Addressing the impending shortage of care for older adults requires coordinated action across workforce development, financing, support for informal carers, prevention, technology, and system redesign. Drawing on recommendations from the OECD, WHO, national experiences in high-aging countries (Japan, South Korea, Germany, Nordic nations), and expert analyses, the following policies target the core drivers: rising demand, workforce shortages, funding pressures, and over-reliance on unpaid family care.
1. Strengthening the formal care workforce
The most immediate bottleneck is the shortage of paid carers.
OECD analyses emphasize that without better job quality, recruitment and retention will fail even with expanded training.
Raise wages and improve working conditions: Higher pay relative to hospital or other sectors, reduced physical strain, better scheduling, career progression pathways, and stronger occupational health protections. Countries have used sectoral minimum wages (e.g., Scotland and Wales) and public funding increases to support this. Collective bargaining and recognition of care work as skilled employment are key. Evidence shows poor conditions drive high turnover; improving them is essential for retention.
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Expand training and recruitment pipelines: Subsidized or free training for unemployed people, career changers, students, and underrepresented groups (including efforts to attract more men). Japan increased its long-term care (LTC) workforce substantially in earlier years through targeted programs. Accelerated training with work placements (as in Canada) and standardized curricula help scale supply quickly. Long-term workforce planning with better forecasting is needed to align education capacity with demand.
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Ethical international recruitment: Targeted migration pathways with visas, language training, and pathways to longer-term residency, paired with bilateral agreements that support origin countries (to avoid ‘brain drain’). Japan uses multiple schemes (economic partnership agreements, specified skilled worker visas, and student-to-worker pathways). South Korea has launched university-based programs for foreign students to train as caregivers with settlement incentives. Germany and Denmark have similar recruitment measures. Migration is a near-term bridge but is not a complete substitute for improving domestic attractiveness.
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2. Sustainable financing mechanisms
Public spending on long-term care must rise in most countries, but new structures can improve equity, adequacy, and fiscal sustainability.
Mandatory or expanded LTC insurance: Japan’s long-term care insurance (introduced in 2000, with contributions starting at age 40) provides a transparent, universal-risk-sharing model focused on maintaining dignity and independence. Germany and Luxembourg incorporate pre-funding elements. Slovenia introduced LTC insurance in 2023. These systems pool risk better than pure tax-based approaches in some contexts and clarify entitlements.
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Diversify funding and improve targeting: Expand beyond labor taxes (e.g., broader bases or pre-funding), while prioritizing benefits for those with the greatest needs and fewest resources. Caps on out-of-pocket costs scaled by need and income can protect the most vulnerable without universal over-coverage. Some countries explore hybrid public-private models or life/LTC insurance products.
Increase public investment linked to broader goals: Treat LTC as a priority tied to gender equality, labor force participation, and economic growth. Higher spending can create jobs while reducing unmet needs and hospital pressures.
3. Supporting informal and family caregivers
Informal care still provides the majority of support in most places. Policies should reduce burnout and enable workforce participation (especially for women).
Paid or flexible carer leave, cash allowances or benefits, respite care services, and free training/support programs.
Recognition of carers’ contributions and measures to prevent them from exiting the labor market permanently.
OECD and WHO frameworks stress integrating support for unpaid carers into formal systems.
4. Prevention, healthy ageing, and demand management
Reducing the intensity or onset of care needs can ease future pressure.
n Invest in prevention, early diagnosis, rehabilitation (‘reablement’), and healthy ageing programs (e.g., home visits in Denmark and Norway, lifestyle interventions). OECD modeling suggests healthy ageing strategies could lower future LTC expenditures significantly (around 13 percent in some scenarios).
Promote age-friendly environments, home adaptations, and community support so more people can live independently longer.
Research into dementia and age-related conditions, supported by public funding.
5. Technology, productivity, and service redesign
Assistive technology and robotics: Japan has subsidized care robots and digital tools in nursing homes. Studies link adoption to better retention, higher employment of flexible workers, reduced physical strain, and improved care quality indicators (e.g., fewer restraints or pressure ulcers). Productivity gains from technology and task-shifting (e.g., advanced nursing roles) can moderate workforce needs.
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Shift toward home- and community-based care: Most older people prefer ageing in place. Expand home care hours, integrated community services, and ‘hospitals at home’ models while ensuring quality. Nordic countries and others demonstrate stronger community orientation. WHO advocates person-centered, integrated health and social care packages as part of universal health coverage.
System integration and governance: Better coordination between health and social care, clear quality standards, staffing ratios where appropriate, and transparent regulation. Long-term national strategies with monitoring of workforce wellbeing and unmet needs are essential.
Implementation considerations and country examples
No single package fits all contexts. High-income super-ageing societies (Japan, South Korea, parts of Europe) prioritize workforce attractiveness, technology, and insurance expansion. Rapidly ageing middle-income countries (China and others) focus on building basic formal infrastructure, community services, pilot insurance schemes, and training at scale, often with international support (e.g., World Bank projects in China expanding community-based care and workforce training). Lower-income settings emphasize supporting family carers while gradually formalizing services.
Challenges include fiscal constraints, political prioritization, and the time lag between training and workforce impact. Success requires sustained commitment rather than short-term measures. OECD reports repeatedly stress that improving job quality and recognition of care work is foundational-without it, other reforms underperform.
These solutions are mutually reinforcing: better-paid, better-supported workers deliver higher-quality care; prevention and technology moderate demand; robust financing enables expansion; and support for families prevents system overload. Countries that treat elderly care as a strategic investment in social cohesion and economic resilience-rather than a residual cost-are better positioned to manage the demographic transition with dignity for older people and fairness for carers.