How to Change Your Care Manager in Japan

Reasons worth naming

Japan's operating standards for home-care support offices say the service must be provided with regard to the user's own choice (Article 1-2, paragraph 2 of the ordinance on staff and operation of designated home-care support providers, MHLW Ordinance No. 38 of 1999). Wanting a different care manager is therefore inside what the system expects. It still costs something: the parent's history has to be explained again. Putting the reason into words makes the decision easier to judge.

For any of the reasons below, the first thing to try is a specific request. Agree on a single contact channel, or ask for a short report after each monthly visit. Some problems end there. If trust is already gone, or the request changes nothing, move on to a switch. For what the role covers day to day, see our article on working with a care manager as a foreign family and the care manager guide; this article only covers the switch.

• Unreachable: calls and emails go unanswered for days and service arrangements stall. Start by noting dates and what happened.
• Unclear answers: questions about the plan or the cost outlook never get an answer you can follow.
• The parent's wishes are missing: the plan does not match how the parent wants to live.
• Circumstances changed: a move or a hospital stay put the home outside the office's usual service area.
• A poor fit: conversations stay awkward, and the parent has stopped voicing worries.

Three kinds of change

A switch can mean three different things, and the paperwork differs. Working out which one applies tells you who to contact.

Changing the person inside the same office is usually the shortest path, since the records stay under one roof. It does not help when the office itself is the problem. In that case the whole office has to change.

Raising it politely

If telling the current care manager directly feels hard, the channels can be used in stages. Thinking in steps lowers the emotional weight of it.

When feelings run ahead, the message gets lost. A relative abroad can prepare a dated list of incidents and add notes on what the parent said. If the parent finds it hard to speak up, ask the counter by phone first whether a family member may raise the matter on their behalf. The choice of office stays with the parent.

• Start with the care manager. Separate the facts from the request, for example: the call on a given date was not returned, and replies within a set number of days are wanted from now on.
• Next, the office manager. A change of person is often settled here.
• If that is difficult, the community support center or the municipal long-term care insurance counter. Our guide to community support centers explains how to find the right one.
• To treat it as a complaint: the operating standards require the office to receive and record complaints and to cooperate with investigations by the municipality or the prefectural insurers' federation (Article 26).

Steps in order

For a move to a different office, the sequence is usually as follows. The order can shift by city and by office.

Between steps four and five, the previous office should hand over the latest care plan and records of how services were delivered. That is covered in the handover section.

• Find candidates. The municipal counter or community support center hands out lists of offices, and the national long-term care information site run by the Ministry of Health, Labour and Welfare can also be searched.
• Ask the new office whether it can take the case and whether the parent's home falls inside its service area.
• Receive the pre-contract explanation and sign. The office owes you this explanation, covered below.
• Tell the current office the date its role ends.
• File the notification with the municipality. The new office normally prepares it, with the change date filled in.
• Confirm from which date the new care plan applies, and share that date with everyone involved.

What the form asks

The form is titled differently from city to city, along the lines of a notification of a request for care plan preparation, with a change version. Kyoto City's form is a useful example of what it contains.

Names and attachments differ between municipalities, so this is an example rather than a template. Check the page of the municipality where the parent is registered.

Who files, and when

Kumamoto City's guidance says the notification is submitted by the office that prepares the care plan. It asks for the form and the insurance certificate, accepts mail, and treats the date of arrival as the filing date. A person filing as an agent needs ID. If the office name stays the same but its registration number changes, a fresh notification is needed.

The same page warns that using services without the notification may mean they are not treated as covered benefits. In practice the new office does the filing, but it helps for the family to ask, with a date: when was it submitted, and which change date was written on it?

For a son or daughter abroad, this is a good place to be useful without being on site. Ask the new office to email the filing date and the change date, and keep both in a shared note. These are examples from Kyoto and Kumamoto, and a parent registered in another municipality may meet different forms and attachments.

Switching mid-month

A switch does not have to wait for the first of a month. Some municipal materials explain that the care-planning fee for that month is billed only by the new office.

