Reorienting Labor Supply Chains for the Healthcare Sector

Since 2008, the Philippines, Indonesia, and Vietnam have been sending candidates for certified care worker positions and candidates for registered nurse position to Japan. This has permitted entry to graduates of three- or four-year nursing schools in their home countries in accordance with the criteria set under the EPAs. To date, 1,598 out of 5,063 care worker candidates have passed the national examinations for care workers by the end of March 2021 to obtain qualifications to work (MHLW 2021b).

EPA candidates are scheduled for arrival every spring; however, the closure of Japan's borders to foreign nationals in 2020 has significantly delayed dispatches from each country. Notwithstanding this delay, some candidates have been able to enter when restrictions were relaxed. From Vietnam, where coronavirus infection rates have been among the lowest in the region, 193 care worker candidates arrived in Japan in early November along with 38 registered nurse candidates; from Indonesia, between mid- to late December, 280 care worker candidates and 23 nurse candidates arrived; and 310 candidates (261 care worker and 49 nurse candidates) due to arrive in 2020, arrived late from the Philippines between May 25–27, 2021.¹⁷ Even during the pandemic, which has made international travel difficult, the urgent need for sending and receiving EPA nurses and care workers has not abated.

Between January 2018 and March 2020, the nursing care industry accepted technical interns from Vietnam, Myanmar, China, and other Asian countries. The organization charged with coordinating trainees, the Organization for Technical Intern Training (OTIT), showed that the number of foreign technical interns receiving training in the nursing care field stood at 8,967 (JITCO 2020). In effect, this accounted for 2.4 percent of all interns present in Japan (366,167). Prior to the pandemic, the reorganization of labor streams meant that the number of nursing care trainees visiting Japan had exceeded the total number of trainees accepted under the EPA programs. By nationality, the largest number of trainees comes from Vietnam (3,523), and they account for 40 percent of the total number of nursing care trainees, followed by nationals from other countries in Southeast Asia and East Asia (Table 4).

For jobs within industries that accept technical interns, the training period necessary to obtain Japanese language and other skills in the sending country has only been six months in length and leading up to date of departure. However, for nursing care work, specialized Japanese language terminology is required. MHLW guidelines for the operation of the technical internship system for nursing care occupations stipulate that the first-year migrant employees with the requisite “specified skills no. 1” visa status must have a passed the “N4” level in the Japanese Language Proficiency Test (JLPT) or an equivalent qualification.¹⁸ For this reason, trainees in the nursing care field receive instruction for one year, therefore requiring substantial commitment. This ultimately means that those wanting to work in this field in Japan spend more time and money prior to leaving their home countries than do their counterparts in other fields.

At present, eighty-two industries, including construction and manufacturing, are accepting technical intern, and many companies hire to cope with labor shortages or to suppress wages. As a result of this situation, numerous labor-related human rights violations have figured prominently in the national news. In 2019, the Ministry of Justice (MoJ 2019) reported that 8,796 trainees had been confirmed as “disappeared,” 1.7 times higher than in 2016 (5,068) (See MoJ 2019). This fact points to ongoing exploitation in various industries. However, this is not the case for trainees in the nursing care field, who are accepted by social welfare corporations. Most are young women in their 20s, and there have been few reports of “disappearances” nationwide in part due to some local governments’ active promotion of acceptance through subsidies.

In December 2018, the Japanese Immigration Control Act was revised to establish new visa residence statuses (tokutei gino [“specified skill worker”]) classified under specified skills for fourteen fields, including nursing care. In addition to passing JLPT N4 or higher in the sending country, those in the field of nursing care are required to pass the Japanese evaluation test for nursing care (Kaigo Nihongo Hyoka Shiken). The pre-pandemic expectation was to receive 60,000 workers in the nursing care sector over a five-year period starting from 2019 within 300,000 positions across fourteen industries. This plan was to serve as a receiving framework for those who would come to Japan under the EPAs and, importantly, allow in even those who would fail to pass the national examination for care workers within the stipulated number of years—a maximum of five—where their status of residence would still be “specified activity.” In other words, the Japanese government opened up an alternative way for those who failed the exam to continue to work in Japan. It allowed those who obtained more than half the required marks on the exam to come into the country and obtain a “specified activity” residence status. This overhaul of the visa system was to operate as a compromise designed to tap potential labor markets in an evolving care chain nexus so as to plug chronic care labor shortages.

