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Vincent Tan

Bessie* left the Philippines for Malaysia more than a decade ago to care for other people’s children. She stayed to look after their parents instead.
Certified as a carer, she now freelances around Kuala Lumpur’s Klang Valley, earning up to 25 ringgit (US$6) an hour for round-the-clock shifts, with clients providing her meals, transport and housing.
“My former employer was very understanding and offered to release me earlier so I could earn a higher salary as a caregiver,” the 50-year-old said.
Her career path is, in miniature, the story of many of Southeast Asia’s carers. Malaysia is often a way station: a place to earn a certificate and some experience before moving on to better paid work, sometimes with a path to residency, in Japan, Canada or Europe.
“A lot of caregivers from the Philippines come to Malaysia or Singapore to work for a while, before they relocate,” Bessie said, adding that, unlike so many others, she planned to stay put.

The region’s wealthier economies are now competing for a workforce that is thinning out as it moves around.
Taiwan employed about 225,000 migrant social welfare workers as of March, 186,000 of them Indonesian, while Japan reached the end of last year with 67,871 foreign nationals employed in its skilled nursing-care category.
Singapore, Thailand and Malaysia are all scaling up recruitment just as two major source countries for carers – the Philippines and Indonesia – are themselves greying. . Over-sixties already accounted for more than 10 per cent of Filipinos in 2024 and almost 12 per cent of Indonesians the following year.
The dilemma now facing Asean governments is how to combat a regional shortage of carers without simply offloading the problem onto poorer states.

Ready buyers
Malaysia illustrates the strain from the buyer’s side. The country has no dedicated immigration pathway for foreign carers, so most arrive as domestic helpers or on temporary work passes – the route Bessie took.
That mismatch has consequences, according to Delren Douglas, president of the Association for Residential Aged Care Operators of Malaysia (Agecope).
“Many of our members have had the Immigration Department coming in and deporting foreign caregivers for doing work that is different from their permit,” he said.
In May, Agecope put the national shortfall at roughly 1,400 carers across some 12,000 nursing-home beds. Douglas said it had worsened since, although he gave no updated figure. “We are being left with carers not adventurous enough to travel abroad or who lack the education required to work elsewhere,” he said.
Local nursing home operator Christine Yee sees the same churn from the training side: carers gain confidence and skills on the job, then leave for Singapore or beyond.
“It’s already very difficult to recruit people who have the temperament, the patience and passion for this type of work, because taking care of the elderly is not easy,” she said.
Money explains much of the drift. Carers in Malaysia start on around 2,000 to 2,500 ringgit (US$490 to US$615) a month, while Singaporean employers pay about triple that, between S$2,200 (US$1,740) and S$2,500.

Singapore’s response, outlined in parliament in March, is to “diversify the sources of foreign recruitment” and secure bilateral labour deals, with talks on care-worker cooperation taking place between acting manpower minister Jasmin Lau and her Philippine counterpart Francis Tolentino last month.
The city state estimates its healthcare workforce will grow by a fifth by the end of the decade, to about 156,000, on top of the 300,000 or so migrant domestic workers who increasingly provide care for the elderly.
Thailand, meanwhile, is entering the bidding rather late. The International Labour Organization (ILO) projects that the country may need over 250,000 additional paid care workers by 2037, roughly 55,000 of them migrants, and has flagged “increased competition for Asean migrant care workers”.
In January, Thailand’s then labour minister Trinuch Thienthong warned that demand for foreign workers could climb by more than half, adding that future labour-import policies “must be clearly defined”. They still have not been.
‘Brain waste’
Indonesia illustrates how the shortage travels. Of the 153,049 Indonesians placed overseas in the first half of this year, 30,514 were carers – the largest single occupational group.
Ferry Efendi, a community health nursing professor at Airlangga University, attributed the outflow to a shortage of jobs at home. “Indonesia has more than 700 nursing schools graduating about 50,000 nurses a year, far beyond what the domestic health sector can employ,” he said.
Some graduates inevitably ended up caring for the elderly overseas, despite their qualifications – creating “brain waste rather than brain circulation”, as Efendi put it.
Indonesia has no national long-term care system or regulated care-worker profession for them to return to.

Malaysia’s proximity and linguistic familiarity could continue to attract Indonesian carers despite lower wages, Efendi added. “A nurse with young children in Sumatra may rationally prefer Malaysia to Taiwan even at a lower wage. But Malaysia would have to recognise her nursing background rather than repeat Taiwan’s practice of hiring nurses as care attendants.”
The Philippines faces a somewhat similar contradiction. Its skills authority certifies about 41,000 carers annually, according to paper from the Philippine Institute for Development Studies published in May. Yet Japan, under a bilateral economic partnership agreement, takes in only about 200 of them a year.
Filipino carers had become an expensive “gold standard” that Japanese employers were increasingly abandoning in favour of cheaper alternatives from India, Nepal and Myanmar, the paper said.
Jean Clarisse Carlos, the paper’s co-author, warned that a training pipeline built for export became a liability once it collided with realities at home, including “persistent vacancies and high turnover in local care services, rising unmet care needs among older persons and continued dependence on unpaid family caregivers”.
Her paper calls for a national care and migration strategy to mitigate what it termed the “care drain”.

An invisible workforce
Behind all of this sits a regulatory blind spot.
The Association of Southeast Asian Nations’ 2006 mutual recognition arrangement on nursing left licensing power with national regulators while entirely excluding carers – “where most of the movement is actually happening”, according to Efendi.
Because so much care for the elderly happened behind closed doors, classified as domestic work rather than a profession, it was invisible to regional skills initiatives, Carlos said.
When Asean labour ministers met in Bangkok on August 26, their published communique focused on skills certification, without once mentioning care.
Today’s employment surplus should not be read as tomorrow’s care surplus
Ferry Efendi, community health nursing professor
The International Labour Organization said in a statement that there was “no comprehensive mechanism within Asean or at the global level” to stop wealthier countries outbidding poorer ones. If workers obtained the right to migrate, restricting where they could work raised “significant labour rights concerns”, it said.
The agency advocates for fair recruitment, portable social security and skills recognition, but that still leaves unresolved the question hanging over the region: whether today’s labour-exporting countries will have any carers left to spare once their own citizens grow old.
“Today’s employment surplus should not be read as tomorrow’s care surplus,” Efendi said.
*Name changed to protect interviewee’s identity


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An elderly woman is pushed through the an old covered shopping street in Osaka. Japan had 67,871 foreign nationals employed in its skilled nursing-care category as of late 2025. Photo: AFP

A Filipino nurse attends to an elderly woman at a temporary shelter in Tagbilaran city following an earthquake in 2013. The Philippines certifies about 41,000 carers per year. Photo: AFP

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Asia’s care economy is booming, but its biggest supplier nations are ageing too, raising fears of a coming carer shortfall


Asia’s care economy is booming, but its biggest supplier nations are ageing too, raising fears of a coming carer shortfall.


As Asia rapidly ages, who cares for the carers when they grow old?

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Asia’s care economy is booming, but its biggest supplier nations are ageing too, raising fears of a coming carer shortfall

Asia’s care economy is booming, but its biggest supplier nations are ageing too, raising fears of a coming carer shortfall