Family caregiving remains the backbone of long-term care in LAC. Around four in five older people who need help with daily activities receive support from an unpaid carer, usually a family member, highlighting both the centrality of households and the limited reach of formal services. At the same time, the report Who Cares? How to Support and Ensure Recognition for Caregivers for Older People in Latin America and the Caribbean (Stampini et al., 2025[1]) estimates roughly 25 million unpaid caregivers in the region, versus about 3 million paid caregivers, an imbalance that becomes more problematic as population ageing accelerates and family networks shrink. This reliance on unpaid caregiving reflects both limited public provision and strong social norms around family responsibility, but it also has significant implications for equity, labour market participation and caregiver well-being. Evidence from both high-income and middle‑income settings shows that heavy dependence on informal care can mask unmet need and shift the costs of ageing from public systems to households (OECD, 2023[2]).
Paid care for older people in LAC is delivered mainly through home‑based arrangements and domestic work, rather than through institutional services (Figure 9.8). Across the LAC17 average, only about one in ten paid caregivers work in institutions; around half are domestic workers with care responsibilities. This reflects both limited formal long-term care provision and the way care tasks are often embedded in broader household services, frequently in informal employment. In practice, domestic workers may gradually take on caring responsibilities as needs increase, yet they may not be declared as carers and may lack social protection. Several countries regulate household services as a whole (without a sharp distinction between domestic work and care), although a number are moving towards more specific occupational profiles and competency frameworks for carers to professionalise the workforce. Cross-country differences in the shares of institutional, home and domestic-work caregivers also reflect variation in long-term care system development, but measurement is challenging because domestic workers with care responsibilities are often estimated rather than directly identified in surveys (Bom et al., 2018[3]).
Unpaid family care remains the backbone of long-term care in LAC. The report Who Cares? estimates around 25 million unpaid caregivers in the region (about 60% women), providing an average of 7.5 hours per week of care for older people; to maintain current caregiver-to‑older-person ratios, the number of unpaid caregivers would need to increase to around 60.5 million by 2050. Time‑use surveys suggest that most unpaid care is provided within households (around 59% across the LAC9 sample; Figure 9.9), although patterns vary and some countries, such as Argentina, report a larger share of care provided to people outside the household. These estimates should be interpreted cautiously: care provided within households is often underreported, particularly when tasks for a spouse or parent are viewed as part of everyday family responsibilities rather than “care”.
These two figures point to a consistent storyline: care for older people in LAC is organised primarily around households – through unpaid family care and, when paid, often through domestic work rather than a clearly professionalised care workforce or institutional sector. In a region where unpaid care is already widespread and demographic trends will increase needs, strengthening long-term care systems will require both expanding and professionalising the paid workforce and better supporting family caregivers (for example through training, information and policies that protect caregivers’ well-being).
