Senior Housing in Japan Explained: Nursing Homes with Care, Residential Homes, Sakōjū and Tokuyō
We may lump them all together as “nursing homes,” but in Japan the way care is provided, the costs and who is accepted vary greatly by type of residence. The overall picture becomes easier to grasp if you organize senior housing by operator (private or public) and by the physical and mental condition of the people it serves (independent to mild needs, moderate to severe needs, or needing medical care). Here we introduce the main types of residence and the points to consider when comparing them.
Private residences
Private nursing homes with care (kaigo-tsuki yūryō rōjin hōmu)
Designated as “specified facilities” under long-term care insurance, these homes provide care through their own staff. Care service fees are a flat rate set by care level, so even as care needs increase, costs are easy to predict.
Residential-type private homes (jūtaku-gata yūryō rōjin hōmu)
These are residences with services such as daily living support; when care becomes necessary, residents contract individually with outside care providers. Costs vary with the amount of service used, so out-of-pocket costs can rise as care needs become more severe.
Serviced housing for older people (sakōjū)
Barrier-free rental housing with wellness checks and daily-life consultation services. It accepts residents who are still highly independent, and, as with residential-type homes, care is generally provided by outside services.
Group homes (communal living care for people with dementia)
Residences where people with dementia live together in small groups with support from specialized staff. Because this is a community-based service, residents can, as a rule, use only facilities in the municipality where they are registered as residents.
Public facilities
Special nursing homes for the elderly (tokuyō)
Long-term care insurance facilities that, as a rule, admit people at Care Level 3 or above (people at Care Levels 1 and 2 are admitted only in special cases). Costs are kept low, but in some areas there is a long wait for admission.
Long-term care health facilities (rōken)
Facilities that focus on rehabilitation with the aim of helping residents return home. They are often used as an intermediate step after a hospital stay, before the person goes home.
Integrated facilities for medical and long-term care (kaigo iryōin)
Facilities for people who need both long-term medical care and long-term care. They have also taken over the role of the sanatorium-type medical care facilities for the elderly that were abolished at the end of March 2024.
Other options include care houses for relatively independent people, and nursing homes for the elderly (yōgo rōjin hōmu), where admission is decided by municipal placement measures.
Five points to compare when choosing a residence
Physical and mental condition, and medical procedures: Does the nursing setup cover the medical procedures needed? Also check night-time staffing and partner medical institutions.
Costs: Compare the total, including the initial cost (advance payment) and monthly fees, plus care costs, medical costs, diapers and other expenses not included in the monthly fee.
Contract rules: Check the short-term cancellation rule, under which the advance payment is in principle refunded in full if the contract ends within three months of moving in, and the measures in place to protect refunds.
Quality of life: Can the person keep living their own way, in terms of meals, recreation and the rules for visits and outings?
Future changes: Can the person keep living there as care needs increase, and through end-of-life care? Under what conditions might they be asked to leave?
Check the cost-support systems, too
Long-term care insurance facilities and similar facilities have a system that reduces accommodation and meal costs according to income (supplementary benefits), but the rent, management fees and meal costs of private nursing homes and serviced housing for older people are not covered by long-term care insurance. Rather than deciding based only on the monthly fee printed in large type in the brochure, it is reassuring to estimate how many years you can keep paying from pension income and assets.
This article is a general explanation based on the systems in place as of October 2026. The range of residents accepted and the costs differ from residence to residence, so be sure to check each one individually.
This is an English translation of a column originally published in Japanese by Next Co., Ltd.
About Next Co., Ltd. We support companies in Japan’s senior care and end-of-life planning (shukatsu) market through research, business development and training. Our English textbook, Senior End-of-Life Planning Textbook, explains the market from the big picture down to day-to-day practice, including senior housing and care facility placement consulting. See the English edition | Buy on Gumroad | Contact us
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