Learn how Tsukui Corporation became Japan’s number one provider of Day Services by putting people first.
Japan is an extremely aged society. Nearly one-third of the population is now over 65, and the number continues to rise. Living beyond 100 is no longer a rarity in Japan. This demographic transformation affects lifestyles, health, and national expenditures. It also creates challenges related to maintaining health, independence, and purpose among older adults challenges the government must address. Could you share your perspective on Japan’s super-aged society, and what you see as the country’s greatest challenges and initiatives in responding to this shift?
Japan’s average life expectancy keeps rising, and we now live in what is often called a “the era of the100-year life.” More than 30 percent of the population is already over 65, and that proportion continues to grow. While longevity is a positive outcome thanks to advances in healthcare and improvements in lifestyle it also brings new challenges. Issues such as maintaining health, ensuring independence, and supporting people in finding a sense of purpose become increasingly significant.
Within the broader context of eldercare in Japan, I believe we face three major structural challenges. First, the caregiving human resource challenge, or the demographic reality of a declining birthrate and an aging population. Second, the financial sustainability of the long-term care insurance system. And third, the challenge of technological integration through tools such as IoT and digital solutions. In short, the challenges can be summarized as people, money, and technology. From a policy perspective, Japan’s long-term care insurance system has now been in place for 25 years. When private-sector participation was opened and the system officially began, it set the foundation for modern eldercare services. The next significant turning point is expected to come by around 2040.
So the next major phase runs from now until 2040?
Yes, that’s correct. What will happen by 2040 is that the population of older adults which has been continually increasing will finally begin to decline. That is one major shift. The other is that the working-age population will shrink markedly at the same time. In addition, regional disparities will widen significantly. Metropolitan areas such as Tokyo will face very different financial and demographic dynamics compared to rural regions, where population decline is far more severe. The flow of people, economic conditions, and available resources will diverge sharply between regions.
Another major change is how the definition of “older adult” itself is shifting. In Japan, we often talk about “healthy life expectancy,” and in that context, the conventional benchmark of being over 65 as “elderly” is no longer accurate. Today, many people remain healthy and active well into their mid-70s. In fact, age 75 seems to be emerging as a more realistic threshold for what we call “older adults.”
People in their 70s today are energetic enough to continue working. That demographic group is becoming an increasingly important part of the workforce. We have been operating on the frontline for more than 40 years, and we’ve seen a dramatic change in the vitality of older generations. Years ago, most of our clients were in their 60s and early 70s. Today, many service users are in their 90s.
Interestingly, the period during which people require long-term care and eventually pass away has not changed much over the decades. It has generally been said to be about 10 years, though in recent years that period has shortened slightly to eight or nine years. What has changed significantly is the length of time people live without needing care. As life expectancy increases, the period of independent living also becomes longer. The key challenge for Japan is how to help individuals remain healthy, independent, and engaged for as long as possible. This is essential not only for quality of life but also for controlling social security and healthcare costs. Policies today increasingly focus on extending healthy longevity and promoting purpose and well-being.
Japan is ahead of most countries in confronting this demographic reality. South Korea is aging rapidly, China is aging, and even Europe is facing similar trends, though Japan is further along. Given Japan’s head start and experience, how do you see Japanese companies leveraging this expertise abroad?
Japan simply entered this phase earlier, which gives us accumulated experience. We have spent nearly 20 years exploring the potential for overseas expansion. However, the challenge is that the structure of Japan’s long-term care insurance system is fundamentally different from systems abroad. Japan’s long-term care insurance system is a universal social insurance scheme in which individuals pay 10% to 30% of the costs depending on their income level, and the remaining amount is covered by the government.This model enabled rapid expansion of care services in Japan. But in many other countries, there are serious concerns about whether such a model is financially feasible. Their fiscal capacity simply cannot support this level of public funding.
Even in Japan, the long-term care system was originally meant to be financed through increases in the consumption tax. Yet the government has struggled to raise the tax rate due to economic constraints, and funding has become a persistent challenge. So bringing the Japanese model overseas is often difficult because it cannot be readily adopted.
Another important difference is historical. Before long-term care insurance began, Japan had a longstanding tradition of Japanese caregivers caring for Japanese families similar to a domestic household helper system. When long-term care insurance was introduced, the caregiving role evolved into a professional discipline. In many countries, caregiving still largely relies on foreign domestic workers who are paid relatively low wages. This creates a perception that care work is something outsourced to lower-cost foreign labor, which differs significantly from Japan’s professionalized model. Additionally, Japan separates its medical insurance system and its long-term care insurance system, whereas many countries integrate the two. This structural difference also poses challenges for exporting Japan’s care model abroad.
