Despite the remarkable health achievements of Japan’s universal health coverage since 1961, along with numerous social programs to ensure financial protection, a growing proportion of the older population reportedly experiences financial hardship for essential health care. The socio-behavioral and economic situation of the households in need and the effective policy interventions remain unknown. To identify the reasons behind older persons’ financial hardship and the effective policy interventions, this study conducted a questionnaire survey of social workers in all hospitals, local government offices and social service agencies across six prefectures in Kansai region. To close the gap between policy and practice, policies should focus on clients’ daily living needs, and new frontline social workers should receive lifelong training that incorporates their own backgrounds, experiences, and values, including the use of anti-oppressive gerontological approaches.