As societies grow older, their needs too evolve, with greater pressure on care systems being widely acknowledged as a critical issue. Broadly, care work involves supporting the physical, mental and development needs of people either directly or indirectly, while a care system refers to its overall organization (UN, 2024). Care is an integral component of the world of work. When care needs are sufficiently met, it can lead to better health and wellbeing outcomes and allow people to reach their full potential in productive work. Caring is in turn also a form of work in both paid and unpaid capacities, whether it is performed within or outside the home. Supporting care givers is therefore essential to maintaining a happy, healthy and productive workforce. In an aged society, care systems tend to be strained as they are expected to tackle a rise in geriatric health conditions, social isolation and general physical and mental decline among other issues.

These challenges have already materialized in much of the Global North and are now becoming urgent concerns in other regions with ageing societies as well. Parts of South and Southeast Asia are for instance aging at rapid rates, with Singapore, Thailand and Sri Lanka at the forefront (Graph 01). Although India as a whole is yet to reach this level, certain states such as Kerala age at a much faster rate (Kumar, 2024). Given the wide variations in levels of wealth, geographies and political structures, the mechanisms employed by these countries in tackling the rising demand for care services presents key differences with valuable lessons for the region as a whole.

Graph 01: Old-Age Dependency Ratio in Select South and Southeast Asian Countries

Source: World Development Indicators, World Bank
Notes: Country selection based on relatively higher rates of population ageing in the regions

 

Graph 02: Old-Age Dependency VS Per Capita GDP in South and Southeast AsiaSource: World Development Indicators, World Bank
Notes: Latest data was available for 2024, except for Bhutan 2023.

Singapore

Singapore’s approach to care systems remains unique in the region due to a reliance on individual contributions, likely rooted in its economic ideology traditionally averse to large welfare payments (Panesar, 2025). Its financial prosperity and highly formal workforce have been compatible with mandatory insurance systems including MediSave and MediShield that have enabled much of the population including the elderly to utilize high-quality and extensive health facilities (ADB, 2020a). With filial piety being a major cultural value, the city-state places the primary responsibility of aged care on the family, reflected in the Maintenance of Parents legislation introduced in the early 1980s (Paneshar, 2025). Also, ‘Ageing in place’ as opposed to institutionalization, is prioritized as in much of Asia (ESCAP, 2015).

Nevertheless, gaps in this system have been exposed over time as the older population has risen coupled with changes to family structures, norms and migration patterns. Caregivers in the home, mostly women, themselves have aged considerably, and nearly half relied on the support of foreign domestic workers (ESCAP, 2015). The government has subsequently shifted to a more holistic ‘Many Helping Hands’ approach where the community, charitable organizations and the state play a greater role in supporting the most vulnerable (ESCAP, 2015).  Targeted financial aid has expanded with the Eldershield, Eldershield plus and CareShield programmes for those with disabilities and low income (ADB, 2020a).

The government has also been more actively involved in planning for an aged society. The Ageing Planning Office for instance was created to better prepare for Long Term Care (LTC) needs. Programmes are implemented through coordinated efforts by the Agency for Integrated Care in partnership with hospital systems, Senior Activity Centres and community networks to provide a range of services (ADB, 2020a). Focus has also expanded towards areas of preventive and promotive health through active ageing and social programmes (Ministry of Health Singapore, n.d.).

Thailand

Similar to its Southeast Asian neighbour Singapore, Thailand too began recognizing the challenges of population ageing since the 1980s. By the early 2000s it had already established national councils, committees and plans for senior citizens and introduced an Elderly Act to recognize the rights and needs of older people. Its Healthy Thailand national agenda of 2005 is notable for including a component on older adults, paving the way for health promotion initiatives in various localities (Jitapunkul and Wivatvanit, 2009). However, unlike the island nation, Thailand’s relative economic constraints, and its vast and diverse geography required a wholly different approach to ensure effective care delivery.

