How does the designation application for a home-visit nursing station proceed?

In short: to start a home-visit nursing station you need designation as a designated home-visit nursing business. To provide home-visit nursing under long-term care insurance, you obtain designation per office from the prefectural governor (in designated and core cities, the mayor) (Long-Term Care Insurance Act, Article 70, paragraph 1). Designated home-visit nursing under medical insurance is designated by the Minister of Health, Labour and Welfare (Health Insurance Act, Article 88, paragraph 1, and Article 89, paragraph 1), but once you receive the long-term care insurance designation you are deemed to have received the medical insurance designation (the "deemed designation" of Health Insurance Act, Article 89, paragraph 2). Staffing requires nursing staff on a full-time equivalent basis of 2.5 or more, and the manager is in principle a public health nurse or nurse. This article organises the flow of the designation application and the required documents, and shows which part to ask whom. Eligibility is decided by the designating authority's review, and our office does not guarantee designation.

Who do you apply to for a home-visit nursing station designation?

Home-visit nursing is a service where nurses and others go to a user's home to provide nursing care and assist with medical treatment. When provided under long-term care insurance, designation as a designated home-service business (home-visit nursing) is obtained per office and per service type from the prefectural governor (Long-Term Care Insurance Act, Article 70, paragraph 1). In designated and core cities, the mayor is the designating authority.

To be designated, being a corporation is a prerequisite. The business purpose in the articles of incorporation must include home-visit nursing (home services); if it does not, a registration to change the purpose is required. A sole proprietor cannot be designated. Deciding which insurance (medical or long-term care) and what range of services you will provide is the starting point for preparing the documents.

How exactly do you meet the staffing standard (full-time equivalent of 2.5, manager)?

The standards for staffing, facilities and operation are set in the "Standards concerning the staffing, facilities and operation of designated home-service businesses" (Ordinance of the Ministry of Health and Welfare No. 37 of 1999; promulgated 31 March 1999), and are given concrete form by the ordinances of prefectures and others. The basics for home-visit nursing are as follows.

Category	Standard
Nursing staff (public health nurse, nurse, assistant nurse)	Full-time equivalent of 2.5 or more; of these, one must be full-time
Physical, occupational and speech therapists	A suitable number according to the actual circumstances of the business (placement is optional)
Manager	A full-time person engaged exclusively in the duty; in principle a public health nurse or nurse

The full-time equivalent is found by dividing "the total working hours of the workers" by "the hours a full-time worker should work." As for facilities, in addition to a dedicated office of sufficient size for running the business, you must provide the equipment and fittings needed to deliver designated home-visit nursing. Because home-visit nursing is a service where staff go to the user's home, no rooms for users are needed, but hygiene management such as hand-washing and equipment storage for infection prevention is required under the operation standards. The employment contracts, working-hour design and social-insurance application that meet the staffing standards are the field of a certified social insurance and labour consultant, who contracts with you separately as an independent business.

How do the designation counters differ between medical and long-term care insurance?

Home-visit nursing may be paid from both medical insurance (Health Insurance Act) and long-term care insurance. The designation counters differ, but in practice the "deemed designation" arranges the procedure as one.

Insurance	Basis of designation	Designating authority
Long-term care insurance	Designated home-service business (home-visit nursing) (Long-Term Care Insurance Act, Article 70, paragraph 1)	Prefectural governor (mayor in designated and core cities)
Medical insurance	Designated home-visit nursing business (Health Insurance Act, Article 88, paragraph 1, and Article 89, paragraph 1)	Minister of Health, Labour and Welfare (delegated in practice to the Director-General of the Regional Bureau of Health and Welfare)

The designation of a designated home-visit nursing business under medical insurance is made by the Minister of Health, Labour and Welfare, but a business that has received the long-term care insurance designation as a designated home-service business (home-visit nursing) is, under Health Insurance Act, Article 89, paragraph 2, deemed to have received the medical insurance designation (deemed designation). Unless you make a separate declining notification, receiving the long-term care insurance designation means you need not separately apply for the medical insurance designation. Because the scope of the deeming and the need for notifications differ by business content, confirm at both the Regional Bureau of Health and Welfare and the prefecture.

How long is the schedule from application to designation?

Many municipalities grant designation as of the first of the month, and the submission deadline is generally set in the month or two months before the desired designation date. Because things are easily sent back if the order is reversed, start the prior consultation early. The general flow is as follows.

1. Fix the business and funding plans, and establish a corporation (or add home-visit nursing to the purpose in the articles of incorporation).
2. Choose premises for the office and confirm conformity with the facility and hygiene-management standards.
3. Hold a prior consultation with the designating authority (prefecture, etc.).
4. Secure a public health nurse or nurse as manager, and nursing staff of full-time equivalent 2.5 or more.
5. Prepare the application and attached documents and submit them by the deadline.
6. Document examination and, as necessary, on-site confirmation.
7. Designation (in many municipalities, as of the first day of a month).

