Abstract:Background: The number of non-Japanese residents in Japan reached a record 3.77 million in 2024, including approximately 220,000 aged 65 and over a 1.5-fold increase over the past decade. This demographic shift raises critical questions about how services for the elderly in Japan should be transformed for people who have various backgrounds. In Okinawa Prefecture, which hosts a large concentration of U.S. military bases, 46% of elderly foreign residents are U.S. citizens, highlighting the need to evaluate their access to and satisfaction with Japanese health and social care systems. Objective: This study explores healthcare utilization, awareness of the long-term care insurance (LTCI) system, and future expectations among elderly foreign nationals in Okinawa to inform future support measures and policy development. Methods: Eligible participants were foreign nationals aged 65 and older, residing in Okinawa Prefecture, who had no cognitive impairments. Using snowball sampling, semi-structured interviews were conducted in English. Topics included experiences with medical and long-term care services, aging-related concerns, awareness of the LTCI system, social connections with co-nationals, and desired forms of future support. Results: Seven individuals were interviewed six men and one woman, all U.S. nationals with varying residency statuses (Permanent Resident, Working Visa, Spouse or Child of Japanese, and Long-Term Resident). Most reported positive experiences with Japan’s healthcare system, while only three participants were aware of the LTCI system by name and none had used it. A need for English-language information on LTCI was consistently expressed. Regarding social networks, one participant noted the loss of peers due to age, while another reported stronger engagement with local community members than with compatriots. Conclusion: While participants generally trusted Japan’s healthcare system, awareness of LTCI was limited. The findings indicated a need for more multi-lingual information and potential vulnerabilities in future care, particularly if current support from Japanese spouses becomes unavailable.
Keywords: Migration and Health, Elderly, Immigrants, The long-term care insurance (LTCI), Health literacy, Cross-cultural, Foreign residents
