’s long-term care insurance (kaigo hoken)

Japan established a mandatory long-term care insurance system (介護保険, kaigo hoken) in 2000 to provide a public funding structure for eldercare and functional support services. The system is administered by municipalities and covers a range of home care, community, and residential care services for eligible individuals.

Enrollment is mandatory for all residents aged 40 and over who are enrolled in health insurance. Premiums are collected automatically — for working-age enrollees (40–64), through the health insurance premium bill; for those aged 65+, through pension deductions or direct municipal billing.

The care level certification process

To access covered services, you must first apply for care level certification (要介護認定, yō-kaigo nintei) at your municipal office. This is a structured assessment of physical and cognitive function. The process:

1. Submit an application at the municipal office’s kaigo hoken section (介護保険課)
2. A trained assessor visits to conduct a standardized physical and cognitive function evaluation (approximately 75-item questionnaire plus direct observation)
3. A committee of physicians and healthcare professionals reviews the assessment
4. The municipality issues a certification in one of seven levels:
   • 要支援1–2 (yō-shien 1–2): support level — functional limitations but not yet dependent
   • 要介護1–5 (yō-kaigo 1–5): care level — increasing degrees of dependence and need

The certification determines the monthly care benefit budget you can spend on covered services. A certified care manager (ケアマネージャー, kea manējā) then develops a care plan within that budget.

Services available under the system

Long-term care insurance covers a substantial range of services:

Home care services (居宅介護サービス, kyotaku kaigo sābisu):

• Home helper visits for personal care (bathing, dressing, eating assistance)
• Home nursing care visits
• Physical and occupational therapy visits
• Day services (デイサービス, dei sābisu) — daytime attendance at a community care center including meals, bathing, and therapeutic activities
• Short-stay (temporary respite) care

Residential care (施設サービス):

• Nursing homes (特別養護老人ホーム, tokubetsu yōgo rōjin hōmu) — waiting lists are typically long
• Care geriatric health service facilities (介護老人保健施設) — rehabilitation-focused residential care

The standard copayment for all these services is 10% of the assessed cost (20% or 30% for higher-income elderly). The system has a monthly ceiling structure similar to health insurance’s high-cost benefit.

Accessing the system as a foreign resident

Foreign residents aged 65 and over who meet the certification criteria are legally entitled to kaigo hoken services on the same basis as Japanese nationals. The certification process itself is conducted in Japanese, but some municipalities have multilingual assessment support or can arrange interpreters. Contact your municipal office’s kaigo hoken section early — the certification process can take a month or more, and waiting for an acute crisis to apply creates unnecessary delay.

The care manager (ケアマネージャー) assigned after certification is the key coordinator. Discuss language support needs with the care manager; they can sometimes identify services with English-capable staff, particularly in major urban areas.

Last reviewed: September 2026