1. What Daily Care Special Nursing Homes (Tokuyo) Provide for Residents
In special nursing homes (known as Tokuyo), staff help with bathing, toileting, and eating. They also provide daily life assistance, functional training, and health management [5]. It is a place where people around you help with essential daily tasks.
Residents are usually people certified as needing care levels 3 to 5. They need constant care and find it difficult to live at home [4]. It is another "home" for when staying at home becomes hard. Short stays for family rest (short stay) and day services are also available through long-term care insurance [5].
According to a survey by the Ministry of Health, Labour and Welfare, there were 8,621 nursing care welfare facilities (the category corresponding to Tokuyo) nationwide as of October 1, 2024. This was 73 more than the previous year [6]. If you divide this by the 47 prefectures, the average is about 180 facilities per prefecture. However, the actual number varies by prefecture. Has this "other home" always been this way?
2. How the Idea of Nursing Homes Shifted from "Institutional Care" to "Living Place"
The types of nursing homes were written into law in the Welfare of the Aged Act of 1963. This act established homes for the aged, special nursing homes, and low-cost homes for the aged [1].
In 1970, the Central Council for Social Welfare Services called for the urgent development of facilities for bedridden people. Two years later, in 1972, their opinion pointed out the need to change nursing homes from places of "institutional care" to "living places" [1]. This call to change the role of nursing homes came two years after the call to urgently develop facilities.
The current Welfare of the Aged Act states that basic principles include respecting the elderly and guaranteeing a healthy, peaceful life with a sense of purpose [2]. The term "living place" points in the same direction as this principle. So, what does a "living place" look like in practice?
3. Why Unit-Type Nursing Homes Use Private Rooms and Groups of About 10 People
A representative example of a "living place" is the unit-type special nursing home. A 2001 discussion paper from the Ministry of Health, Labour and Welfare showed a direction for new homes to have a home-like atmosphere. It proposed that new homes have private rooms for all residents and provide care in units of about 10 people [3].
A simple way to picture it is several "small homes" of about 10 people lined up inside one large building. In practice, traditional facilities built mainly around shared multi-bed rooms still exist alongside private-room and unit-type facilities today [4].
The more a home works as a place to live, the next question arises: what does it mean for the people of the town?
4. How a Nursing Home in Fukushima Became a Gathering Place for Neighbors
In Fukushima Prefecture, there is a complex that combines an elderly care facility with a facility for community exchange. A report from the Minister of Health, Labour and Welfare’s visit in October 2022 noted it had a fitness facility and workshops for locals. It helped support social interaction and health [7]. The report described it as a place for local people to gather.
The law also asks something of the organizations that run such homes. Social welfare corporations running special nursing homes must strive to provide welfare services free or at low cost according to local conditions. This duty was established in the 2016 revision of the Social Welfare Act [8].
Note that this is a duty to "strive." It does not mean "all homes definitely do this." The Fukushima example is a single case from the visit and cannot be said to represent every home in Japan. How does daily interaction help in emergencies?
5. How Nursing Homes Serve as Welfare Shelters During Disasters
During disasters, some people find life in general shelters difficult. These include the elderly, people with disabilities, infants, pregnant women, and their families. Facilities designated to accept these people are called welfare shelters. Municipalities designate facilities that are easy for people needing care to use and where support systems can be secured [9].
How many are nursing homes? In Miyagi Prefecture, as of November 2025, 606 out of 786 welfare shelters (77.1%) were elderly care facilities [10]. This is slightly more than 3 out of 4. This is an example for Miyagi Prefecture, not the national average.
Municipalities make the designations, so not all special nursing homes are welfare shelters [9].
6. How to Find Nursing Homes and Care Facilities in Your Own Town
With your family, open a map of your town. How many buildings have names like "Special Nursing Home," "Nursing Home," or "Welfare" nearby? You can check the names from outside; you do not need to go inside.
Next, search for "welfare shelters" on your city or town’s website. Some municipalities list designated facilities, while others do not. If you find them, read how the municipality describes who uses these facilities.
Check your town’s newsletter for announcements about events or workshops hosted by homes. Is there a face of a "gathering place for neighbors" in your town? New questions may arise from there.