Aging Before Affluence: Why Investing in the Care Economy Matters

In the PRC, rapid urbanization, the impact of changing demographic patterns on families, and large-scale internal migration of the workforce to urban areas have made it difficult for traditional family support systems to meet the needs of older family members.^[1]

Since the early 2000s, the government has been developing a three-tiered care system for seniors: home-based care, community-based care, and residential care. Home- and community-based care supports older people living in their own residences through day care centers and home services. Residential care provides round-the-clock services for older people residing in a residential care facility with at least 10 beds.^[2] The majority of older people prefer home- and community-based care but services have not kept pace with demand.^[3] 

As the current structure of care delivery remains compartmentalized across hospitals, community health centers, and home-based services, this results in inefficiencies, duplication, and limited continuity of care. The absence of interoperable data platforms, standardized clinical protocols, and mechanisms to facilitate coordinated care exacerbate such challenges.^[4]

PPP for delivery of aged care services

In Yichang, a third-tier city in Hubei province, ADB introduced the first sovereign public–private partnership (PPP) for care of older persons.  The project sought to transform the delivery of social services by local governments by building capacity for developing, procuring, and managing transparent PPPs and financing a demonstration PPP for socially inclusive, efficient, and quality care services in the municipality.

Ten years after its initiation, the project has established two integrated complexes providing both medical and community-based care for older persons. The facilities opened in November 2025 currently accommodate around 400 residents and will reach full capacity of over 1,000 beds by November 2026. Fully operational outpatient services are supporting several thousand seniors annually.

The $50 million ADB results-based loan mobilized about $108 million in combined financing, catalyzed a $150 million follow-on operation, and seeded replication in the Guangxi Zhuang Autonomous Region, Xiangyang, and beyond.

AI-based chronic disease care system

In Tianjin, a new technical assistance project is testing artificial intelligence for chronic disease management among residents over 65. The region has some of the PRC's highest hypertension rates due to elevated salt intake. Digital tools can strengthen early detection of complications, improve treatment adherence, and enable personalized and preventive care.  Addressing precisely the fragmentation described earlier, project activities aim to integrate fragmented electronic medical records across hospitals, communities (through follow-up records), and homes (wearables) using internationally recognized standards. 

Other ADB support for senior care in the PRC explores the links between fertility decline, female labor participation, and unpaid care, treating them as connected issues. The bank is also working on age-friendly and healthy cities, viewing aging as a city-wide investment challenge.

Programs in other countries

In Pakistan, the Punjab Nursing and Health Workforce Reform Program is addressing a projected shortfall of more than 400,000 nurses by 2030—a gap that would undermine care for older persons and maternal-child health alike. The program is establishing three Centers of Excellence to expand training capacity, raise standards, and professionalize the nursing workforce at scale.

In Georgia, a Gender-Responsive Care Workforce Study projecting a 24% rise in the 65+ population by 2040 is underpinning home-based and personal assistance services within the Health Sector Enhancement Program.

In Mongolia, projects are advancing aging care and disability inclusion, expanding access to community-based senior care services, and strengthening support systems for people with disabilities.

In Turkmenistan, the country’s  first health-sector engagement is centered on nursing, including modernizing curricula, upskilling faculty, and professionalizing a workforce essential to maternal-child health and care for older persons.

Most  societies in Asia and the Pacific region are growing old before growing rich and many countries have not yet fully confronted this. A shrinking working-age population means slower potential growth; a rising old-age dependency ratio means heavier pension and health spending; and an under-invested care economy means productivity losses from absenteeism, lost female labor supply, and avoidable long-term care costs. Once the curve bends, retrofitting is far more expensive than building ahead of it. Four priorities stand out.

First, multilateral development banks, governments, foundations, and the private sector should treat aging as an immediate economic issue, not just a future or social concern. Demographic and macro-fiscal analysis can be integrated across all programs, with care workforce and long-term care seen as strategic investments. Additionally, investing in regional public goods like standardized data, quality benchmarks, financing models, and South-South learning is essential.

Second, public budgets cannot and should not bear this burden alone. Private sector engagement must be deliberately expanded , bringing insurers, age-tech firms, care providers, and institutional investors in early. That means scaling up PPP models, piloting innovative and blended financing instruments, such as outcome-based contracts, silver economy bonds, results-based lending, and risk-sharing facilities that crowd in private capital, and designing fiscal and regulatory incentives that make the care economy a genuinely investable sector, expanding fiscal space rather than consuming it.

Third, digital and AI innovations must be harnessed as core enablers, not optional add-ons. From AI-based chronic-disease management to telecare, remote monitoring, predictive risk tools, digital nursing-education platforms, age-tech devices, and digital social-protection delivery, technology can both lower the unit cost of care and extend reach into underserved populations.

Fourth, migration belongs in the demographic conversation. Growing numbers of workers from developing Asian countries are moving to advanced economies in East Asia, Europe, and the Gulf. Sending countries benefit when these workers are well trained and protected, earning more and remitting reliably. Key priorities include skills partnerships, recognition of qualifications, ethical recruitment, and linking remittances to care financing.

Asia and the Pacific are undergoing a profound demographic transformation. The question now is whether  the response will be coordinated—before inaction becomes too costly.