The rise in nuclear family households and more married women engaging in paid work have forced governments to address the issue of aged care for the elderly to a greater degree. A good illustration is home care in Japan where the government introduced a Long Term Care Insurance scheme (LTCI) (2000) focused on offering affordable almost universal care by extending existing home care services. Japan’s home care services were privatized in 2006 and, while this is not unique to Japan, the combination of cost-cutting measures and the client-driven model encompassed in the LTCI has had a significant impact on employment conditions and the organization of work in home care services. This research assesses the impact on employment conditions and the organization of work in Japan’s former government-run home care sector compared with the pre-LTCI period and argues that privatization has resulted in work intensification and deteriorating employment conditions.