The basic health needs of the entire Thai population are effectively funded through the Universal Health Coverage (UHC), a tax-funded healthcare system along with smaller employment linked insurance schemes for some workers (ADB, 2020b). Nevertheless, gaps have persisted in this system as the range of facilities and their uptake varied significantly by locality. While out-of-pocket expenses were low on average, they remained a challenge for the poorer elderly requiring specialized care and those living away from urban centers due to high transport costs (World Bank, 2016). Furthermore, despite the country’s burgeoning private sector for LTC facilities attracting foreign residents and wealthier Thais, the less affluent segments of the society were in dire need of affordable and accessible LTC services (World Bank, 2021).

These factors led to the development of a community based LTC model that has achieved considerable success. Built on the foundations of earlier volunteer programmes and policy efforts, the current decentralised model enables older adults to receive 2-8 hours of care each week in the home according to their specific requirements (ADB, 2020b; World Bank, 2021). Caregivers include family, neighbours and other volunteers who receive training and are overseen by care managers, typically local health professionals such as nurses with more extensive experience. The programme is covered under the UHC system with finances allocated to Local Health Funds (ADB, 2020b). While the system is in need of improvements in terms of capacity building, coordination and sustainable funding, it remains a cornerstone of the aged care system of Thailand.

Sri Lanka

Much like its rapidly ageing regional peers, Sri Lanka too has introduced numerous policies and institutions to better prepare for this demographic transition (ADB, 2019). The National Policy for the Elderly, updated in 2025 highlights the health and wellbeing of older adults as a core policy area (Ministry of Rural Development, Social Security and Community Empowerment Sri Lanka, 2025). The National Elderly Health Policy 2017 and the Essential Services Package of 2019 are significant in recognizing elderly care as a key component of the country’s health policy (UNFPA Asia-Pacific Regional Office, 2022) Despite this, the implementation has been sluggish due to a lack of clear responsibilities, measurable targets and evaluation mechanisms. As in Singapore, the primary responsibility of providing care for the elderly in Sri Lanka rests with the family and is enshrined in laws such as the Protection of the Rights of Elders Act of 2000. However, with rising demand for care and the burden of unpaid care remaining high, there has been increasing pressure towards greater state involvement (ILO, 2023; ADB, 2019). This is a particularly urgent concern in remote areas as noted by Rathnayake (2026), through research conducted under the FutureWORKS Asia programme. Greater support is required by certain communities for instance in the hilly central region of the country, where the care needs of many elderly are not met as a result of accessibility barriers, scarcity in services and limited income earning opportunities.

In terms of healthcare, Sri Lanka utilizes a tax-funded model in a similar spirit to Thailand.  This has yielded impressive results in maternal and child health outcomes, but faces difficulty in adapting to the needs of an ageing population (ADB, 2019). Currently some services exist to treat and manage NCDs. Yet the need for continuous care and a growing reliance on private facilities, have led to concerning levels of out-of-pocket health expenditure (Pallegedara, 2018; Gamage et al., 2024). Palliative care is another area in need of improvement. Services have gradually expanded, with the introduction of interventions such as the Healthy Lifestyle Centres supported by Public Health Nursing Officers. These aim to provide  services in NCD prevention and management, geriatric and palliative care. Yet, their uptake has been relatively low (Ministry of Health Sri Lanka, n.d.; Herath et al. 2024).

