<p>In the late 1990s, the problem of care for the elderly was a growing concern in Japan. Under these circumstances, care services for the elderly in the former village of Sato attracted the attention of many specialists who regarded it as having the most developed community-care system. In general, it is believed that the provision of medical welfare services on remote islands is mediocre in comparison with the standards of the mainland. This paper discusses the process of the provision of high-level care for the elderly in the former village of Sato, which is located on an island handicapped by socioeconomic problems. In addition, the paper also clarifies the impact that the provision of care for the elderly has had on the local system of provision of services for the elderly, after the implementation of long-term care insurance in 2000.</p><p>The former village of Sato is located on Kamikoshiki Island in the East China Sea, 30 km west of Ichiki-Kushikino, Kagoshima. The production system reflected the characteristics of an isolated island, such as low land productivity and an economic discrepancy with the mainland, which was augmented by mutual aid between island residents and the remittances of migrant workers who went to mainland cities to work. However, this production system was changed as a consequence of the revenue transfer stipulated by the Law for Promotion of Detached Islands and the Law for the Development of Depopulated Areas. Consequently, a considerable number of young workers migrated to the city, leading to a rapid decrease in the village population. Moreover, the proportion of elderly people in the village rose quickly, and the problem of care for the elderly accelerated in Sato. Subsequently, a system of care services that included mutual assistance was formulated. Consequently, in Sato the quantity and quality of the level of care services for the elderly improved.</p><p>This system had a structure that included resident health care volunteers and provided the necessary manpower, which included professionals. Moreover, it not only corresponded with the needs of the elderly who wished to continue living happily on the island, but also provided the elderly who were still active with the opportunity to achieve something significant by becoming volunteers. However, this system was forced to undergo large-scale reorganization with the implementation of the long-term care insurance system in 2000. As a result, a conflict arose between the norms of the local care system in Sato and those related to the care provided by the long-term care insurance system. This was because the norms based on the long-term care insurance system were unable to adequately cater to the needs of the elderly. Moreover, the incentive for participation as a volunteer was reduced after the introduction of the social insurance system.</p><p>In conclusion, the long-term care insurance system seems to have disturbed the community that existed in Sato and was supported by mutual assistance. Further, the income transfers between areas were further reduced. In addition, in detached island areas where autonomous discretion has been reduced, it is urgent that local governance over elderly care should be implemented because, at present, social security funds are decreasing and decentralization is being strengthened.</p>