Why is the Turnover Rate High for Care Workers? Analyzing the Structure of “Heavy Physical Labor,” “Low Wages,” and “Mental/Ethical Burden”

Care work is a specialized profession that plays an extremely important role in an aging society, yet its high turnover rate has been a persistent issue for years. The biggest factors are the heavy physical labor involved in direct personal care, the immense mental pressure of being responsible for the lives and well-being of users, and the low wage level that is entirely incommensurate with the expertise and harshness of the work. Furthermore, the combination of excessive workload due to staff shortages and irregular night shifts creates a structure highly prone to mental and physical exhaustion.

This article provides a detailed explanation of the factors leading to the high turnover rate in this profession, examining them from four perspectives: working conditions, compensation/benefits, workload, and career development.

Turnover Rates in the Medical and Welfare Industry (Reference Data)

The turnover rate for the Medical and Welfare industry, which includes care workers, remains higher than the all-industry average. The care sector, in particular, faces challenges with staff outflow to other industries.

1. The Issue of Working Hours (Night Shifts, Irregular Work, and Long Commitment)

Since facilities operate 24 hours a day, night shifts are unavoidable, and staff shortages often lead to long working hours.

Burden of Night/Shift Work:

• Irregular Life Rhythm: Night shifts and late shifts are essential in facility care, leading to disrupted life rhythms and accumulated physical and mental fatigue.
• Frequency of Night Shifts: Chronic staff shortages increase the number of night shifts per person, leading to an excessive burden.

Normalization of Long Working Hours:

• Documentation and Handover: Time is required for recording user conditions and handing over information to the next shift, often leading to overtime even after the shift ends.
• Excessive Workload: Due to staff shortages, tasks that should be performed by multiple people often fall to a single individual, frequently resulting in long hours and inability to take breaks.

2. The Issue of Compensation and Benefits (Wages Not Commensurate with Work Severity)

The low wage level, despite the specialized nature of personal care and the mental strain involved, is the single biggest cause of turnover.

Relatively Low Wage Levels:

• Constraints of Public Pricing: Income sources are restricted by the official long-term care reimbursement rate (Kōtei Kakaku), creating a structure where wages are difficult to raise.
• Mismatch with Heavy Labor: Many feel that compensation does not match the heavy physical labor of personal care and the grave mental responsibility for users’ lives.

Self-Payment of Expenses:

• Cases exist where staff must partially cover the costs of training fees or the maintenance costs of personal vehicles used for commuting.

Difficulty Taking Paid Leave:

• Due to strict staffing ratios in facilities, staff are reluctant to take paid or long-term leave, believing their absence places a heavy burden on colleagues.

3. Workload and Mental Stress (Extreme Physical and Mental Strain)

Due to the nature of “caring for people,” staff are highly susceptible to strain that exceeds their physical and mental limits.

Heavy Physical Labor:

• Physical Care Load: Heavy labor such as bathing assistance, toileting, and transfers (moving from bed to wheelchair, etc.) is a daily occurrence, carrying a high risk of occupational illnesses like lower back pain.

Mental and Emotional Stress:

• Pressure of Life Responsibility: Staff frequently face users’ sudden health deterioration or end-of-life care, leading to immense mental pressure.
• Ethical Dilemmas: Under pressure from staff shortages and efficiency demands, staff often face ethical dilemmas and guilt over being unable to provide ideal care.
• Harassment from Users/Families: There is a growing number of cases where staff suffer harassment, such as unreasonable demands, verbal abuse, or violence from users or their families.

Volume of Documentation/Administrative Work:

• Indirect tasks beyond care—such as recording care, writing daily reports, handovers, and documentation for multi-disciplinary coordination—are extremely numerous, exacerbating the workload.

4. Issues with Career Development and Training Systems

Despite being a specialized profession, insufficient training and complex workplace dynamics contribute to turnover.

Insufficient Education and Training Systems:

• Lack of Systemic OJT: Due to the busy environment, On-the-Job Training (OJT) for new staff is often not systematized, leading to staff being placed on the floor without adequate guidance.
• Lack of Training Opportunities: Although new knowledge is constantly required in care techniques, dementia care, and medical procedures, training opportunities are often insufficient.

Complexity of Interpersonal Relationships:

• Interpersonal conflicts within facilities or teams, or friction in coordinating with other professionals (nurses, rehabilitation staff, etc.), can be a major source of stress.

Career Stagnation:

• Staff may feel a sense of career stagnation if obtaining certifications like Certified Care Worker (Kaigo Fukushishi)does not lead to a clear change in field duties or salary.

The Structure of the Vicious Cycle

The care industry suffers from a severely critical vicious cycle: “Low wages and heavy physical/mental burden →Exhaustion from night shifts and long hours → Staff shortages become more severe → The burden on remaining staff becomes excessive, and quality of care declines.” Crucially, the high commitment to “helping people” often leads staff to tolerate harsh working conditions, which accelerates turnover.