Amidst a worsening shortage of pediatricians nationwide, "accompanying hospitalization," where parents of hospitalized children stay overnight in the hospital room and provide 24-hour care in place of nurses, has become a social issue. NPO Keep Smiling (Headquarters: Chuo-ku, Tokyo; Representative Director: Yuki Mitsuhara; hereinafter referred to as Keep Smiling) has published the "Accompanying Hospitalization White Paper 2025," compiling the results of a survey of 1,198 individuals who accompany hospitalized children, a survey of 242 medical institutions nationwide, and a survey of all 47 prefectures.

Survey Background

Accompanying hospitalization places severe physical, mental, and financial burdens on the families involved. In some cases, the alternative care provided by families includes actions that are effectively medical procedures or specialized medical care equivalent to them. In response to this situation, a survey and petition gathering the voices of over 3,600 accompanying families nationwide was submitted to the government in 2023. This served as a catalyst, leading to the establishment of new support measures in the 2024 medical fee revision and the creation of the "Environmental Improvement Project for Children's Hospitalization Companionship" (subsidy) by the Children and Families Agency in 2025. This marked the first time national financial support was introduced for improving hospital environments.

However, consultations from accompanying individuals nationwide have continued unabated. There was no existing survey to track changes in the circumstances of those involved or improvements in hospital environments, leaving it unclear how much these systems were being utilized and to what extent they were contributing to improvements on the ground. Therefore, Keep Smiling, an organization supporting accompanying families, conducted a large-scale survey from December 2025 to January 2026, targeting 242 medical institutions nationwide, 1,198 accompanying individuals, and all 47 prefectures. The survey visualized the latest realities, including how the situation has changed following a series of system revisions and societal shifts, and what challenges remain for 1 individuals, 2 medical institutions, and 3 municipalities.

The results revealed that while some changes have occurred in the problems faced by accompanying families, new challenges related to remaining issues and hospital environments have also emerged. Based on these survey results, Keep Smiling will proceed with initiatives to support improvements in hospital environments and the creation of new mechanisms to directly support pediatric wards.

Survey Results Summary

1 Living environments show an improving trend following the medical fee revision and the establishment of national subsidy programs (Lack of restful sleep: 85.4% → 80.0%; No hospital meal provision: 84.1% → 80.2%; Able to bathe almost daily: 61.6% → 70.0%).

2 Conversely, 75.0% responded that they were "requested by the hospital to accompany," revealing a situation where families effectively have no choice in whether to accompany.

3 58.9% experienced "health deterioration," and 82.6% stated they "did not receive adequate support when unwell," indicating that managing the health of accompanying family members remains a significant challenge.

4 78.1% of accompanying families feel economic anxiety, with those feeling "very anxious" increasing from 31.0% to 39.7%. The economic burden on accompanying families is becoming more severe.

5 In the first-ever hospital survey, 82.2% of medical institutions responded that "the environment is not sufficiently prepared to prevent families from substituting for nursing care."

6 33.3% of hospitals were "unaware of the subsidy," revealing that the subsidy system is not adequately reaching the front lines.

Detailed Survey Results

1 Signs of improvement in living environments such as meals, sleep, and bathing, but still 80% face sleep challenges.

In this survey, "lack of restful sleep" decreased from 85.4% to 80.0%, "no hospital meal provision" decreased from 84.1% to 80.2%, and "able to bathe almost daily" increased from 61.6% to 70.0%, showing signs of improvement in living environments.

The hospital survey also confirmed that medical institutions plan to improve accompanying environments within the current fiscal year, suggesting that the front lines are beginning to move towards improving living environments, which have been a long-standing issue.

However, 80% of facilities still do not provide hospital meals, and 80% of individuals experience a lack of restful sleep, indicating that the issues faced by accompanying families have not yet been resolved.

2 Over 70% responded "could not choose" or "were requested," revealing that families do not have a choice in whether to accompany.

Even after system revisions, there has been no significant change in whether accompanying was done by the family's own volition.

73.5% responded that they "could not choose to accompany," and 75.0% responded that they were "requested by the hospital to accompany," indicating that many families are placed in a situation where accompanying is effectively a prerequisite.

While there has been some improvement compared to the 2022 survey, approximately three out of four people (73.5%) still cannot choose whether to accompany. While the presence of family is important for children, "wanting to accompany" and "having to accompany" are different. Creating an environment where families can choose based on their wishes remains a significant challenge.

3 Impact on family health is worsening. Approximately 60% have experienced health deterioration.

While there are signs of improvement in bathing and sleep environments, the health of accompanying family members has not improved. 58.9% reported experiencing health deterioration while accompanying, an increase from 2022. Furthermore, 57.5% continued to accompany even when unwell, and 82.6% reported not receiving adequate support.

The background to this situation includes the inability to find a substitute or leave the child alone to rest. The health of accompanying family members is the foundation supporting the child's recovery. Mechanisms are needed to allow for rest and rotation when family members fall ill.

4 Approximately 80% feel "economic burden." Resignation, leave of absence, and dual living expenses are straining household finances and lives.

This survey once again highlighted the severity of the economic burden on accompanying families. 78.1% felt economic anxiety, and the proportion answering "very anxious" increased from 31.0% to 39.7%.

