Asia needs millions more long-term care workers to look after its ageing population. A new report, published by the Center for Global Development (CGD), argues that only by expanding migration can this target be met, and outlines how this can be done.
The number of people in Asia aged 60 or over will reach 1.3 billion by 2050 as a result from increasing life expectancy and falling total fertility rates. For example, in 1960, the average life expectancy in Thailand was just 53. By 2060, it is expected to reach 77. These older people have more complex conditions, leading to a greater need for long-term care.
In the past, this meant that younger people stayed close to home to care for their older relatives. But more and more, younger people are moving to cities and seeking out new opportunities. Women are seeking fulfilling careers and are less likely to take up a traditional caring role. As a result, many older people -- especially women, those living in poverty, and those living in rural areas -- are not able to access the care they need.
Today, Asia and the Pacific is lacking 8.2 million care workers. The global recommendation is that there are at least 4 formal long-term care workers per 100 older people; only Japan meets that threshold. Whether it is due to the wages and working conditions offered, perception and status of those who work as carers, or true labour scarcity, the demand for long-term care in Asia is just not being met through local recruitment.
To fill this gap, many countries have turned to international recruitment. In 2017, Japan developed a new care work visa, kaigoryugaki, to help people with a job offer in the care sector to move to Japan.
Singapore admits care workers through the Foreign Maid Scheme and the S-Pass. And Taiwan has been handing out three-year visas to live-in caregivers since 1992. An increasing share of this international recruitment is now coming from Thailand.
But these efforts are not enough to meet the vast care worker shortages that exist now and are predicted to increase. Countries throughout the region should reform their immigration policies to make it easier for care workers to migrate.
So, how can this be done?
First, countries of migrant destination should create multi-year visas for care work. They shouldn't be restricted to a specific employer but could be restricted to a certain region or the health care sector in general. As migrants gain training and experience, they should be able to take on higher-skilled roles. Ideally, given the huge scale of need, these visas should enable permanent residency and citizenship.
Second, governments should ensure that care worker emigration also benefits countries of origin. Developing new migration pathways for long-term care could provide a lot of opportunities for young people and economic growth through remittances and skill transfers, but only if those pathways are managed properly. Ministries of health on both sides should work together, learning lessons from trailblazers in this field like the Philippines.
Third, regional collaboration is key. Asian country governments, the Association of Southeast Asian Nations (Asean), the World Health Organization (WHO), and the Asian Development Bank (ADB) must work together to tackle this issue.
The entire region is ageing; countries of origin will need their own migrant care workers in the decades to come. All policy actors therefore need to come together to work on regional solutions, including skills and qualification recognition and harmonisation, to ensure that all of Asia's older people have the care that they need.
If Asia is to appropriately care for its millions of new older people, it will need millions of new care workers. While countries should improve wages and working conditions to make the sector more attractive to locals, expanded immigration will be required. The new report by the CGD outlines some initial steps, but it will require all countries to come together to tackle this shared problem.
Helen Dempster is a Policy Fellow at the Center for Global Development (CGD) in the UK.