The impact of the coronavirus and the government's subsequent stringent restrictions on entry has meant that the number of people coming to Japan under the specified skilled worker system has been extremely limited due to delays in negotiations with sending Asian governments. The Immigrant Services Agency of Japan (ISA) has stated that the number of foreign nationals staying in Japan under the visa status of “technical intern”¹⁹ was 410,972 as of the end of March 2020 (ISA 2020; OIC 2020). In the same year, the number of approved technical trainee plans was 256,408, of which 12,068 were in the nursing care field. This accounts for 4.7 percent of the total (JITCO 2021).

In 2016, the Japanese government revised its Immigration Control Act to create a “nursing care” residence status (effective as of 2017). This was established as a partial response to the problem of foreign nationals graduating from Japanese schools and obtaining qualifications as care workers, but not being able to work as care workers in Japan. However, the reality is that, with many cases, “nursing care” residence status was being granted to international students who had entered or graduated from welfare vocational schools (fukushi kei senmon gakko) or junior colleges via Japanese language schools and who had obtained the qualifications to become care workers. Of interest is the fact that those who came to Japan under the EPAs and obtained the qualifications of a care worker could now change their residence status from “specified activities” to “nursing care.”

With the establishment of the “nursing care” visa status, welfare colleges, which have experienced a large shortage due to a decrease in the number of students, have begun to focus on attracting foreign students. For local nursing care facilities, foreign human resources who graduate from vocational schools and obtain qualifications as nursing care workers are seen as a more stable and long-term workforce than EPA candidates, many of whom do pass the stringent national examination. In many cases, they work part-time (no more than the twenty-eight hours per week as permitted by law) while attending vocational schools.

Over the past few years, the number of such (nursing) care students has dramatically increased across Japan. The Japan Association of Training Facilities for Care Workers (JATFCW) has shown that the number of foreign students enrolled in training facilities nationwide was only 257 in 2016 (Table 5). However, this has since rapidly increased over the years, rising to 2,037 in 2019. At the outbreak of the coronavirus, a total of 2,395 foreigners from twenty countries were enrolled in 2020. This accounts for 34 percent of the total number of students (7,042) enrolled in training facilities nationwide (JATFCW 2021). Thus, pre-pandemic the situation showed an evolving system diversifying and pulling in migrants to work in the care sector. Due to the high number of layoffs in the retail industry during the pandemic, some evidence points to students shifting to care work in the short term to cover income losses. This suggests a reorganization of labor to cope with the urgent need to provide societal care.

Refocusing Administrative Support and the Governance of Migrant Labor

As argued above, there has been an acceleration in the acceptance of technical interns and foreign students in the nursing care sector, which is especially pronounced in urban areas where there has been a chronic shortage of labor. Because of this trend, many nursing care facilities have accepted foreign workers. Here, we focus on Fukuoka Prefecture on the southern island of Kyushu. With a population of 5.1 million, just over 1.4 million are over 65 years of age (27.5 percent). In line with the national trend for aging, the prefecture suffers from a shortage of labor for the nursing care industry (ratio +3.4). Over the last ten years, various individual, city, and prefecture initiatives have aimed at ameliorating labor shortages, including the provision of care giver training to resident migrants (Lopez 2012). This section focuses on Fukuoka's experience of assessing the labor situation under the pandemic through research conducted in late October 2020. Fukuoka was chosen as one location for research due to the existence of contacts from previous research projects in the region and due to low infection rates at the time of research.²⁰

