Ageing Asia needs immigration reform to end care worker shortage

Asian countries in need of long-term carers cannot meet the growing demand through domestic recruitment alone
Multi-year visas, emigration that benefits countries of origin and regional collaboration can all help ensure proper care

Helen Dempster

Published: 9:45am, 12 May 2022

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Asia needs millions more long-term care workers to look after its ageing population. Fuelled by increasing life expectancy and falling total fertility rates, the number of people in Asia aged 60 or over will reach 1.3 billion by 2050.

For example, in 1960, the average life expectancy in China was just 44. By 2060, it is expected to reach 83. These older people have more complex conditions, leading to a greater need for long-term care.

In the past, this meant younger people tended to stay close to home to care for their older relatives. But, increasingly, they 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 in rural areas – cannot access the care they need.

Today, the Asia-Pacific region lacks 8.2 million care workers. In China, it is estimated there is just one formal long-term care worker per 100 older people, compared to the global recommendation of at least four.

Whether it is because of 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 not being met through local recruitment.

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To fill this gap, many countries have turned to international recruitment. In 2017, Japan developed a new care work visa called kaigoryugaku to help people with a job offer in the care sector move to Japan.

Singapore admits care workers through the work permit and S Pass schemes. Taiwan has been handing out three-year visas to live-in carers since 1992.

Even China, which has long viewed international immigration with a wary eye, has enacted a new agreement with the Philippines to bring in 300,000 Filipino workers, including carers and nurses. The impact of this new agreement on care worker shortages remains to be seen.

But these efforts are not enough to meet the vast shortages that exist now and are predicted to increase. Countries throughout the region, including China, should reform their immigration policies to make it easier for care workers to migrate.

How can this be done? First, destination countries for migrants should create multi-year visas for care work. They should not be restricted to a specific employer but could be restricted to a certain region or the healthcare sector in general.

Migrants are a help to Hong Kong’s ageing society, not a hindrance

As migrants gain training and experience, they should be able to take on higher-skilled roles. Ideally, given the huge need, these visas should lead to permanent residency and citizenship.

Second, governments should ensure care worker emigration also benefits the countries of origin. Developing new migration pathways for long-term care could provide many opportunities for young people and economic growth through remittances and skill transfers, but only if those pathways are managed properly.

Health ministries on both sides should work together, learning lessons from trailblazers in this field such as the Philippines.

Third, regional collaboration is key. Asian governments, the Association of Southeast Asian Nations, the World Health Organization and the Asian Development Bank must all 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 recognition of skills and qualifications, and harmonisation, to ensure all Asia’s older people receive the care they need.

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If Asia is to care appropriately for its millions of extra 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 also be required.

A new study by me and my colleagues outlines some initial steps. To address this looming labour crisis, countries in the region must come together now to create new ethical and sustainable channels for legal migration.

Helen Dempster is the assistant director for the Migration, Displacement, and Humanitarian Policy Programme at the Centre for Global Development

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