Japan’s rapidly aging population is putting unprecedented pressure on its long-term care system. Few issues illustrate this strain more clearly than the debate over the Specified Skilled Worker (SSW) visa program. Supporters argue that foreign caregivers are essential to sustaining elder care services as the Japanese workforce shrinks. However, critics worry about the social and political implications of expanding immigration in a historically cautious country.

Political rhetoric around immigration shows little sign of cooling. Yet, one perspective is often missing from the debate: the voices of the essential foreign workers themselves.

To shed more light on this situation, Real Gaijin spoke with a licensed caregiver at an elderly care facility in Osaka. As an essential worker on the front lines of Japan’s healthcare challenges, our guest outlined her journey from the Philippines to a training program in Yokohama and ultimately to a long-term care home in Osaka. She told us about her work responsibilities and provided a firsthand perspective on the labor shortage in Japan’s care homes. She also shared her personal perspective on addressing some of the bigger issues, such as who will care for the rapidly growing elderly population, and expressed her wish for caregivers from abroad to be more welcomed by Japanese society as a whole.

Who is she?

Anna, who prefers to use only her first name for this interview, is a registered nurse in the Philippines. She currently works as a licensed care worker, the Japanese equivalent of a certified nursing assistant (CNA), in an elderly care facility in Osaka.

Originally, Anna came to Japan as a care worker candidate under the Economic Partnership Agreement (EPA) from 2021 to 2025. She recently passed the national care worker exam, also known as the kaigo fukushi kokka shiken (介護福祉士国家試験).

Anna was kind enough to reach out to Real Gaijin after reading “Japan Quietly Rewrites the Rules for Foreign Care Workers: How a new “partial pass” exam system is extending visas and reshaping Japan’s elder care labor strategy.” So, who better to ask about working as a foreign caregiver at a Japanese elder care home?

On the agenda

We traced Anna’s journey from the Philippines to Japan and discussed what her experience was like participating in the EPA program. We also talked about her current role as a caregiver in Osaka, her legal status in Japan, particularly in relation to her nursing degree from the Philippines, and her plans to continue living and working in Japan.

Key takeaways

We could have continued for many more hours and certainly covered a lot of ground during the podcast, but some of the big takeaways were the following:

* Japan is already structurally dependent on foreign caregivers.

Foreign care workers are not just filling marginal gaps; they are now structurally embedded in Japan’s elder care system. In Anna’s facility, the majority of staff are foreign. In the four years she has worked there, she has not seen a single new Japanese care worker join—a fact that strongly signals a collapse in the domestic labor supply for this sector. Her observation that younger Japanese workers are largely unwilling to enter the caregiving field reinforces this idea, leaving “heavy lifting” (both literal and operational) to foreign staff. The implication is structural, not cyclical: absent major policy or labor-market changes, Japan’s care system will remain dependent on continued inflows of foreign labor, regardless of political rhetoric around immigration.

* The system extracts high human capital, but does not leverage it effectively.

There is inefficiency—and arguably misallocation—of skilled labor within Japan’s caregiving pipeline. Anna is a fully qualified nurse in the Philippines, yet she is employed as a clinical nurse assistant (CNA) in Japan because her credentials are not recognized. In order to advance, she must work full-time while studying Japanese for a difficult national certification exam, effectively re-credentialing from scratch. While the system is structured and supportive, offering training, matching, and visa pathways, it imposes a lengthy, language-intensive conversion process that delays the full utilization of existing medical expertise. This suggests a policy tension: Japan urgently needs skilled healthcare labor, yet it maintains high institutional barriers that slow the integration of professionals who are already trained.

* Economic incentives, not cultural preferences, drive migration decisions.

Migration decisions are primarily economic and pragmatic, not ideological. Anna explicitly frames her decision to stay in Japan as a function of the relative viability of the labor market: while the Philippines offers cultural comfort, it does not offer comparable employment opportunities or wages. Meanwhile, policy frictions, such as rising visa and residency costs, directly impact workers whose salaries remain relatively low, raising questions about sustainability and fairness. Anna’s perspective reshapes the immigration debate, portraying foreign workers as rational economic actors who weigh trade-offs across global labor markets rather than passive beneficiaries of Japan’s system. For policymakers, this implies that tightening financial or administrative burdens could reduce Japan’s competitiveness in attracting and retaining this workforce. For example, the government recently proposed increasing the application fee for permanent residency from 10,000 yen ($63) to 300,000 yen ($1,900). This increase would place a significant financial burden on Anna. Since she would have to pay the fee herself, Anna has suggested setting the fee at a graduated rate based on the applicant’s income. Additionally, the Japanese government plans to raise the fees for renewing various work visas. For many care workers at the bottom of the pay scale who, unlike Anna, have not yet passed the national care worker exam, these annual additional fees will be a significant financial burden. Thus, there will soon be a new disincentive for relatively low-paid care workers from abroad to remain in Japan.

* There’s a discrepancy between how much foreign caregivers contribute and how much they’re socially acknowledged.

Anna emphasizes that many foreign caregivers undergo years of language training and certification studies and perform physically demanding work to provide high-quality care, often to Japan’s most vulnerable population, including centenarians and individuals with dementia. Yet, she feels that Japanese society does not fully appreciate this commitment and, in some cases, makes generalized or negative assumptions about foreigners. Her request is not abstract; she asks that Japanese people judge individuals based on their actions rather than stereotypes and recognize that foreign caregivers are quietly and diligently working to support the country’s aging population. Foreign caregivers are already essential to the system, yet social acceptance and acknowledgment have not kept pace with their indispensable role in caring for Japan’s parents and grandparents.

Timeline

Substack does not yet have the functionality to allow you to use a link to jump to a specific section like YouTube’s “chapters.” Please refer to the times listed below to navigate through our hour-long conversation. Thank you for your understanding.

Key contacts

* Substack: https://substack.com/@annainjpg

Full disclosure

For an unknown reason, possibly related to the release of significant new functionality by Substack last week, we experienced technical difficulties during the live video session. This limited the audience’s ability to listen to the discussion and participate via chat. Anna and I continued to record. We apologize for any inconvenience and encourage you to enter your questions in the comments below. One or both of us will address your questions and concerns.

Real Gaijin is working with Substack to ensure that we do not continue to experience these sorts of technical difficulties.

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