Since 2000, both Japan and the United States have experienced rapid expansion of their personal and elder care workforces. The demographic pressures that drive this demand are more severe in Japan, where by 2030 an estimated 30% of the population will be 65 or older, compared with about 21% in the United States.  How to they compare in staffing for personal care, which is overwhelmingly for elder care?

Japan’s long-term care workforce has roughly quadrupled, rising from about 550,000 workers in 2000 to 2.1 million in 2024. The United States saw its direct care workforce more than double—from roughly 2 to 2.5 million in 2000 to 5.4 million in 2024.  That is, 3% of the Japanese workforce in 2024, compared with 3.2% in the U.S. – basically equal in total workforce dependence.

What about family care, the subject in Yasujirō Ozu films such as An Autumn Afternoon (1962) and Tokyo Story (1953)?  It is possible that in Japan family members today take on more of the burden of personal caregiving in Japan than in the U.S.  The demographics show that a “family burden ratio” — the ratio of persons 45 years old (middle age, with the potential burden of elderly parents) to persons 75 years old is much lower than in the U.S. – i.e relatively fewer 45 year olds compared 75 year olds.  This ratio will worsen in the future in Japan but not appreciatively in the U.S.

But Japan’s share of foreign-born workers in the care sector remains modest—practically zero in 2000, just 0.2% in 2010, around 1.5% in 2020, and about 4% in 2024. Japan relies much less on foreign workers overall (3% of its entire workforce, vs. 19% in the U.S.) and it shows in the tiny numbers of foreign-born personal aides. Japan introduced over the past 10 years some policies to attract foreign works, such as the 2019 “Specified Skilled Worker” program designed to attract overseas caregivers.

Japan depends now mainly on Vietnam, Indonesia and Philippines for these workers. Automation (robots) and domestic recruitment will have to be heroic to be the solution without a major increase in foreign worker involvement.

The U.S. care sector has become increasingly immigrant-dependent. Some estimates say that foreign-born workers represented about 10–13% of the direct care workforce in 2000, rising to close to 30 percent by 2024. In some U.S. states, such as New York and Florida, immigrants now make up over half of all home health aides.  The foreign-born share is at about 40% for home health aides.

Does ICE enforcement cause a major reduction in personal care workers? Estimates of the share of personal care workers who are unauthorized tend to be low – less than 10%. One research team estimated in early 2025 that persons on Medicaid needing personal care will be most adversely. affected.