Aging nations have experienced a significant shift in the old-age dependency ratiothat is, the number of adults aged 65 years or older in relation to the number of working-age adults between the ages of 15 and 64. Globally, in 1950, there were 11.75 working-age individuals for every person 65 or older. That figure fell to 8.5 in 2012, and it is expected to further decline to 3.9 by 2050 (KPMG International 2013). As a result of this trend, countries with aging populations have begun to face serious shortages of long-term care workers. A report by the International Organization for Migration showed that, because of the declining availability of native-born long-term care workers, countries such as the United Kingdom, Ireland, Canada, and the United States are increasingly relying on migrant workers for long-term care (Spencer et al. 2010). Typically, foreign long-term care workers are concentrated in low-paying jobs with temporary visa statuses. The same report indicated that about 20 percent of foreign-born direct or social care providers in the United States are workers without proper authorizations (Spencer et al. 2010).

Some countries that have traditionally been reluctant to allow less-skilled migrant workers have adopted immigration policies that now invite foreign long-term care workers. For instance, Japan, with its exceptionally rapid rate of population aging, has had an urgent need for workers in its long-term care facilities. In 2008, the country enacted a new immigration policy, called the Economic Partnership Agreement (EPA), that allowed foreign workers into the long-term care industry for the first time in the country's history (Tsukada 2013). The agreement was made first with Indonesia and then with the Philippines. The migrant workers take mostly low-paying jobs in Japan and encounter language and cultural barriers; however, older adults have expressed appreciation for the generally high quality of care they have provided (Tsukada 2013). With further shortages of long-term care workers anticipated in the years to come, governments must carefully reexamine issues of both domestic healthcare policy and immigration policy.

old-age dependency ratio

The ratio of the population aged 65 years or older to the "working-age" population (defined as people aged 15 to 64).

What is the old-age dependency ratio, and how does it affect the need for long-term care workers? What solutions might be introduced to alleviate the shortage of long-term care workers? What training and educational programs should be provided especially to migrant workers in long-term care facilities?