Establishment of 'Out-of-pocket Visiting Nursing Guidelines' and Certification System Based on METI Policies; Industry-First Official Training to be Held on April 16

The Visiting Nursing Support Association (Representative Director: Kei Takamaru) and the Japan Male Nurses Association (Representative Director: Kosuke Tsubota, hereafter 'our association') have formulated the 'Out-of-pocket (Non-insurance) Visiting Nursing Guidelines' based on the Ministry of Economy, Trade and Industry's (METI) policy 'Direction of Healthcare Service Guidelines.' In conjunction with this, a certification system based on these guidelines will be launched.

■ What is Out-of-pocket Visiting Nursing?

Visiting nursing includes 'insurance-covered' services, to which nursing care insurance or medical insurance is applied, and 'out-of-pocket' (non-insurance) services that fall outside these systems. Insurance-covered services have restrictions on frequency, time, and content. Out-of-pocket visiting nursing fills the 'gaps' where these systems cannot reach.

Specifically, the following services are included:

Ceremonial occasions and outing accompaniments: Support related to one's 'purpose in life,' such as attending a daughter's wedding or accompanying a grandchild's sports day.

Additional rehabilitation: Rehabilitation aimed at functional recovery with a frequency and content that exceeds the limits of nursing care insurance.

Terminal/End-of-life care support: Time-intensive end-of-life care aligned with the wishes of the individual and their family.

And more.

Guidelines: https://www.meti.go.jp/policy/mono_info_service/healthcare/houmonnkanngo.pdf

Out-of-pocket services are fully self-funded but can flexibly respond to users' needs.

■ Background: Two Issues Surrounding Out-of-pocket Visiting Nursing

While the trend of visiting nursing stations providing out-of-pocket services is expanding, serious issues are arising on the front lines.

1. Complication of administrative guidance regarding records and operations

Because out-of-pocket visiting nursing is not covered by nursing care or medical insurance, the standards for handling it have remained unclear. By having unified industry guidelines, we will solve this structural problem.

2. Absence of service quality management

Currently, there is no common standard to ensure the quality of out-of-pocket visiting nursing services. In order to create an environment where users can choose services with peace of mind, there is a need for a mechanism where the industry itself sets and visualizes quality standards.

In formulating these guidelines, we have proceeded in consultation with the Nursing Service Promotion Office and Visiting Nursing Promotion Office of the Health Policy Bureau, and the Health and Welfare Division for the Elderly of the Health and Welfare Bureau for the Elderly at the Ministry of Health, Labour and Welfare.

■ Overview of the Guidelines

This guideline is an industry guideline compliant with the Ministry of Economy, Trade and Industry's 'Direction of Healthcare Service Guidelines.' It aims to establish standards, records, and operational requirements that stations providing out-of-pocket visiting nursing services must comply with, thereby creating a highly transparent environment for users, businesses, and government administration alike.

■ Mechanism of the Certification System

Certification can be obtained mainly by fulfilling two requirements: 1) Business Management Certification and 2) Training Course Completion. This certification serves as proof of high-quality service provision and stable business operations.

1. About Business Management Certification

Management certification is mandatory to confirm that the organization has a robust management foundation capable of responding appropriately when unforeseen problems or troubles arise, especially when providing out-of-pocket visiting nursing services. Specifically, it is required to prove this system through the following initiatives.

<Utilization of METI's Management Plans>

Through the formulation and implementation of early management improvement plans, we will demonstrate transparency in management status and the desire for improvement. This serves as an important indicator to confirm financial stability to enhance business sustainability and prepare for unforeseen circumstances.

This management certification acts as a mark of official public trust from METI to establish an environment where users can confidently use out-of-pocket services.

2. About Training Course Completion

In the training, participants will learn the practical knowledge needed to 'properly separate and manage' insurance-covered services and out-of-pocket services.

Why is separate management necessary?

Stations where the management of insurance and non-insurance services is ambiguous run the risk of being cited for 'fraudulent billing' or 'inappropriate operations' during on-site inspections by Regional Bureaus of Health and Welfare. It is necessary to clearly distinguish them in all processes: time management, recording, billing, and collection of user fees.

What you will learn in the training

We will explain the specific operational methods for managing insurance and non-insurance services separately, as well as the contents of the latest guidelines.

Flow of obtaining certification

Attend training → Submit checklist → Clear training attendance requirement.

Submission of the checklist serves as proof that the necessary knowledge and operational structure are in place.

Benefits of obtaining certification

Stations that have obtained certification will be more easily chosen by users as a 'trustworthy business.' In the growing out-of-pocket service market, this will lead to clear differentiation from other stations.

First [Out-of-pocket Visiting Nursing Guidelines] Practical Training for Certification Acquisition

https://hokengai.peatix.com/

■ Comment from Kosuke Tsubota, Representative Director of the Japan Male Nurses Association

Out-of-pocket visiting nursing is an important option for local residents to receive the care they need, as much as they need. However, expanding without a system to protect its quality will lead to unfortunate results for both users and businesses. The formulation of these guidelines and the launch of the certification system are declarations of intent that the industry will create its own rules and abide by them. As the first organization certified to provide educational programs, our association will deliver high-quality training to stations nationwide.

■ Comment from Marin Iwanaga, Executive Officer of the Japan Male Nurses Association

Inherently, nursing, including visiting nursing, should be closely tailored to individuality without limits. However, precisely because public insurance applies, there are unavoidably areas where intervention is not possible. Yet, as the community-based integrated care system deepens today, I feel there is a need for an environment that transcends these constraints, where users can utilize nursing services more freely and with greater peace of mind. Based on the philosophy of 'Nursing for Nurses,' our association will make every effort to establish this environment as the first certified organization to provide educational programs.

■ Comment from Kei Takamaru, Representative Director of the Visiting Nursing Support Association

The two major issues faced by out-of-pocket services—namely, the 'complication of guidance due to unclear standards' and the 'absence of common quality standards'—have long hindered the sound development of the industry. Having been involved in this field for nearly 20 years as a player in out-of-pocket visiting nursing, I have felt this structural problem firsthand. Formulating guidelines based on METI policies and launching this certification system represents an extremely important step toward enhancing transparency across the industry and establishing an environment where users can confidently choose services. I am convinced that this framework will serve as the foundation for the sustainable and sound development of out-of-pocket visiting nursing.

■ Further Strengthening Visiting Nursing Support from FY2026

Starting in fiscal year 2026, our association will further strengthen support activities for visiting nursing operators. With the four pillars of guideline development, certification systems, on-site education, and policy proposals, we will support the sustainable development of visiting nursing, regardless of whether it is covered by insurance or not.