The World Is Running Out of Care Workers Just as It Needs Them Most

What happened?

Population ageing is colliding with a persistent shortage of long-term care workers, and 2026 has become a year in which multiple governments have moved from diagnosing the problem to legislating responses. Germany, Japan, South Korea, Canada and several US states have all expanded dedicated visa or training pathways for care workers over the past two years, while unions in the sector have pushed successfully for wage increases in several jurisdictions, citing chronic understaffing that has left care homes and home-care agencies turning away new clients.

The International Labour Organization has continued to describe the long-term care sector as facing a structural workforce gap that will widen over the coming decade as the share of people aged 65 and over rises across nearly every region, according to United Nations population projections.

Key points

• The UN Department of Economic and Social Affairs projects the global population aged 65 and over will continue rising sharply through the 2030s and 2040s, especially in East Asia and Europe.
• The ILO has flagged long-term care as one of the sectors most exposed to labour shortages worldwide, citing low pay, physically demanding work and high turnover.
• Germany, Japan and Canada have each expanded dedicated immigration pathways for care workers in recent years.
• Several US states and UK local authorities have raised minimum pay rates for care workers following prolonged workforce shortages reported by industry bodies.
• Robotics and assistive technology are being piloted in Japanese and South Korean care facilities to supplement, not replace, human staff.

What we know

Demographic data from the UN Population Division show that the old-age dependency ratio — the number of people aged 65 and over relative to the working-age population — is rising fastest in Japan, South Korea, Italy and Germany, but is also increasing steadily in the United States, China and much of Latin America. National statistics agencies in these countries have documented rising vacancy rates in long-term care: Germany’s Federal Employment Agency has repeatedly listed elder care among its most understaffed occupations, and the UK’s Skills for Care organisation has tracked vacancy rates in adult social care that remain well above the wider labour market average.

Wages remain a central constraint. Care work is disproportionately performed by women and, in many countries, by migrant workers, and pay in the sector frequently sits near minimum-wage levels despite the physical and emotional demands of the job. This combination has produced high turnover, which in turn increases training costs and reduces continuity of care for residents and clients.

Background

The demographic transition behind this shortage has been visible in population projections for decades, but policy responses have historically lagged behind the data. Japan, further along the ageing curve than most large economies, was among the first to introduce a national long-term care insurance system in 2000 and has since experimented with technology-assisted care, immigration reform through its Specified Skilled Worker visa category, and wage subsidies for care staff. South Korea, now ageing even faster than Japan by some UN metrics, has followed a similar policy trajectory with a lag of roughly two decades.

European countries have relied heavily on migrant labour to staff care homes and home-care services, a dependency that became starkly visible during the Covid-19 pandemic when travel restrictions temporarily disrupted staffing in countries such as Germany, Italy and the UK. That experience prompted several governments to formalise dedicated care-worker visa routes rather than relying on general labour migration channels.

Detailed analysis

The care workforce shortage sits at the intersection of three difficult policy areas: immigration, wage-setting and public spending on health and social care, each of which is politically contentious in most democracies. Expanding immigration to fill care roles is often the fastest lever available to governments, but it can run into domestic political resistance even when labour market data clearly show unfilled vacancies. Japan and South Korea, both historically restrictive on immigration, have had to make notable exceptions specifically for care work, reflecting how acute the shortage has become relative to political caution on migration more broadly.

Raising wages is the more structurally durable solution favoured by labour economists, since it would make the sector more competitive with retail, hospitality and other lower-wage service industries that care workers can often move into with comparable or better pay and less physically demanding conditions. However, wage increases in publicly funded or heavily subsidised care systems ultimately require either higher public spending, higher fees for families, or productivity gains — none of which are straightforward given tight fiscal environments across many advanced economies in 2026.

Technology is frequently proposed as a partial solution, and Japan in particular has invested heavily in care robotics, from mobility-assist exoskeletons to monitoring sensors that reduce the need for overnight staff to physically check on residents. Independent evaluations, however, generally find that such technologies augment rather than replace human care work, particularly for tasks requiring emotional support, complex medical judgement or intimate personal care, meaning the underlying staffing gap is unlikely to be closed by automation alone within the next decade.

Why it matters

A shortfall in long-term care capacity has consequences well beyond the sector itself. Family members, disproportionately women, often step in to provide unpaid care when formal services are unavailable or unaffordable, which research consistently links to reduced labour force participation and retirement savings among informal carers. This creates a secondary economic cost that rarely appears in headline labour market statistics but compounds gender gaps in employment and pensions over time.

At a macro level, unresolved care shortages could constrain economic growth in ageing societies by tying up working-age adults in unpaid care duties rather than paid employment, at precisely the moment when shrinking workforces make every unit of labour supply more economically valuable.

What happens next?

Expect further expansion of dedicated care-worker migration pathways, particularly in Japan, Germany and Canada, alongside continued union pressure for wage increases in markets such as the UK and several US states. The OECD and ILO are likely to publish further comparative research on long-term care workforce planning, which could inform coordinated policy responses, though implementation will remain uneven given differing fiscal capacities across countries.

Watch for pilot programmes combining care robotics with revised staffing ratios in Japan and South Korea, and for possible bilateral labour agreements between ageing high-income countries and countries with younger populations, such as the Philippines, Indonesia and parts of Sub-Saharan Africa, which have historically supplied significant shares of the global care workforce.

Insight Media Opinion

Insight Media Opinion: The care worker shortage is one of the most predictable crises in modern policy — demographers have modelled it for thirty years — and yet most governments are still responding reactively rather than with the long-term workforce planning the data has long demanded. Countries that continue to treat care work as low-skilled and low-paid will keep losing staff to sectors offering easier conditions for similar wages, regardless of how many visa categories they create.

Immigration reform can buy time, but it is not a substitute for paying care workers what the physical and emotional demands of the job actually warrant, nor for building the fiscal capacity to fund an ageing society’s care needs honestly rather than through unpaid family labour by default. Governments serious about ageing well should treat care workforce investment with the same urgency as energy or infrastructure planning — because, demographically, the bill is already due.