Japan is among the most disaster-prone nations globally, and independent long-term care (LTC) facilities—those unaffiliated with corporate groups—often face acute difficulties in securing external assistance during large-scale emergencies. In response to this systemic vulnerability, four independent LTC facilities from Kumamoto, Aichi, Tokyo, and Ishikawa established Japan’s first cross-prefectural disaster support agreement without any governmental involvement in 2025. To explore the formation and sustainability of this agreement, we conducted semi-structured online interviews with three facility directors and analyzed the transcripts using a qualitative descriptive approach.
The analysis revealed a multilayered process in which prior disaster experience instilled a strong recognition of the indispensability of external support; awareness of systemic limitations in current frameworks, such as the Disaster Welfare Assistance Team (DWAT), heightened the need for alternative strategies. Trust was cultivated through pre-disaster online dialogues and reciprocal site visits, while a norm of reciprocity—shaped by past support—motivated collaborative commitment. Maintenance of the agreement was supported by monthly online meetings, a "staff fellowship" practice enabling staff exchange and training, mutual understanding of support boundaries, and cultural values emphasizing mutual aid.
This case demonstrates how structurally vulnerable LTC facilities can proactively build sustainable, cross-prefectural disaster resilience. It suggests that grassroots, trust-based alliances may complement or even compensate for institutional gaps in Japan’s aging care infrastructure, especially in disaster contexts.

Authors:
Miwa Furukawa, Kyorin University, Japan

About the Presenter(s)
Miwa Furukawa is a Lecturer in the Department of Nursing and Teacher Education at Kyorin University. Her research focuses on geriatric nursing, particularly emergency response in long-term care facilities, ethical decision-making support, and interpr

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