To come up with strategies for caring for an aging population, the local government city hall has established an office for securing human resources for nursing care under the division responsible for the promotion of comprehensive care for the elderly. One basic principle adopted was to aim for the creation of a local society where the elderly play an active role in their communities as part of an ongoing elderly health and welfare plan.²¹ Internal figures collected show that the number of nursing care workers in the prefecture stood at 70,253 in 2013. By 2018, this had increased to 82,635 as the population aged. By 2025, it is forecast that 95,246 nursing care workers will be in demand. In line with the government's policy, the prefecture's policy for securing nursing care workers by 2025 is based on improving and strengthening measures to secure human resources domestically. However, this also includes securing foreign human resources considering the decline in the prefecture's working-age population and inability to entice local workers into the care industry. By 2025, Fukuoka City expects to suffer from a demand-side gap for care workers of around 5,500, and in response to this it peremptorily established a platform for accepting foreign nursing care workers in 2019. In 2021, the city aims to send several trained care workers to Myanmar to assist and provide guidance to those who wish to work in Japan and specifically to promote Fukuoka as an ideal region in which to work.²²

The prefecture is among a number in Japan that have a history of accepting nurses and care workers, and several care facilities have accepted them under the framework of the EPAs. Since then, 112 individuals have come to work in the prefecture (eighteen have obtained qualifications as nursing care workers). Forty-nine are from Indonesia (including five who completed their term, four who have passed the national licensing exam, and two who returned), fifty-seven are from the Philippines (including sixteen who completed the term, thirteen who passed, and three who returned), and six from Vietnam (one who passed the exam and one who returned). As of October 2020, twenty-two facilities in the prefecture had accepted eighty-four candidates for care worker positions. Most of these are in the southern part of the prefecture (Chikugo area), which has the largest shortage of workers. Running parallel to this are other local ventures that have trained foreign residents married to Japanese and with resident visas. One local company has trained over 300 (mainly Filipino women) between 2006 and the present.

With the acceptance of foreign nursing care workers, Fukuoka Prefecture has followed a similar national trend where technical trainees have far exceeded the number of EPA nursing care workers. Since 2019, there has been a significant increase at facilities within Fukuoka City, and the data shows that the number of people the prefecture aimed to accept under plans approved by the OTIT by the end of June 2020 amounted to 439. The majority had already been deployed and been working at nursing homes in the prefecture. In line with the national trend and in terms of nationality, the most numerous care worker groups come from Vietnam (182), Burma (86), and Indonesia (42).

An interview with a prefectural official shed light on their engagements and revealed that Vietnam has one of the most developed systems facilitating the dispatch and acceptance of workers. Presently, Vietnam's government has an active policy of sending workers overseas, and the prefecture has taken advantage of this policy. Additionally, there has been a rapid increase in Burmese coming to Japan in the past few years, which Fukuoka has also accepted. In 2016, the city entered a sister city partnership with Yangon, which included sending a delegation to Vietnam, including the prefectural governor. Relations focused on cultivating “welfare missions” fostering ties to bring over trainee workers and foreign students. One plan prior to the pandemic was to send Japanese nursing staff to Yangon to train local nurses directly and raise the profile of the city (in part because foreign staff would often move to other larger cities where pay is higher and where there are more activities available to them). The city official had this to say:

From now on, we hope to be able to send a nurse to train (them) there directly … so it's our hope to send trainers to support education there as well as bolster education here and leave a positive impression of Fukuoka because many people inevitably go to Tokyo. Our recognition (as a city) is low.

However, through these newly forming networks, discourses on the kinds of qualities that migrant workers possess in respect to types of work are taking shape. The majority of Burmese are Buddhists, and there exists a widespread belief among more elder Japanese that caring for physically disabled elderly is a way of fulfilling the Buddhist doctrine of “accumulating virtue” (toku wo tsumu). As such, caring for the elderly is not a profession that is shunned; rather, it rests upon a particular worldview of religious relations. This view has spread to the nursing care industry and was also shared by the city official, who spoke of the Burmese migrants’ “suitability” for such care work.²³ In an interview with the director of another care facility, a similar observation arose when the latter asked about whether the Burmese care workers, he had employed were suited to care work:

There might be personal differences, but on the whole their national qualities are close to ours. They are Buddhists and believe in accumulating merit and virtue for the next life and as such work hard.

