According to 2018 population estimates from the Ministry of Internal Affairs and Communications, the total population of Tokushima Prefecture was 736,000 citizens, of which 243,000 are aged over 65 years. This represents 33.1% of the total population which is well above the national average of 28.1%. It is estimated the number of senior citizens will continue to increase while the core workforce population, between 15 years old and 64 years old, will significantly decline.

Additionally, the Ministry of Health, Labour and Welfare forecasts a serious shortfall in care workers and estimates that Tokushima Prefecture will be short of approximately 1,409 care workers by 2025.

A pilot project has been in operation since 2017.

Project Objectives

• Procure additional care workers by encouraging middle-aged and older people to enter the nursing care service field
• Increase the number of middle-aged and older people with basic nursing care knowledge
• Deliver work style reform in nursing care sites
• Assist active seniors in having productive lives

The Tokushima Prefecture Nursing Care Assistant System supports a new style of work at nursing care sites.  It allows people without any previous experience or qualifications to work under supervision, even for a short period of time.

The system aims to improve the working environment for nursing care workers by delegating peripheral care work including cleaning, bedmaking and companionship to nursing care assistants. This helps to streamline nursing care workers’ work and develops an environment where care workers can focus on technical work, and subsequently improve the quality of nursing care services.

The key point of this system is that care assistant work is restricted to peripheral care work, which places a relatively low physical burden on the workers. This results in developing a system where those without qualifications or experience can easily participate, and also those with experience can come back to work even if they have previously left the industry.

Additionally, the project is easy to join as it is based on short working hours that take into account a workers’ physical strength and lifestyle, while providing on the job (OJT) training for a certain period of time to allow participants to acquire the necessary knowledge and skills.

The lead agencies for the project are Long Life and Life Motivation Promotion Office, Long Life and Life Motivation Division and the Public Health and Welfare Department from the Tokushima Prefecture.

In the two fiscal years 2017 and 2018, 94 active seniors between 51 and 80 years old (average age of 67) participated in the pilot project (for three months) as nursing care assistants, of which 67 (71%) continued working after the pilot project finished.

More than 90% of seniors who participated in the pilot project answered that it was “good” or “somewhat good” and over 90% of the peer workers answered “very helpful” or “somewhat helpful”.

Due to favourable coverage in the media and the reputation of nursing care assistants after the launch of the project, some seniors chose to become care assistants. At least fifteen senior workers were employed by nursing care facilities independent of the prefecture’s pilot project, and some applicants for nursing care assistants were hired as full-time nursing care workers.

More than 30% of nursing care assistants are qualified with nursing care or care experience, which resulted in contributing to the procurement of potential care workers.

Although, over the course of the two years, no less than 347 people participated in the preliminary briefing held before recruitment interviews, and the prefecture felt that many seniors were interested in working at nursing care service sites, only 178, around half of them, proceeded to the interview stage. This is thought to be because of a mismatch in the preferred working hours between workers and employers; although the senior workers preferred working a shorter time, such as “2-3 days a week” or “morning only”, the facilities wanted them to work, if possible, “5 days a week” and not only morning but also “late afternoon”, when workers raising children left and it gets busy.

Another factor is that not many facilities are ready to accept nursing care assistants.  

Another issue was related to “defining work”; facility workers answered, “it is a great burden to sort out work when accepting nursing care assistants”, and “the scope of their work is not clear, and it is difficult to determine to what level we can ask them to work”. There was also an issue in “cooperation and mentoring” and there was feedback from a nursing care assistant that “it is difficult to ask questions about work when the existing care workers are busy”.

To solve such issues, the Prefecture provides a training system for existing workers to introduce their facilities, offers personal training and a psychological care service for nursing care assistants by preparing and distributing guidelines for facilities that accept nursing care assistants, and has professional advisors in place.

It is expected that the number of young people will decline in the region due to increasingly low birth rates combined with the increase of the aged population, as well as depopulation. The prefecture is putting significant effort into expanding opportunities where active seniors can play important roles in other sectors besides nursing care.

CLAIR | case study: Nursing Care Assistant System (Tokushima Version) Lifelong Active Citizen Acceleration Project for Active Seniors

http://www.clair.or.jp/e/bestpractice/docs/2019Tokushima_e_full.pdf