Hello. I am Hisashi Shibata, a Labor and Social Security Attorney at the Shibata Management and Labor Administration Office.
From October 1, 2026, measures against customer harassment (kasuhara) became mandatory for all employers. In a previous article, I organized customer harassment measures specifically for the field of disability welfare.
▼ Click here for the article on customer harassment measures in disability welfare
https://note.com/shibata_sr/n/n41fe833b690b
This time, I will focus on developments in the nursing care sector. On August 28, 2026, at the Social Security Council’s Long-Term Care Benefit Expenses Subcommittee, the Ministry of Health, Labour and Welfare (MHLW) presented a document titled “Harassment Countermeasures in Nursing Care Settings.” Reading this document reveals the nature of the discussions currently underway in the nursing care field.
Many social welfare corporations operate both nursing care and disability welfare businesses. In this article, based on the MHLW document, I will organize the common aspects and the aspects unique to each regarding customer harassment measures in both fields.
1. What is currently being discussed in the nursing care field?
Measures taken to date
According to the MHLW document, the following measures have been taken in the nursing care field so far.
Positioning in operational standards: In the FY2021 nursing care fee revision, measures against sexual harassment and power harassment were clearly stated in the operational standards as “measures that nursing care providers should take.” Regarding customer harassment, it was defined in an interpretation notice as “measures that are desirable to take.”
Evaluation of multi-person visits: In home-visit nursing care and home-visit nursing, when there are acts of violence or significant nuisance behavior, there is a reward-based evaluation for visits made by multiple staff members with the consent of the user or their family.
Development of manuals, etc.: Creation and publication of harassment prevention manuals for providers, training guides, training videos, and case collections.
Subsidies through funds: Subsidies for local government training, consultation counters, and expenses for multi-person visits using the Comprehensive Support Fund for Community Medical and Nursing Care.
The reality of harassment in nursing care settings
In a survey (FY2018) included in the document, it is stated that staff who have experienced physical violence, mental violence, or sexual harassment from users or their families account for 40-70% from users and 10-30% from families, etc.. It has also been confirmed that harassment occurs across all types of services.
Ensuring the safety of care managers becomes a major issue
The document places particular weight on ensuring the safety of care managers (long-term care support specialists). In June 2026, there was an incident in Saitama Prefecture where a care manager was harmed and died at a user’s home.
While there is a mechanism to evaluate multi-person visits for home-visit nursing care and home-visit nursing, there is no additional nursing care fee even if a care manager visits with multiple people. Expenses for multi-person visits are covered by fund projects using supplementary budgets, but it is noted that there are issues with continuous budgetary measures.
Points presented
The document presents the following four points as future discussion topics.
How to promote effective measures, including the prevention of customer harassment and responses when it occurs, within nursing care fees and operational standards.
What measures can be considered to ensure the safety of nursing care workers, including care managers?
How should collaboration with local relevant organizations—such as municipalities, community comprehensive support centers, doctors, care managers, lawyers, and the police—be advanced?
Under the regulation that service provision must not be refused without a ‘justifiable reason,’ how can the safety of staff and the continuation of necessary services be balanced?
In the opinions of the Long-Term Care Insurance Committee from December of last year, it was deemed appropriate to make anti-harassment measures mandatory in operational standards. At the same time, it is also required to give sufficient consideration to cases where care is needed due to symptoms such as dementia or mental illness.
It can be read that we are in a trend where anti-harassment measures will be materialized from both the operational standards and remuneration aspects toward the nursing care remuneration revision in fiscal year 2027.
2. The common foundation for nursing care and disability welfare
From here, I will organize the parts common to both fields.
The measures that business owners should take are the same
The measures based on the revised Labor Measures Comprehensive Promotion Act and guidelines are the same for both nursing care and disability welfare. In the MHLW materials, the measures are organized as follows:
Clarification of policies and dissemination/awareness-raising (showing a policy of responding firmly to harassment and protecting workers)
Dissemination of pre-determined response content (not letting staff handle it alone, reporting behavior that could constitute a crime to the police, etc.)
Establishment of consultation counters and ensuring that staff in charge can respond appropriately
Confirmation of facts, consideration for victims, and prevention of recurrence
Policies for dealing with particularly malicious harassment and the development of a system capable of executing them
Protection of the privacy of consultants and prohibition of disadvantageous treatment due to consultation
What I want to draw attention to is the point explicitly stated in the materials that when taking measures, it is necessary to keep in mind the prohibition of unfair discriminatory treatment and the obligation to provide reasonable accommodation based on the Act on the Elimination of Discrimination against Persons with Disabilities. Although this is a document for the nursing care field, it is an even more important perspective for disability welfare establishments.