With this new link in Japan's migrant care chain there is the risk in creating a new discourse that essentializes the national qualities of a people, which can serve to legitimize the kinds of work they engage in. Discourses in the mid-2000s also framed an earlier stream of Filipino migrants as apt care workers based on their perceived national hospitality skills (Ito et al. 2008; Lopez 2012). The “accumulation of virtue” discourse is now employed by some companies to place emphasis on the merits of the trainees they bring over as “good” nurses who will bring a valuable service that does not culturally destabilize Japanese practices. This fits into a capitalist discourse about matching (creating) a suitable labor pool to a particular market to fill with workers.

Aside from the above initiatives, another reconfiguration is taking place. In the prefecture, there are fifteen vocational schools and other institutions for training care workers. Some 277 (49.6 percent) of the total 559 current students are international students. The students are mainly concentrated in Fukuoka City, where 142 international students are studying.²⁴ At the prefectural level in this field, foreign students numbered 67 in 2018. As such, this means that the number has quadrupled since then. Foreign students are able to switch their residence status to “nursing care” once they graduate and obtain a nursing care worker visa.

At one prominent medical and welfare college (vocational school), interviews with foreign students training to be care workers (Chinese, Burmese, and Vietnamese) and the chief in charge of education there revealed that the pandemic had led to a new stream of students shifting over to studying care due to the collapse of work in the food, retail, and hotel industries, where many students would work part time. The chief said:

We had a request from one company with strong contacts with Vietnamese foreign students (in Japan), who were aiming to work in [the] advertising, food and hotel industries, that they would like to shift to the care sector. Some students had been studying hospitality at technical colleges and are now switching to care. The pandemic really brought the winds of change (to Japan).

The impact of the pandemic has reoriented the flow of student labor (as a potential buffer workforce in Japan). As a result of this trend, the college provides (sells) a package of training to facilities that will become guarantors for the students. They will pay for their daily expenses and once they graduate, the students will work full time for these facilities. Students who graduate and work night shifts are guaranteed an initial monthly salary of JPY190,000 (USD1,738) after tax. The students who strategically come to train and then work and settle in Japan have been termed “migrant working students” (dekasegi ryugakusei), a new phenomenon arising from the need to increase temporary labor in the workforce.²⁵ The director of one college offering packages to students to study care frustratingly noted how difficult the situation was in responding to Japan's urgent needs for care labor:

If we don't match workers to fields such medical education through a labor policy, they won't stick around. Japan's migration strategy is a halfway measure, and if we don't take a more friendly stance toward foreigners, no field will be able to survive.

A temporary internal reconfiguration is taking place to deal with the demand of care workers in a vastly undersupplied market through recruiting students. It is being somewhat stymied by political aversion to developing a more concrete migration policy. In a way, Fukuoka's experience offers a microcosm of the issues that many other prefectures are presently facing in the country under the pandemic.

Transformations in Hiring Trends in Nursing Care Facilities

At present, in Fukuoka Prefecture, technical interns and nursing care students are the main group of hired workers and not EPA care workers. One president of a local care training company,²⁶ Nakamura Masahiro, has been at the forefront of an independent initiative to retrain foreign migrants, which has been providing employment support and training for foreigners since 2006. In an interview, he made it clear that “in Fukuoka and other parts of Kyushu, EPA personnel do not stay for long, so businesses are switching their employment to technical interns.” One social welfare corporation in the Chikugo area had been continuously accepting EPA Filipino candidates for care workers since 2009. Yet from 2020, the focus has shifted to hiring technical interns from Myanmar. In part, this is due to a low retention rate, as many nurses move to larger urban areas where wages are higher. So far, nine people have passed the national exam, but only three of them have continued to work as of October 2020. After obtaining national qualifications, foreign nationals working under the EPAs can freely transfer jobs without restrictions. This has meant that the outflow of human resources to urban areas has become a source of concern for local care provider organizations, which have repeatedly experienced this trend. However, this trend was not exacerbated under the pandemic.

