Accessing the hard and soft infrastructure of residential care services for older adults in Japan: implications for post-growth East Asia

Globally, populations are getting older. Japan is at the forefront of addressing the challenges posed by population ageing and decline—particularly in ensuring the accessibility and availability of long-term care services for its growing older population. This study investigates accessibility to older adult beneficiaries of the spatial and operational dimensions of care service provision in Sendai City. Quantitative analysis, based on an improved gravity model, reveals a spatial mismatch between the accessibility of long-term care facilities and the distribution of older residents. Complementing this, qualitative data collected through non-participant observation and in-depth semi-structured interviews with care managers reveals challenges faced in daily care provision. These include managing relationships with care recipients and families, coordinating within and across institutions, and responding to complex end-of-life care demands. Overall, our study synthesizes key challenges and countermeasures within Japan's long-term care system and reflects on the relevance of Japan’s experience for other East Asian societies undergoing similar demographic transformations.