The ‘one-on-one’ situation becomes a risk
The nursing care harassment prevention manual cites ‘one-on-one or one-to-many relationships or situations’ as risk factors. In visiting services, there are many situations where staff must handle things alone at the user’s or their family’s home. Even in facility-based or day-care services, the same situation arises depending on the content of care and the time of day.
The structure of home-visit care, heavy-duty home care, and nighttime support in group homes for disability welfare is exactly the same.
A ‘justifiable reason’ is required to discontinue service
In both nursing care and disability welfare, operational standards stipulate that “services must not be refused without a justifiable reason.”
The nursing care manual states that the following factors must be considered when determining a “justifiable reason” for contract termination due to harassment.
The severity of the consequences caused by the harassment
The likelihood of recurrence
Whether there are preventive measures other than contract termination
The degree of disadvantage to the user resulting from contract termination
In disability welfare as well, a phased response based on the same line of thinking is required.
Do not handle it alone at the facility
The nursing care manual states that there are limits to what can be handled within a facility and calls for cooperation with local related organizations, experts, and the police. This is also a concept common to both fields.
3. Issues specific to the nursing care business
Words and actions due to dementia symptoms
The most distinctive aspect of the nursing care field is how to deal with words and actions caused by symptoms of dementia. Opinions from the Long-Term Care Insurance Subcommittee also explicitly state that consideration should be given to cases where care is needed as a symptom of dementia or similar conditions.
Determining whether it constitutes customer harassment versus determining whether it should be addressed as care. The difficulty of the nursing care workplace lies in the fact that these two must be considered simultaneously.
Harassment from family members or key persons
According to a survey by the Japan Care Manager Association published in the document, 33.7% of care managers had experienced customer harassment in the past year. The most common perpetrators were “the user’s primary caregiver or key person” (44.8%), which exceeded “the user themselves” (27.6%).
In nursing care, there is a structure where care managers, who act as service coordinators, are prone to becoming targets for excessive demands from families or long and frequent phone calls.
Additional charges for multiple-person visits and user burden
Multiple-person visits for home-visit nursing care are premised on the consent of the user and their family. Because the additional charge increases the user’s out-of-pocket expenses, the low actual rate of calculation is considered an issue. Even if one wants to visit with multiple people for safety, there is the barrier of not being able to obtain the user’s consent.
4. Issues specific to disability welfare service businesses
Since I wrote in detail about disability welfare in the previous article, I will focus here on points that clarify the differences from nursing care.
Drawing the Line Between Disability Characteristics and Reasonable Accommodation
In disability welfare, various disability characteristics—not limited to dementia, but including intellectual disabilities, mental disabilities, developmental disabilities, and severe behavioral disorders—are behind certain words and actions. Requests for reasonable accommodation based on the Act on the Elimination of Discrimination against Persons with Disabilities do not, in themselves, constitute customer harassment. This line is a more daily challenge than in nursing care.
Long-term Relationships and Guardians
In disability welfare, relationships with users and their families can span decades, from childhood to adulthood. In support for children with disabilities, such as after-school day services, the relationship with guardians is also a major theme. Because the relationships are long-term, a characteristic is that once they become strained, they are difficult to repair.
Type A Continuous Employment Support Users are also ‘Workers’
Users of Type A continuous employment support are also workers who have signed an employment contract with the facility. For harassment by users against staff, options such as responding based on service regulations or disciplinary rules in the work regulations are possible. This is a point unique to disability welfare that does not exist in nursing care.
The Coordinator is the Consultation Support Specialist
The equivalent of a nursing care manager in nursing care is the consultation support specialist in disability welfare. When considering service reviews or changing facilities, coordination with consultation support specialists, municipalities, and core consultation support centers is essential.
Also a Topic in Disability Welfare Reward Revisions
In disability welfare as well, customer harassment countermeasures are listed alongside abuse prevention measures and business continuity plans in the ‘Main Points of Discussion (Draft)’ for the Reiwa 9 fiscal year reward revision. The direction of discussions in the nursing care field may also influence the operational standards and rewards for disability welfare. fukushi-kaizen
5. Municipal Support: The Example of Tokyo
There are also differences between nursing care and disability welfare in municipal support measures. Let’s look at the Tokyo Metropolitan Government’s ‘Project to Strengthen Customer Harassment Countermeasures in Nursing Care Settings’ as an example.