Foreign students in the nursing care field are granted a provisional national license as a nursing care worker if they graduate from a training facility. This they obtain on passing the national examination within five years of graduation or if they gain five years of continuous practical experience in nursing care. Facilities offer scholarships under a contract where students will work for a certain period after graduation, and there is an expectation that this will be a more stable workforce than EPA personnel. Recent research on facilities operating long-term care services has shown that a substantial number of foreign students and technical interns have become a dominant stream of labor exceeding care workers who arrive due to the EPA program (NCLSC 2020). This suggests that prior to the pandemic one part of the emergent care nexus was diversifying in order to capture different labor streams in a flexible fashion. The pandemic accelerated the speed at which these streams were reorienting to deal with the need to fill vacancies in the care market. Within this context, we now turn to discuss what problems staff care residences faced under the coronavirus pandemic.

The Challenges of Care during the Pandemic: Impact on Care Workers in Facilities

Over the course of the ongoing pandemic, nursing care facilities have had to deal with the fact that elderly people have a high chance of becoming seriously ill due to infections from the coronavirus. Elderly welfare facilities have been the worst, with 1,498 registered infections (up to 17 May 2021). At these facilities, foreign staff, as well as their Japanese counterparts, have been forced to work and live under a great deal of stress. In late October 2020, ten nursing care technical interns from Vietnam and Myanmar, and five Chinese and other international students from a welfare college were interviewed about their motivations for coming to Japan, their current circumstances, and life under the pandemic. Many shared a primary concern over restrictions on personal activities. One Burmese technical intern (mid-20s), who had entered Japan in March 2020 days before entry restrictions, spoke of the monotony of going back and forth between her workplace at a special nursing home for the elderly and her apartment. Her employer had instructed her to only go out to shop for necessities, and she could rarely walk around the vicinity of her apartment.

Among the interns, one Vietnamese woman (mid-20s) became a trainee in the field of nursing care shortly after completing five years as an intern in the field of agriculture. This was possible due to a special government measure that allowed trainees who were unable to return to their home countries due to the pandemic to work in other occupations that they previously they had not been allowed to before. Due to an unstable income during harvest seasons, this woman's monthly take-home pay was more than JPY100,000 (USD917), but during the off-season this was reduced by half. A high level of proficiency (N3) worked to her advantage when she sought out a job in the field of nursing care, which she is currently training in. When asked about why she chose to go to nursing, she replied that it “because it is what I want to do in the future. This is so that my Vietnamese grandparents will be as happy as the Japanese in the future.” The number of Vietnamese and Burmese technical intern trainees working in the field of care has risen significantly over the last year, yet many came to Japan with numerous motives. In one group interview with four Vietnamese care work interns (arrived in January 2020) at an intensive, day-long care training session, two trainees with N4-level Japanese explained that they were previously nurses (one an anesthetist, another a general nurse) at two general hospitals in Hanoi before deciding to come to work in Japan, partially out of interest in Japanese popular culture and partially to gain new skills in another language.

One thing that stood out for them is the existence of care homes for the elderly due to the lack of private nursing homes within Vietnam. As a culture with strong collectivist tendencies where the elderly are treated with deference and respect and live with children or grandchildren, coming to work in Japan in day care and long-term facilities came across as a shock:

In Vietnam, day care services for the elderly don't really exist. If something happens you just go to the hospital. We don't do care work for the elderly. So, when I first came here to do this, I was quite shocked. It was quite a surprise for us.

However, jumping into care work during a pandemic did not pose a great challenge for them as trained nurses, and they did not experience any major problems in their workplaces. Aside from restrictions on travel outside of work, they followed masking and disinfection procedures, something they had experience with from their work in Vietnam. Despite language difficulties, particularly with the local dialect the elderly use, they related that the professional training they received in Vietnam and subsequently in Japan translated into a positive experience to help them cope as they adjusted to new working conditions.

