What is it about?
Japan has a growing number of older people but a shrinking working-age population. Providing long-term care therefore depends on two things: having facilities in the right places and having enough skilled people to deliver care within them. We examined both aspects in Sendai, a city of approximately 1.1 million people in northeastern Japan. We mapped access to long-term care facilities and compared it with the location of older residents. We also studied the daily work of care managers, who assess individual needs, prepare care plans and coordinate families, care workers, medical staff and public authorities. We found a mismatch between where older people live and where care services are most accessible. Central urban districts generally have better provision, while some rural and outer suburban communities have older populations but poorer access. One central district had more than eight times the accessibility of a peripheral district, despite the latter having a substantially higher proportion of older residents. Physical proximity is only part of the problem. Staff shortages, excessive paperwork and unclear responsibilities can prevent care managers from concentrating on beneficiaries. They must also manage disagreements between older people and their families and coordinate professionals who may assess a person’s needs differently. The research shows that good long-term care requires both “hard infrastructure” (facilities, roads and transport) and “soft infrastructure” (trained staff, effective relationships and well-organized institutions). Governments must plan both together if older people are to receive equitable and person-centred care.
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Why is it important?
Population ageing is accelerating across East Asia and many other parts of the world. Japan is experiencing this transformation earlier and more intensively than most countries, making its successes and difficulties valuable for societies that will soon face similar pressures. Our research is timely because care demand is increasing while the workforce available to provide care is shrinking. This problem is especially serious in suburban and peripheral communities constructed during earlier periods of rapid urban growth. Many residents arrived at similar ages and are now growing old together, while younger generations have moved elsewhere. What makes our research distinctive is its combination of geography and lived institutional experience. Studies often measure the number and location of care facilities or examine what happens inside them. This paper does both. It demonstrates that a facility can exist without being readily accessible, while physical access alone cannot guarantee good care if staff are overburdened or institutional coordination is poor. For policymakers and care professionals, the study shows why citywide averages can conceal serious local inequalities. Planning based only on total population may direct investment towards densely populated central areas while neglecting smaller communities with much higher proportions of older residents. Authorities should therefore consider population size, age structure, transport, environmental risks and workforce capacity together. For general readers, the paper makes clear that care is more than a building or an insurance entitlement. It depends on whether people can reach services, whether families can remain involved and whether care workers have sufficient time and institutional support to understand each person’s needs. Our study’s wider message is that an ageing society must treat care as essential social infrastructure. Planning it well will determine whether longer lives are accompanied by security, dignity and continuing social connection.
Perspectives
For much of my career, I have examined what happens when regions, institutions and infrastructures created during an era of population growth must adapt to ageing and demographic contraction. This paper applies that question to one of the most important issues facing a post-growth society: how to provide equitable care with fewer working-age people and increasingly uneven local populations. The research matters personally because it brings together several strands of my and my co-authors' work. My studies of Japan’s shrinking regions have shown that demographic change unfolds unevenly. Some urban centres continue attracting people and investment while surrounding rural and peripheral communities age and decline. My work on post-disaster recovery has also demonstrated that older people in geographically isolated communities face compounded social and environmental risks. This particular paper shows how those processes affect everyday access to care. Sendai’s care facilities remain concentrated in more accessible urban locations, while some peripheral districts have higher proportions of older residents and fewer services. These inequalities partly reflect patterns of postwar development. Suburban communities built for young families have aged, but infrastructure and service provision have not always adapted with them. I also value the paper’s treatment of care as both physical and relational. Buildings, roads and transport constitute the “hard” infrastructure, but they cannot deliver care by themselves. The “soft” infrastructure consists of care managers, frontline workers, professional relationships and the trust established with older people and their families. Staff shortages, paperwork and poorly defined responsibilities can weaken care even where suitable facilities exist. This supports a broader conclusion across my research: demographic contraction demands institutional adaptation rather than simply more or less infrastructure. Governments must decide what to maintain, where to concentrate services and how to protect people in communities that markets or conventional population-based planning may overlook. Japan is potentially acting here as a “Depopulation Vanguard Country” (See Uchida et al, 2025, Biodiversity Change under Human Depopulation in Japan, Nature Sustainability). Its experience can help China, South Korea and other ageing societies anticipate rather than merely react to these pressures. For me, the paper’s central importance lies in showing that a just transition to a sustainable post-growth society must judge care provision by whether older people can actually access it, experience it as person-centred and remain connected to their families and communities.
Dr Peter Matanle
University of Sheffield
Read the Original
This page is a summary of: Accessing the Hard and Soft Infrastructure of Residential Care Services for Older Adults in Japan: Implications for Post-Growth East Asia, Ageing International, March 2026, Springer Science + Business Media,
DOI: 10.1007/s12126-026-09659-7.
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