In comparison to LTC and social services for the elderly in Singapore and Thailand, the facilities in Sri Lanka remain highly fragmented. The limited availability of state services has given rise to an uncoordinated upsurge of services by private entities, charitable groups and informal caregivers (ADB, 2019). The rapid expansion of unregulated care homes in particular faces public scrutiny (newsfirst, 2026). Although the Elders Act (2000) makes provisions for the registration of organisations providing services to the elderly, challenges exist in establishing minimum standards and continuous monitoring. Smaller independent initiatives in the public health system also exist such as Elderly Care Units promoting healthy ageing practices (Central Province Council, 2018). These require greater recognition and institutional support to reach their full potential. More recently the government has made efforts to enhance elderly care at the primary level (Ministry of Health Sri Lanka, n.d.). Among the latest initiatives are plans to support local institutions in carrying out health promotion camps, improving access to assistive devices and disbursing financial aid for low income groups, overseen by the NSE (NSE, 2026). 52 state run day-centers are also expected to be set up in underused spaces of hospitals for promotive and preventive healthcare activities (Centre for Poverty Analysis, forthcoming). Whilst these developments are promising, the country is yet to tackle fundamental gaps in enacting planned programmes, continuous monitoring of standards and encouraging greater uptake by the public.

Kerala, India

Along with its neighbour, Sri Lanka, the Indian state of Kerala stands out as one of the most rapidly ageing regions of South Asia (Kumar, 2024). Cultural norms in India too, emphasize the role of adult children in providing care for ageing parents as seen through the Maintenance and Welfare of Parents and Senior Citizens Act 2007 (GOLTC, n.d.). Yet, given that this is a relatively less urgent concern at the national-level, the government of Kerala has introduced several state-level policies and interventions to address this challenge. Notable among these are the Old Age policy of 2006 and its successor Vayojana Nayam 2013 that enabled the state to support Local Governments with care services and infrastructure through funding and standardization of care (Deepa et al., 2024).

Resembling Thailand and Sri Lanka, Kerala ensures healthcare access for all through a series of universal health coverage programmes (Adithyan, 2024). More specific support for older adults has been provided through initiatives such as Vayomadhuram and Vayoraksha that provide medical devices and aid, mobile clinics, nutrition programmes, memory clinics, as well as day care centers for elderly (Kumar, 2024). One of the most lauded aspects of aged care in Kerala is their low-cost palliative care model. Unlike services of comparative countries and regions, typically embedded into the general healthcare system, the palliative care model in Kerala utilises community level resources, integrated with local health systems. Initiated in 1993 in a clinic in Kozhikode, this later expanded as a state-wide practice supported by the palliative care policy of 2008. The system provides regular home-based care to patients based on their requirements with the support of healthcare and social workers, community volunteers rendering medical aid and psychosocial support (Gowri and Azeez, 2025).

Gaps have nevertheless persisted in the aged care system in the region comparable to those of Sri Lanka and Thailand, with rising  chronic disease incidence, surging healthcare costs, persistent urban-rural disparities and limited availability of LTC options among them (Muraleedharan and Chandak, 2021; GOLTC, n.d.). The government has recently taken more concrete measures in an attempt to pursue these challenges as reflected in their very first Elderly Budget 2026-27 presented alongside the state budget for the year.  This aims to fund initiatives including menopause clinics, adult immunization programmes, targeted health insurance for low income groups and enhanced palliative care facilities (The Hindu, 2026).

Towards Better Care in an Ageing Asia

Population ageing is pressurising care systems across South and Southeast Asia. This in turn impacts people’s ability to work consistently and productively both within the care sector and the broader economy. With such emerging concerns, governments have gradually shifted away from the belief that elderly care remains an exclusively family-level concern. Singapore has increasingly utilised targeted welfare initiatives to support the most at-risk groups, while state-backed community care systems have seen success in Thailand and Kerala in providing LTC and palliative care within low-resource settings. Sri Lanka has shown potential in its recently expanded public health programmes that adapt existing resources. Although some differences to approaches remain across the region based on specific contexts, it is apparent that elderly care is most effective when carried out through coordinated and regulated efforts involving families, communities, governments and private entities. As societies in the region age further, expanding on such initiatives will be a vital step in planning for the future of work.

Written by Thisuri Rojie Ekanayake, with the contribution of Gayani Hurulle (LIRNEasia) , Gayathri Lokuge (CEPA) and Nilupulee Ratnayake (CEPA).