Higashiyamato City in Tokyo, in a Q&A on insurance benefits prepared in April 2018, cites a national interpretive notice and says that when the provider changes in the middle of a month, only the new provider claims the home-care support fee. A move to another municipality is treated as an exception. Care planning for people living at home currently carries no co-payment for the user, so families are not charged twice. Separate rules are being set for some paid homes under the 2026 law, so confirm the position for your parent.

Even so, the offices have to pass case management and billing work between them. There is no need to aim for the first of the month. Agreeing one change date among both offices and the family helps prevent mismatches between the claim and the notification. Because the billing treatment above comes from one city's materials, ask the municipality or the new office how it applies to your parent.

What the office must explain

Before the contract, the operating standards require the office to explain certain things. Many of the questions a family would ask are already on that list.

Paragraph 3 is an effort duty, so an office that cannot give figures can be asked why. Paragraph 2 is also a reminder that the user chooses the office. Under paragraph 5, the explanatory document can be provided electronically if the user or family asks and agrees, which suits relatives abroad.

Service area, travel fees

Each office has an area where it normally operates. The standards say that when an office judges it cannot properly serve a user, considering that area, it must take steps such as introducing another office (Article 6). This matters after a move, or when the home sits at the edge of the area.

Visits outside the area can carry a travel charge if they are made at the user's choosing (Article 10, paragraph 2), and the user is to be told the content and cost and agree beforehand (paragraph 3). Before signing, ask whether the home is inside the service area. If the parent is moving cities, our guide to moving a care-certified parent to another city covers the certification side.

Getting the records

Users have a right to the paperwork. Article 15 of the standards says that when a user wishes to move to another home-care support provider, the current one must hand over the latest care plan and the records of how services were delivered.

That gives the new care manager a view of the parent's current life and services. The request has to come from the user, so tell the current office: a move to another office is wanted, and the latest plan and service records are requested. From abroad, ask first how the documents will be sent: post, electronic data, or direct to the new office. Offices have their own rules on personal data, so ask whether the parent's consent is needed. That avoids a second round.

The first month

A new care manager does not necessarily continue the old plan unchanged. Article 13 of the standards sets how plans are made, and in the first month with someone new those steps are in motion.

The first interview and meeting are therefore the best chances to say what the parent wants kept: the number of day-service visits, the time of home-visit care. Write these down beforehand and hand them over.

• Assessment: visit the home and interview the user and family to identify needs (Article 13, item 7).
• Draft and service meeting: gather the people providing the services in the draft and ask for their views. User and family participation is the basic rule, and using communication devices needs the user's consent (item 9).
• Explanation and written consent: explain which items are covered by insurance and obtain written agreement (item 10).
• Delivery of the plan to the user and service providers (item 11).

A one-page briefing note

The new care manager knows the parent only from paper. There is no need to write the note as criticism of the old office, but it should carry what prevents a repeat of past friction.

Hand the note over before the assessment and the meeting. If it is only spoken, details fall out in a short first session.

• Current services and weekdays, with those to continue marked.
• What worked at the old office, such as the contact method or reporting rhythm.
• Past problems as one dated line each. Facts only, no judgement of people.
• The family contact and hours available, with time zone if abroad.
• The parent's own priorities, such as meals, bathing, outings.

Updating contact details

A frequent gap is that people around the parent do not hear about the change. Questions then go to the old contact and emergencies slow down.

If the new arrangement still does not suit, the same steps can be repeated. Several changes in a short time mean explaining the parent's situation each time and breaking the thread of the plan. Before a second switch, work out whether the first problem was left unsolved or whether expectations were set wrongly. The community support center can help to sort this out. For the system as a whole, the overview of long-term care insurance for foreign residents is the entry point.

• The family doctor and hospital: give the new care manager's name and contact. The standards ask offices to tell users to pass this on at admission. See our article on care services during hospitalization.
• Each service provider, such as day service and home-visit care offices.
• Within the family: pick one contact person and tell siblings and relatives abroad the change date.
• At the parent's home: leave the new office's name and number near the phone.