Aging Populations and the Urgent Need for Sustainable Long-Term Care Systems

The rapid global aging trend, especially in low- and middle-income countries, is driving the need for more formal long-term care (LTC) services. Governments must prioritize affordable, accessible LTC systems and support for informal caregivers, particularly women, to address the growing care demands of aging populations.

The world is experiencing an unprecedented demographic shift as populations age rapidly, particularly in low- and middle-income countries (LMICs). The percentage of individuals aged 65 years and older is projected to increase from 9% in 2019 to 16% by 2050, with the “oldest old,” those aged 80 and above, expected to reach 4.4% of the global population by that time. This surge in the aging population is accompanied by a growing number of people facing age-related disabilities, functional dependencies, and the increasing burden of non-communicable diseases (NCDs). As a result, there is a rising demand for long-term care (LTC) services worldwide, particularly in LMICs where traditional family-based caregiving is no longer sufficient to meet the needs of rapidly aging populations. Historically, informal care provided by families, especially women, has been the primary means of supporting elderly individuals. However, the growing care needs of older adults, coupled with the societal changes in these countries, have made it clear that family-based care alone is inadequate. Yet, in many LMICs, LTC has not received the policy attention or funding it urgently requires. This gap has highlighted the need for more structured and formal LTC services that can accommodate the needs of aging populations in a sustainable and equitable manner.

Expanding the Range of Long-Term Care Services

LTC encompasses a range of healthcare and social services that assist people who, due to mental or physical frailty, old age, or disabilities, require help with daily living activities. These services can be provided in various forms, including residential care, home care, day centers, tele-assistance services, and support for informal caregivers. While LTC services are more commonly available in high-income countries (HICs), LMICs are beginning to see the emergence of new and innovative LTC models. For instance, in China, governments at both the national and local levels have promoted public-private partnerships to deliver LTC services. In these models, the government contracts private companies to provide services or operate LTC facilities. Other LMICs are focusing on fostering home and community-based care services, such as community homes or day centers, to meet the preferences of older adults who wish to age in place. A notable example of such an initiative is China’s “Happiness Homes,” which allow older adults to maintain independent lives while helping one another, providing an alternative to institutional care.

Barriers to Affordability and Access

Despite these efforts, the affordability and accessibility of LTC services remain significant barriers in many countries. Publicly financed LTC services are limited in LMICs, leaving older adults and their families to pay out-of-pocket for formal care, which is often unaffordable. The availability of formal home care, community-based services, and institutional care is generally limited, and in many cases, the cost of care is prohibitive for most older adults. For instance, World Health Organization (WHO) data show that a high percentage of older adults in LMICs cannot access healthcare services due to financial constraints, lack of transportation, and inadequate service quality. These barriers further exacerbate the already limited access to LTC services for the elderly in LMICs. The reliance on informal caregivers, particularly family members, continues to be a widespread practice in these regions. However, caregiving responsibilities can significantly impact the well-being and economic opportunities of caregivers, particularly women. Women, who are traditionally the primary caregivers, often face reduced participation in the labor market and lower earnings due to their caregiving duties. Studies have shown that women providing care for aging parents are more likely to leave the workforce or reduce their working hours, leading to financial strain and reduced career prospects. In China, for example, over 48% of caregivers in rural areas reported reducing or giving up paid work to care for elderly relatives.

Prioritizing Long-Term Care Systems

Recognizing the growing demand for LTC services and the challenges associated with informal caregiving, policymakers are increasingly calling for the expansion of formal LTC systems. Governments, particularly in LMICs, need to prioritize the development of LTC services that are accessible, affordable, and of high quality. Engaging the private sector through public-private partnerships is one way to expand LTC service delivery, as seen in countries like China. Furthermore, supporting informal caregivers by providing financial assistance, training, and flexible work arrangements can help alleviate the burdens of caregiving and improve the quality of care for older adults. Governments must also consider establishing sustainable public LTC financing systems to ensure equity, fiscal sustainability, and efficiency. Building a robust LTC workforce through recruitment, training, and retention strategies will also be essential for improving the quality of care and narrowing gender gaps in labor participation and financial autonomy.

Addressing the Gender Imbalance in Caregiving

As societies continue to age, the demand for LTC services will only increase, and women, who are most often responsible for unpaid care, will bear the brunt of these growing care responsibilities. This situation presents an opportunity to expand formal LTC services and create new employment opportunities for caregivers. However, it also highlights the need for a paradigm shift toward a more integrated and person-centered approach to care. Addressing the challenges of aging societies will require innovative solutions, increased public and private sector involvement, and a strong commitment from governments to support both formal and informal care systems. In the face of these growing challenges, it is imperative that LMICs take steps to strengthen their LTC systems to ensure that aging populations receive the care and support they need.

A Paradigm Shift Towards Sustainable Long-Term Care

The development of long-term care services is essential for addressing the rapidly aging populations in LMICs and beyond. A coordinated and integrated approach to care is crucial, balancing the roles of informal family caregivers and formal LTC systems. This evolution will not only improve access to quality care but also relieve the economic and emotional pressures on families, particularly women. Governments must act swiftly to strengthen LTC policies, improve access, engage the private sector, and ensure that aging individuals across the globe can live their later years with dignity and support.