Training and time are two of the tightest constraints on the sustainability and quality of LTC in LAC. Care work is inherently complex – spanning personal care, household support, monitoring changes in condition, and emotional support – and 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]) stresses that weak skills development and poor support translate into lower-quality care and worse outcomes for caregivers themselves. Unpaid caregiving is strongly gendered: women constitute around 60% of unpaid caregivers and, driven by social norms, tend to spend more time on care and take on the least flexible tasks, with knock-on effects on paid work and well-being.
Large training gaps among paid caregivers are likely to undermine care quality and retention (Figure 9.10). Across LAC22, 37% of paid caregivers report no training, 16% rely on self-study and 47% report some course‑based training – often shorter than the Ibero-American Protocol’s 260‑hour recommendation. Where training exists, it tends to emphasise technical tasks while giving less weight to communication, emotional resilience, caregiver self-care and person-centred approaches. Inadequate training can increase preventable complications (for example through unsafe mobility support, poor infection prevention or delayed recognition of deterioration) and can contribute to caregiver stress and turnover. Evidence from structured education and skills programmes for carers, particularly in dementia care, suggests such support can improve caregiver outcomes and be cost-effective, indicating a missed opportunity to strengthen long-term care systems (Livingston et al., 2020[2]).
Women spend more time providing unpaid care for older people than men in every country with data (Figure 9.11). Across the LAC8 average, women provide 8.8 hours per week compared with 6.0 hours for men. Gender gaps are particularly large in some Southern Cone countries, reflecting both labour market patterns and persistent gender norms. Most time‑use surveys miss “passive care” (being on call) and, as noted above, may undercount care provided within households, so total hours – and gender gaps – are likely underestimated. High time burden without adequate preparation elevates stress, musculoskeletal injury and mental health risks, threatening the sustainability of care arrangements; prolonged high-intensity caregiving is linked to worse caregiver health, especially when responsibilities arise suddenly or with little support (Bom et al., 2018[3]). These pressures will intensify as dementia and multimorbidity increase with population ageing.
These two figures point to a dual challenge for LTC policy: professionalise and standardise skills in the paid workforce while reducing the time and intensity burden that falls disproportionately on women in unpaid care. The report’s direction of travel is clear – expand accessible, higher-quality training pathways (including recognition of prior learning), and strengthen caregiver support policies (information, psychological support, respite, and flexible work/leave), alongside efforts to shift gender norms and increase men’s participation in care.