A different picture emerged at two care facilities that employ nursing care workers from several countries under four different streams: EPA nursing carers, those who graduate from local junior colleges with recognized qualifications, technical trainees, and foreign students. One facility (A) with a capacity for up to eighty elderly persons, had extensive experience in accepting workers and currently employs a mixture of EPA, foreign students, and technical interns to cover its deficits (from Myanmar, Vietnam, the Philippines, Sri Lanka, and Nepal). Early in the pandemic, the facility registered a mild outbreak of infection. The employer swiftly suspended Japanese nursing staff who had children or other family members living with them from going to work for up to two weeks. Yet foreign staff, who were all single, continued to work to cover the shortages, resulting in a substantial increased workload. Some of them had their night shifts doubled, which is usually only permitted a few times a month. As the facility manager put it, “they worked at full steam and were very active.” One carer was Ms. A (mid-30s), a Filipino national who came to Japan under an EPA and obtained her qualification as a certified care worker in 2015. A unit care leader with fluent Japanese, she spoke of her experience in English mixed with Japanese:

I worked about ten night shifts a month, and sometimes I had to work until around 1 pm, after the night shift, when my work would usually end at 9 am. Even then, there were times when I couldn't provide high-quality care to the residents because the workplace was less crowded than usual. I'm supposed to help with bathing twice a week, but sometimes I had to do it once because we didn't have the manpower.

And, her relationship with her colleagues was also affected:

Some of us were stressed, some of us were a little upset, and there was some misunderstanding. Some Japanese resigned because of the stress of corona, and my EPA colleagues also felt stressed. Since we couldn't meet with them as before, we exchanged messages in a LINE group and shared with each other how stressed we were. I made them some Filipino food and gave it to them, which made them feel better. I thought about them (my colleagues), and we felt each other's feelings.

Furthermore, the practice and awareness of care for patients also changed in some ways:

At work, I always wear a mask and (plastic) gloves. And I'm more sensitive to my patients (the residents) than I used to be. I also avoid body contact, but sometimes I can't avoid it. I still hold my patients (which I used to do), but I don't hug them anymore.

She also spoke about her personal life under the ongoing pandemic:

We can't go out freely … seigen sarete imasu (“like we are restricted”). We have, for example, precautions … of course working here as a care worker and dealing with older people every day. … When I go to the supermarket or when I do my grocery shopping, I'm like “oh, I have the coronavirus and I shouldn't stay here for long,” so I leave after ten or fifteen minutes. I've also stopped going to the Catholic church, which I used to go to every Sunday, because I'm afraid (of the infection). I can't go anywhere; it's so stressful.

Employers did not prohibit staff from going out into crowded urban areas. However, in wanting to counter the virus, facilities would quarantine residents with fever or those coughing, for certain periods of time, and ensure ventilation. Such tension in the workplace led to the narrowing of the living space for Ms. A and other foreign staff, and to self-restraint in everyday activities.

The facility director made clear some of the problems that foreign staff had to confront. Young Burmese trainees who had only been in Japan for a short time became mentally unstable under conditions and expressed a desire to return home. The employers responded to the situation by asking other colleagues to prepare food from their home countries and bring it to the workplace. In an interview, the Japanese director noted that there were times when friction arose in relations due to the increasing stress of life both physically and mentally, but as they were forced to deal with this crisis, solidarity between staff increased. Reflecting on the overtime and efforts they made throughout the pandemic, the director said:

Here in the workplace, they really worked hard, and we see them differently now. You really think about this. Friction arises (between Japanese and foreign staff) as we get tired, but this is the same for us Japanese.

What should be noted is that those who came under the EPA system demonstrated a high professional capacity to work as the pandemic played out. Many are graduates of nursing colleges in their home countries, and some of them, like Ms. A, are registered nurses in their own countries, whose training meets global standards. The facility director candidly remarked:

They (the nurses with qualifications from overseas) are more qualified than the technical interns and foreign students at responding to emergencies or when something is wrong with patients, and have a better understanding of clinical issues … They (the foreign staff) are warm. And in terms of respect for the elderly, they are better than [the] Japanese.