Deadlines differ by designating authority and may be brought forward at the change of fiscal year, so always confirm on the relevant municipality's official page. Also confirm with the Regional Bureau of Health and Welfare the timing of any notification relating to the medical insurance deemed designation. Confirming conformity in the prior consultation before finalising recruitment or the premises contract reduces the risk of missing the desired designation date.

Who should you consult about labour, registration and premises?

The designation application crosses several fields of expertise. The roles are divided as follows.

• Preparation of the designation application, appendix and attached documents, and support for prior consultation → Yotsuba Administrative Scrivener Office (administrative scrivener)
• Selection, lease and important-matters explanation of the business premises (office) → Yotsuba Real Estate Co., Ltd.
• Employment contracts, work rules, working-hour management, on-call (standby) allowance design, and social-insurance application that meet the staffing standards → a certified social insurance and labour consultant
• Registration of corporate establishment and changes → a judicial scrivener
• Corporate accounting, tax and tax calculation → a tax accountant
• Individual legal judgement on rights, obligations and disputes → an attorney

Yotsuba Administrative Scrivener Office and Yotsuba Real Estate Co., Ltd. are separate businesses. Our office handles only support for the designation application as an independent business, and premises, labour, registration and tax are contracted separately with each qualified professional. Our office receives no referral fee. For the whole picture of licensing, see Licensing and Permits; for the flow of engagement, see Engagement Flow; and for fees, see Fee Schedule. The premises-side requirements are the real estate practice, centred on the office, the infection-prevention area and the use zone.

FAQ

Q. Can you start a home-visit nursing station with just one nurse?
A. No. The staffing standard requires nursing staff of full-time equivalent 2.5 or more (one of them full-time). The manager is in principle a public health nurse or nurse, engaged exclusively and full-time. Placement of therapists is optional according to the circumstances of the business.

Q. Must you apply for designation twice, for medical and long-term care insurance?
A. Once you receive the designation under Long-Term Care Insurance Act, Article 70, paragraph 1 (prefectural governor), you are deemed to have received the medical insurance designation as a designated home-visit nursing business under Health Insurance Act, Article 89, paragraph 2 (deemed designation). Unless you make a separate declining notification, you need not separately apply for the medical insurance designation. Confirm the need for notifications with the Regional Bureau of Health and Welfare.

Q. Can an individual be designated?
A. Designation as a designated home-visit nursing business presupposes being a corporation. The business purpose in the articles of incorporation must include home-visit nursing (home services); if it does not, a registration to change the purpose is required.

Q. How large must the office be?
A. The standard states "a dedicated office of a size sufficient for running the business" and does not set a single nationwide numerical area. You provide the necessary equipment and fittings together. Confirm the specific size and layout in the designating authority's guide and the prior consultation, and proceed with premises selection under a separate contract with the real estate company.

Sources (Primary Information)

• e-Gov Law Search, "Long-Term Care Insurance Act" (Act No. 123 of 1997), Article 41, paragraph 1, and Article 70, paragraph 1 (accessed 2026-09-03)
• e-Gov Law Search, "Health Insurance Act" (Act No. 70 of 1922), Article 88, paragraph 1, and Article 89, paragraphs 1 and 2 (accessed 2026-09-03)
• Ministry of Health, Labour and Welfare, "Standards concerning the staffing, facilities and operation of designated home-service businesses" (Ordinance No. 37 of 1999; promulgated 31 March 1999), Articles 60–62 (home-visit nursing) (accessed 2026-09-03)
• Guides to designation (home-visit nursing) applications published by the prefecture and Regional Bureau of Health and Welfare of the planned site (each municipality and bureau; accessed 2026-09-03)

This article is general information and does not guarantee individual eligibility for designation, conformity with the staffing, facility and operation standards, the scope of the deemed designation, or the application schedule. The final review of designation is made by the designating authority (the prefecture, designated city or core city for long-term care insurance; the Minister of Health, Labour and Welfare, i.e. the Regional Bureau of Health and Welfare, for medical insurance). Confirm the deadlines, forms and required documents for each office on the relevant municipality's or bureau's official page. Selection, lease and important-matters explanation of the business premises (office) are handled by Yotsuba Real Estate Co., Ltd.; employment contracts, working-hour management, on-call allowance design and social-insurance application by a certified social insurance and labour consultant; corporate establishment and change registration by a judicial scrivener; accounting and tax by a tax accountant; and individual legal judgement on rights, obligations and disputes by an attorney, each as an independent business under a separate contract. Our office receives no referral fee. Individual judgements are made by a qualified professional after a meeting. Written by Joji Uramatsu, administrative scrivener and licensed real estate broker.