Home care requires a lot of book keeping. First, recipients must select providers which can provide services in their place of living at desirable time. Then they have to keep book to verify the claims of providers. So majority of recipients entrust these time consuming tasks to professional care managers. Care management fee will be fully paid by insurers with no copayment and there is no additional cost for recipients.

Care managers are expected to act as an agent of the recipient and select providers as a neutral buyers. However majority of care managers are at the same time employees of home care providers. So they tend to act more like sales agents to channel service orders to the companies which employ them. This is a crucial difference from the U.K. care management system, in which all care managers are civil servants who are separate from service providers mostly in private sector.

More and more care managers in Japan are aware of their difficult postion: a dillemma between split loyalties. Care management is perhaps the best achievement of Japan's LTCI system. However for the care management to be able to fulfill its intended mission, it is mandatory to establish care managers as independent professionals with high standard of skills and morale.

Recently care managers organize themselves to form professional associations like medical associations. When care managers are established as truly independent professionals, then Japan's LTCI will be able to be a model for the world.