On May 14, 2026, Shunsuke Mitsui, chair of certified NPO SET, spoke at the Urban Nursing, Elder Care, Medical and Related Services Collaboration Study Group. He reported on 15 years of practice accumulated in Rikuzentakata, Iwate Prefecture, to medical and welfare professionals from Tokyo, Nagoya, and Osaka. After the presentation, Yoshinori Fujiwara of the Tokyo Metropolitan Institute for Geriatrics and Gerontology said, “It is not about building communities for preventive care, but about preventive care existing within community building. This reaffirmed that reversal in thinking.” It was a day when the “design of relationships” fostered in a small town facing ongoing population decline reached professionals in large cities confronting rapid aging. Rikuzentakata’s practice has shown a reversal: it is not that relationships are lost because the population declines, but that a community can withstand population decline because relationships exist. This question was brought into discussions among experts working on elder care in urban settings. The study group, under the theme “Community-based services: the current state and future of small-scale multifunctional care, nursing small-scale multifunctional care, dementia group homes, and related services,” explored how multidisciplinary collaboration can help older adults continue living in the communities where they have long resided. Mitsui presented Rikuzentakata’s model, which has nurtured connections through exchanges between young people from outside the region and local residents. Its activities include career education for about 1,300 junior and senior high school students in Iwate Prefecture, week-long stay programs joined by about 1,500 university students, hosting about 17,000 school trip students, and exchange programs involving about 3,000 local residents each year. Behind these numbers is the steady work of carefully building relationships that do not end after a single encounter. Some migrants have also t