Consultation Counters Expanded to Disability Welfare
In the Reiwa 7 fiscal year, the Tokyo Metropolitan Government expanded the consultation counter previously implemented in the nursing care field and opened the ‘Tokyo Comprehensive Consultation Counter for Customer Harassment of Nursing Care and Disability Welfare Service Staff,’ which also includes staff working at disability welfare service facilities. Consultations are accepted by phone or via a reception form, and can be anonymous and free of charge. If legal action is necessary, there is also guidance for legal consultation with lawyers. tokyotokyo
Subsidies are Targeted at Visiting Nursing Care Services
On the other hand, subsidies for accompanying support for visiting care workers and the introduction of security equipment are targeted at visiting nursing care service facilities such as home-visit nursing care, home-visit nursing, and home-visit care support. Disability welfare services like home-visit care are not included in the scope. tokyo
While consultation counters have become available in both fields, financial support for safety measures during visits is currently ahead in nursing care.
6. To Corporations Operating in Both Fields: Proposals from a Labor and Social Security Attorney
For corporations operating both nursing care and disability welfare, I recommend the following approach.
① Create Policies and Regulations Common to the Corporation
The basic policy for customer harassment countermeasures, work regulations, and harassment prevention regulations should be unified across the entire corporation. The stance of protecting staff does not change depending on the field.
② Prepare Judgment Criteria and Response Procedures for Each Field
The difficulty of judgment, such as dementia symptoms, disability characteristics, and relationships with families, differs by field. Response procedures and case studies should be prepared according to the actual circumstances of nursing care and disability welfare, respectively.
③ Unify Consultation Counters and Share Knowledge Across Fields
While consolidating the corporation’s consultation counters into one, create a place where nursing care and disability welfare case studies can be learned from each other.
4. Communicating differences to staff transferring between fields
For staff transferring from nursing care to disability welfare, or vice versa, carefully explain the differences in perspectives and collaborative partners specific to each field.
5. Tracking trends in compensation revisions for both fields
Revisions to operational standards and compensation in the nursing care field may also impact disability welfare. It is important to monitor discussions in both fields in parallel.
Conclusion
Measures against customer harassment in nursing care and disability welfare share a common foundation in legal obligations. On the other hand, there are characteristics unique to each field regarding the condition of the users behind the behavior and the nature of collaboration with relevant parties.
As indicated by the Ministry of Health, Labour and Welfare’s documents, measures against customer harassment are a theme that requires balancing ‘ensuring the safety of staff’ and ‘continuing necessary services.’ Rather than considering only one or the other, let us start building a system that keeps both in mind.
Sources and Reference Materials
Ministry of Health, Labour and Welfare, ‘Harassment Measures in Nursing Care Settings’ (Social Security Council, Nursing Care Benefit Subcommittee, 263rd Meeting, Document 5, August 28, 2026)
https://www.mhlw.go.jp/content/12300000/001743318.pdf
Ministry of Health, Labour and Welfare, ‘Harassment Measures in Nursing Care Settings’ (Manuals, Training Guides, Case Collections, etc.)
https://www.mhlw.go.jp/stf/newpage_05120.html
Ministry of Health, Labour and Welfare, ‘Harassment Measures in Disability Welfare Settings’
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000070789_00012.html
Ministry of Health, Labour and Welfare, ‘Guidelines on Measures Employers Should Take Regarding Employment Management Concerning Problems Caused by the Behavior of Customers, etc. in the Workplace’ (2026 Ministry of Health, Labour and Welfare Notification No. 51)
https://www.mhlw.go.jp/content/001662625.pdf
Tokyo Metropolitan Government Bureau of Social Welfare and Public Health, ‘Project to Strengthen Measures Against Customer Harassment in Nursing Care Settings’
https://www.fukushi.metro.tokyo.lg.jp/kourei/hoken/kaigo_lib/customer_harassment
Shibata Management Labor Consulting Office
Hisashi Shibata, Certified Social Insurance and Labor Consultant
Specializing in human resources and labor management support for social welfare corporations, NPOs, disability welfare facilities, and childcare centers.
https://shibata-sr.jp/