These interactions present a reevaluation of foreign workers in Japan's healthcare system as frontline personnel. Whereas previously the presence of migrant healthcare workers may have remained relegated to the fringes of discussions on solutions to labor shortages, this particular care home now aims to increase foreign staff to just under half of their total once the pandemic subsides. These micro-level encounters may shift opinions on the procurement of migrant labor when the pandemic abates and allow us to observe some of the possibilities of a post-COVID-19 Japanese society that becomes more flexible in attending to a demographic crisis that will not abate.

Responding as Managers for Foreign workers

Another important issue that is arising is the newly emerging trend of employing foreign staff as managers of foreign and Japanese staff in the workplace. These positions have gone to EPA nursing care workers with high-level Japanese and the capacity to manage staff both Japanese and foreign. Ms. B (mid-30s), a Filipino EPA certified care worker and manager at one healthcare facility in Fukuoka shared her experiences during the initial lockdown in April 2020. During an interview, she indicated that Japanese staff were more anxious and tense than their foreign counterparts:

They [Japanese care workers] said that the virus [corona] will never end, but I replied: “Any disease [viral infection] will come to an end, so don't worry.”

However, she remained optimistic that the situation would improve, and shared a discussion she had had with a concerned fellow Filipina while comforting her. She related how she reassured her colleague: “You can always go home when it (the pandemic) settles down. In a follow-up interview in late October 2020, she noted that her life was the same as before and that she was avoiding the risk of infection by eating lunch in her car:

Some friends [Filipino colleagues] were lonely and lost motivation to work and study (for the national examinations and so on), but they seemed to calm down when I talked to them.

Asking about the difficulties of life during the pandemic, she answered that she was “not being able to go anywhere,” a common point raised in other interviews as well. Since the beginning of October 2020, when infection rates decreased, her facility finally allowed family members visits to patients, but only by appointment and only for ten minutes in a designated space. Employers did not prohibit travel outside the city, but did request that people travel by car rather than by train. Even so, since March 2020 Ms. B has refrained from traveling to the city center, where there are many people, and shared her concerns about becoming infected: “I'd like to go, but I wouldn't be able to forgive myself if I'd brought it (the virus) back.”

These examples of Filipino nationals considering the needs of others stem partially from the sociocultural care connections that form between them and others, and that are fostered in a different cultural context. However, it is also partially in reaction to and in interactions with Japanese norms regarding distancing (kyorikan) and thoughtfulness (omoiyari). The way that different care regimes interact presents the complexities of micro-encounters and the ways in which foreign and Japanese healthcare personnel may be party to negotiating and producing a newly emerging “socioemotional commons.” As some researchers have recently noted, this is a space where different intimate care regimes (embodied and discursive) merge and interact, transforming and producing new notions of care (Navallo 2020).

Over the past couple of years, the number of “care migrants” in Japan have dramatically increased, and this been accompanied by persons trained within different care regimes with varying levels of technical skills, language ability, and cultural understandings of care. Accepting nurses and care workers has been more a symbolic token gesture than a move that addresses core issues in Japanese society. To date, migrants have not been considered as part of any long-term solution to Japan's demographic contraction.

However, the pandemic has starkly offered a very clear encounter with difference at an everyday level through both Japanese and migrant workers collectively caring for the nation's elderly. Local government and the private sector, which were accepting foreign nationals, have had to restructure employment strategies in the direction of promoting the acceptance of foreign human resources and shift to student labor streams in the short term. Yet, labor shortages in the nursing care field will remain acute for the foreseeable future and those foreign staff who have been frontline “essential workers” have come to present a very different alternative for who can work and contribute to the societal safety and security of the nation.

Peter Herrmann and colleagues have noted that social quality theory aims to “discriminate among different types of daily life to inform social and other policies oriented on society” (2012: 96). Yet this requires that we keep in mind the complex interactions between those who provide care, those who receive care, and interaction between both the intimate and public domains. This is not just about improving the capacities of care for the elderly, but a deeper reflection on the body politic itself and how political communities interpret a broader transnational sense of well-being that leads to improved social quality. The examples in this article suggest that the effects of the pandemic may open up a more public discussion and change the direction of conversations over who can participate in the future constitution of Japan as long-term migrants raise questions about who can become citizens and care for Japan's elderly.