The future is older

As demand for Nepali geriatric caregivers rises, Nepal’s population itself is ageing fast

In the next four decades, half of Japan’s population will be above 65. Last year, Japan signed an agreement with multiple countries, including Nepal, to supply 60,000 caregivers. Photo: Yoshi Shimizu WHO

The world’s 65+ population is growing faster than all other age groups, and by 2050, one in six people globally are going to be older than 65, compared to 1 in 11 in 2019. Nepal itself is ageing fast even as overseas demand continues to grow for Nepali migrant geriatric caregivers.

Even before the current health crisis, the care sector was already facing critical shortages worldwide. The OECD estimates that maintaining the current ratio of 5 workers for every 100 individuals above 65 will itself require 13.5 million more caregivers.

As the deaths from Covid-19 worldwide exceeds 1 million, the pandemic has drawn attention to the lackluster situation of elderly care, inadequate staff, PPEs, high turnovers, and with a big share of Covid-19 deaths taking place in old age homes.

There are signs that the demand for geriatric caregivers globally is on the rise. A bilateral labour agreement between Israel and Nepal to hire 500 more caregivers in the midst of the pandemic is expected to be signed soon. But even as Nepal mobilises frontline workers to help countries fight Covid-19, tens of thousands of current migrants languish overseas.

Even traditionally closed countries which are concerned about social cohesion are now being forced to relax their admission policies for caregivers. Japan stands out as a striking example: 28% of its population is already 65, and this will increase to 50% in the next 40 years. The country hosts over 80,000 centenarians.

The worker shortage, including in the care sector, led to a bilateral agreement between Japan and Nepal in March 2019 to mobilise workers under the Specified Skilled Workers (SSW) visa category. Japan is expected to hire over 300,000 workers over the next five years from several countries including Nepal, which includes a quota for 60,000 care workers.

But so far Nepal has not mobilised a single workers, and the SSW program itself has got off to a shaky start, meeting less than 10% of its target of recruiting over 47,000 foreign workers in fiscal year 2019.

Even in the midst of the pandemic, Nepali migrants are re-migrating. Such is the desperation to provide for families, despite knowing the risks. But for many, remittance is the difference between being poor versus non-poor.

A much older tomorrow, Sonia Awale

Emigration of caregivers as the health crisis rages on seems counterintuitive. But we know from experience that restrictive policies fail.  When Israel banned Nepali caregivers in 2012, they chose to travel irregularly through India, paying exorbitant fees.

When the Philippines banned emigration of health workers during Covid-19 to ensure that its own health care requirements were fully met, very few took up the domestic job opportunity and pressured the government to release the ban. The response from Filipino Nurses United was: ‘It is a nurse’s right to seek better work opportunities and better pay outside of the country especially if the government cannot give this to us.”

Nepal therefore needs a clearer stance on dealing with the increasing global demand for workers in the care economy. Of Nepali migrant workers emigrating overseas annually, only around 10% are women. But demand is rapidly growing in the female dominated care sector across more countries, including OECD members and East Asia.

Without a vision on how to better manage migration in the care sector Nepali will continue to resort to irregular travels, allow exorbitant recruitment costs, provide skills training that are not recognised abroad, and let workers invest time and money in admission exams without success.

Nepali workers stuck in no man's land, Nepali Times

Experience shows that willingness to pay recruitment costs is higher for attractive destination countries. Nepal needs clear sector-specific policies and bilateral agreements that address the peculiarities of the care economy.

All this while the share of Nepal’s own elderly population is rising. By 2028, Nepal will be an ‘ageing society’ with 7% of the population above 65, and the figure will double by 2054, making Nepal an ‘aged society’. In addition to reaping the demographic dividend in the remaining decades, it is also a priority to make the society more geriatric friendly for seniors who have additional care needs.

With thousands of returnees with experience in the care sector, there is scope to mobilise them. Returnees from Israel report that a platform that would help them engage in collective initiatives in the professional care economy would allow them to use the skills and experiences to make a living in Nepal itself.

It is cheaper for employers to invest in training in the origin country especially in healthcare, one of the rationales for skills partnerships. Since destination countries like Israel and Japan are also Nepal’s development partners, there is scope to mobilise funds to design mutually beneficial skills training for geriatric care. This would help equip Nepal’s training centers as we transition rapidly into an ageing society.

Caring for those who care, Sikuma Rai

Caregivers in countries like Israel and Japan enjoy equality of treatment with locals in employment, and earn between $1,000-1,500. But there is also illicit migration of other types of care workers such as household help, which is currently banned by the Nepal government.

The Israel admission requires at least a high school education as well as completion of language and skills tests. In Japan, foreign caregivers require rigorous computer based language and skills tests. These are not options for most Nepali migrants taking surreptitious travels through India because of the ban, which makes them vulnerable to exploitation.

The blanket ban on domestic care workers without addressing the rising international demand or credible alternatives for the women opting this path therefore remains ineffective.

There is also support needed for ageing returnees. Yubraj is a second generation Gulf migrant following his father who spent his youth in the Gulf. There is no formal support system, and the father-and-son duo simply switched their remittance transfer role.

The Nepal government’s policies such as promoting savings or investment of remittances through the Foreign Employment Savings Bond and Remit Hydro have failed to yield results. Countries like the Philippines allow migrants to contribute to their national social security system, and secure a safe future while they are still earning overseas. Nepal needs to explore these options and help current migrants plan for their future.

Overseas work outside India, unless they travel irregularly, are formal and contract-based, so the employers can be held responsible to contribute to the social security funds.

For example, Malaysia’s Social Security Organization (SOCSO) and Nepal’s Foreign Employment Board are set to sign an agreement providing workers and their dependents a range of benefits, especially related to work related injuries, illness or death. Employers are required to pay 1.25% of monthly wages while workers are not required to contribute.

Nepal can easily enter into a similar Social Security Agreement with South Korea under the Employment Permit Scheme (EPS), similar to other EPS member countries like the Philippines that entered into an SSA last year that allow Filipino migrants to refund their social security contributions.

The future is older, and it is also mobile. In this new demographic era, caring for the elderly is a policy priority in Nepal and globally which has implications on the future of labour mobility management, both for migrants as carers and as elderly returnees.

Upasana Khadka writes this column Labour Mobility every month in Nepali Times analysing trends affecting Nepal’s workers abroad.

Upasana Khadka