During the period of accompanying hospitalization, in addition to transportation, accommodation, and food costs, dual living expenses arise from commuting between home and the hospital. Furthermore, cases of reduced income due to taking leave or resigning from work due to accompanying are not uncommon. The resignation rate for long-term hospitalizations reaches 13.1%, making it a major challenge to balance the child's treatment with the family's livelihood.

5 Over 90% of facilities do not staff night ward childcare workers. 82% of hospitals recognize that "the environment is not sufficiently prepared to prevent families from substituting for nursing care."

The hospital survey, conducted for the first time this year across 242 facilities, revealed that medical institutions are aware of the current issues but face obstacles to improvement. While 95.5% of hospitals responded that "accompanying has positive effects on children," 82.2% stated that "the environment is not sufficiently prepared to prevent families from substituting for nursing care."

Furthermore, 93.8% of facilities do not staff night ward childcare workers, and 74.6% do not staff nursing assistants, revealing that support systems are weaker during the night, when the burden on families increases.

6 33.3% of hospitals responded "unaware of the system." Challenges in system dissemination and operation are highlighted.

In the hospital survey, 33.3% of hospitals responded that they were "unaware of the environmental improvement subsidy" established by the Children and Families Agency. Even if a system is established, its utilization will not progress if information does not reach the front lines.

Additionally, there are differences in system dissemination and support structures among municipalities, leading to variations in the speed of improvement by region.

This survey highlighted the importance not only of establishing systems but also of creating mechanisms that hospitals and municipalities can easily utilize, as well as providing ongoing support.

Future Initiatives Based on Survey Results

This survey revealed that while many medical institutions recognize the need to improve accompanying environments, they are unable to provide adequate support due to a lack of personnel, budget, and expertise. It also became clear that national subsidy programs are not being fully utilized.

[1] Launch of Support Program to Promote Hospital Environmental Improvement *Release planned for a later date*

We will establish the "Accompanying Environment Improvement Consultation Service" for medical institutions aiming to improve their accompanying environments. Depending on the challenges of each hospital, we will provide material support, introduce best practices, and facilitate matching with local companies and organizations. We will also produce the "Accompanying Environment Improvement Handbook and Case Study Collection (tentative title)" compiling survey results and nationwide practical examples, and provide it to hospitals and municipalities nationwide. Through a system that allows hospitals to learn from each other and promote improvements, we will support the enhancement of the recovery environment for accompanying families. *This project is implemented with the support of The Nippon Foundation.*

[2] Launch of "Pediatric Ward Support Portal (tentative title)" enabling supporters to directly assist hospitals *Release planned for a later date*

In collaboration with Congrant Inc., we will launch an online platform where individuals and companies can directly donate to the necessary supplies and environmental improvement projects for pediatric wards nationwide. By visualizing the needs of each hospital and enabling targeted support by region or hospital, this system will promote environmental improvements across the country.

[3] Crowdfunding to further accelerate environmental improvements *See separate release*

To reach more hospitals with the above initiatives, we will conduct crowdfunding. We will widely disseminate the challenges revealed by the survey to society and promote the creation of a system where hospitals, municipalities, companies, and citizens collaborate to support accompanying families.

(Details here: https://congrant.com/project/momsmile/23288)

Message from the Representative Director

Approximately three years have passed since the announcement of the previous survey, and national systems and hospital initiatives have begun to move forward gradually. The 2024 medical fee revision recognized environmental considerations for accompanying families, and a subsidy system for environmental improvements was established for fiscal year 2025. The signs of improvement in sleep, meal, and bathing environments observed in this survey are, I believe, the result of many individuals' and supporters' voices moving society.

On the other hand, the significant health and economic burdens faced by accompanying families have also come to light. The situation where they cannot rest even when unwell, or cannot leave their child's side even when their income decreases, continues to this day.

Furthermore, the hospital survey revealed that while many medical institutions feel the need for environmental improvement, they are unable to provide adequate support due to a lack of personnel, budget, and expertise. Improvements in accompanying environments are steadily progressing. However, it is not enough to simply create systems; they must be utilized on the ground and deliver tangible changes that families can feel.

Therefore, we will proceed with establishing a consultation service for hospitals, creating new mechanisms to connect supporters with hospitals wishing to assist pediatric wards, and conducting crowdfunding to accelerate environmental improvements.

We aim to realize a society where children and families can spend their time with peace of mind, by joining forces with hospitals, municipalities, companies, and citizens.

"Accompanying Hospitalization White Paper 2025" Overview

Survey Target (Individuals): 1,198 family members who have experience accompanying a hospitalized child.

Survey Target (Medical Institutions): 242 medical institutions with pediatric wards nationwide.

Survey Target (Municipalities): Conducted for all 47 prefectures. Survey Period: November 2025 - January 2026.

Survey and Publication: NPO Keep Smiling

Grant: This white paper was produced and published with the support of the Policy Fund "Masayoshi Yamamoto Policy Fund."

Detailed Report URL and Previous Survey Details: https://momsmile.jp/activity/survey/

About NPO Keep Smiling

We are a certified NPO that supports families accompanying hospitalized children. We work to improve accompanying environments, primarily through food and material support for accompanying families nationwide.

Organization Website: https://momsmile.jp

[Contact Information for Inquiries]

NPO Keep Smiling (Public Relations)

E-mail: pr@momsmile.jp Phone: 03-6822-5371

Media Inquiries: https://momsmile.jp/contact/media/

FACT BOX

  • Source: PR TIMES
  • Category: Survey報告