Because of these factors, it is not easy for us to directly operate care businesses overseas. If we attempted to replicate our model as is, the services would only be financially accessible to affluent clients. That is a major difference between Japan and many other regions, especially parts of Asia and the United States. Of course, in some European countries where social welfare systems are robust, the model is more compatible but in most places, it remains difficult.
I see. And I’ve heard from other companies that differences such as religion also affect how eldercare must be adapted in different countries. You are active in Vietnam how does that work in practice?
In Vietnam, our work focuses primarily on two areas. One is supporting training programs for people who wish to work in Japan. The second is supporting the government-led Technical Intern Training Program, which is designed so participants can acquire skills abroad and then return to contribute to their home country.
Our overseas recruitment efforts are not merely a response to labor shortages. Rather, our aim is to help trainees take the Japanese-style caregiving skills they learn at TSUKUI back to their home country and apply them in local facilities and hospitals. In doing so, we hope to fulfill the original intent of the Technical Intern Training Program—to develop human resources who can contribute to the economic growth of their home countries.
Although we do not directly operate Japanese-style care services in Vietnam, we provide consulting, as well as support for training and workforce development. As part of these efforts, we established our local subsidiary, TSUKUI PLAN VIETNAM. Japanese staff are stationed on-site to conduct caregiving training programs based on Japanese standards. Trainees learn not only the language but also caregiving skills in depth. This initiative has produced many technical trainees who now work not only at TSUKUI facilities but also at a wide range of external institutions.
We are also strengthening our consulting business that leverages Japanese caregiving expertise. In 2025, we opened IKI IKI CENTER, a community-based facility in Ho Chi Minh City designed to promote health maintenance and preventive care for older adults. The center has attracted attention locally as a facility that incorporates Japanese caregiving practices. In addition, Japanese-made care products have gained recognition for their high quality, and we are also engaged in the sale of items such as adult diapers.
I’d like to ask about digital transformation and technology. You have also initiatives through your group company, DIGITAL LIFE. How are you advancing your digital strategy, and how do you see digital technology shaping the future of eldercare?
As the workforce shrinks, one of the biggest challenges is how to maintain the same level of service quality for the same number of clients with fewer staff. Historically, Japanese eldercare has relied heavily on human labor. That personal involvement is part of what makes Japan’s care model so strong. But with fewer workers available, we must reduce the tasks that humans must handle manually.
This is where digital transformation plays a key role. For example, long-term care insurance requires extensive paperwork, documentation, and procedural compliance. These tasks consume enormous labor hours. By digitizing them, we can free staff from administrative burdens. In addition, as smartphone ownership has increased among our clients and their families, we launched a members-only online platform called “100-Year Notebook” last fiscal year, which enables the digitalization of communication logs, invoices, and receipts.
Another area is standardizing and digitizing internal rules and procedures across our organization. By collaborating with our group company DIGITAL LIFE and digitizing these processes, we can free staff from administrative burdens. These are relatively straightforward applications but have substantial impact. A more complex area is identifying which caregiving tasks truly require human expertise and which do not. For instance, communication with clients is essential, but not all communication must be handled by staff. And some older adults have difficulty expressing themselves verbally. Digital tools such as sensors and cameras can support monitoring and understanding their needs without requiring constant staff presence.
In Japan, most DX efforts in eldercare currently focus on operational efficiency. That’s because the core human-to-human caregiving cannot and should not be replaced. Robots that can physically assist clients in daily movement are still limited in practicality. So our strategy is: people focus on what only people can do, and digital systems handle the rest.
On the topic of staffing, you bring many caregivers from Vietnam. What steps do you take to train them sufficiently before they arrive so they can contribute quickly once in Japan?
Yes, we train them both in Vietnam and in Japan. They first undergo several months of training in Vietnam, then an additional period also about two to three months after arriving in Japan. Altogether, they receive around six months of training before fully entering the workforce.
As of the end of September 2025, We currently have over 100 technical trainees from Vietnam, and across all nationalities, around 340 foreign staff are working with us.
At present, some of them have begun to take on the challenge of advancing from general positions to higher-level career opportunities. Having a diverse workforce has helped embed a wide range of values across our organization, and today we are truly able to embody diversity and inclusion throughout the company.
How do you help older Japanese clients who may be unfamiliar with foreigners connect comfortably with foreign caregiving staff?
First, language is essential. We require all candidates to achieve at least N4 level on the Japanese Language Proficiency Test before coming to Japan. Second, we generally recruit individuals who already have nursing qualifications in their home country. Having a medical background makes it easier for them to adapt to Japanese caregiving practices.
In Vietnam, only those with government-recognized licenses can work in medical settings, so coming to Japan to learn caregiving actually gives them additional professional value. Of course, there are differences in religion, customs, and cultural norms. But one thing shared across cultures is the deep respect for elders. In Vietnam, the tradition of cherishing grandparents and caring for one’s parents is particularly strong. In fact, we Japanese have much to re-learn from that mindset. Their genuine affection for older adults resonates deeply with our clients.
Over the past decade, both our clients and our staff have gradually become more comfortable with multicultural care environments. Our role is to support foreign caregivers in adapting to daily life in Japan while also helping them and our clients build relationships rooted in mutual respect. Success ultimately comes down to selecting the right people those with the right character and commitment and supporting them through cultural and workplace integration.
You mentioned earlier that long-term care insurance is unique to Japan, and you also touched on the challenge of generating revenue outside the insurance system. How do you view the growth of these businesses, which operate outside the long-term care insurance framework?
Japan’s long-term care insurance covers services for older adults who need support, but as longevity increases, there is growing demand from healthy older adults those who are not yet using long-term care insurance. This is an important market.
Another critical area is supporting family caregivers. Japan faces what we call the “business caregiver problem,” where individuals in their working years leave their jobs to care for aging parents. The economic loss from this is estimated at approximately 9 trillion yen, according to research by the Ministry of Economy, Trade and Industry. Supporting these families is both a social responsibility and a major business opportunity. This is where services such as Yorisoi Concierge and our “100-Year Life Notebook” come in. These help connect older adults with their families and provide support that sits in the space between family and formal care providers.
What exactly is Yorisoi Concierge?
Yorisoi Concierge is a service designed to support families. It also supports care managers who play a central role in Japan’s care system. Care managers create care plans with the older adult and their family and coordinate service providers. They are essentially the control tower. However, care managers are extremely busy. Yorisoi Concierge helps reduce their workload through digital tools and support functions.
We also offer services to family members who are not our clients people working at other companies but facing caregiving responsibilities at home. We provide consultations, advice on navigating the long-term care insurance system, and general caregiving guidance. Our AI partner company supports this, allowing us to respond quickly and accurately. These businesses are still in their early stages and not yet large revenue generators, but I see enormous potential for expansion.
You also operate Mirai Innovation Lab, where you collaborate with local communities and companies to identify real challenges. How are those insights applied to your business and to improving the quality of life for older adults?
When we started Mirai Innovation Lab, we invited local residents mainly people who were not yet using care services but were approaching older age to visit daily and share their experiences, concerns, and needs. Many companies also visited to gather insights and test ideas.
Interestingly, we discovered that the older adults themselves were not facing major difficulties. Rather, it was their families who struggled feeling vague anxieties, uncertainty about caregiving, and concerns about their parents. The issues between generations often differed significantly. This insight led us to focus on how to support the family side of caregiving more effectively, which ultimately shaped the Yorisoi Concierge concept. We also explored what kinds of products older adults actually need, how they use digital devices like smartphones, and we provided these insights back to companies. Mirai Innovation Lab helped us deepen our understanding of both older adults and their support networks. After these explorations and validations, Mirai Innovation Lab concluded its operations in December 2025.
And SONOSAKI LIFE the e-commerce business was influenced by those findings as well?
Yes. The target audience for SONOSAKI LIFE is adults in their 40s to 60s who are caring for their parents. The product development reflects many insights gained through Mirai Innovation Lab. We don’t simply sell products we aim to provide correct caregiving knowledge and reliable information alongside them. That combination is what differentiates us.
Do you see e-commerce becoming a much larger business for you?
Yes, but not in the conventional sense. We don’t want to simply sell products; we want to maintain ongoing dialogue with customers. The value comes from continuing to support them with guidance and follow-up. That is our competitive edge compared to the world’s largest e-commerce platforms.. We focus on creating meaningful touchpoints rather than purely transactional sales.
My last question: your eldercare business began in 1983, meaning you will reach your 50th anniversary in 2033. What goals or milestones would you like to achieve by then?
The company itself is older we were established in 1983, but our origins go back to 1969. The 2033 milestone represents 50 years in the eldercare business On the service side, many older adults wish to remain at home and live in their familiar communities for as long as possible. But society has changed most households no longer live with their children, which makes aging in place more challenging. Twenty years ago, most people passed away in hospitals. Now, national policies aim to create systems that allow people to spend their final days at home or in care facilities, rather than hospitals.
For us, the key to extending home-based living is the combination of day services where clients come to us during the day and return home and home-visit care services. We also consider short-stay facilities important, though TSUKUI itself does not operate them. SOYOKAZE Co., Ltd., a company we have a business partnership with, provides these services, is the largest operator of short-stay facilities in Japan. Together, we aim to integrate day services, home-visit care, short-stay care, and home-visit nursing services into a cohesive system. Over the next ten years, our goal is to strengthen and expand these four pillars and ensure that communities across Japan have access to this full combination of services. This integrated model will allow older adults to live at home longer, with dignity and support.
For more information, visit their website at: https://www.tsukui.net/
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