How Community-Rooted Care Systems Are Shaping Healthier Aging Across Asia

ADB’s report shows how Indonesia, Mongolia, and Vietnam are building innovative community-based long-term care systems that integrate health, social support, technology, and trained local workforces to help older adults age safely and with dignity. These pilots demonstrate that coordinated, community-rooted models can reduce caregiver burden, improve elder well-being, and offer scalable solutions for rapidly aging societies.

The Asian Development Bank (ADB), working closely with national ministries, local governments, and research partners such as HelpAge International Vietnam, the National Gerontology Centre of Mongolia, Achlalt Khuukhduud NGO, and Indonesia’s Ministry of National Development Planning (Bappenas), presents a compelling blueprint for reshaping long-term care (LTC) in Asia. As Indonesia, Mongolia, and Vietnam confront rapid population aging, the report underscores the growing mismatch between complex elder-care needs and overstretched family-based support systems. Chronic diseases, frailty, and social isolation have become entrenched challenges, while shrinking households and migration weaken the traditional safety net. The result is a widening gap between what older adults need and what communities can provide.

Aging, Frailty, and the Limits of Family Care

Across all three countries, noncommunicable diseases now dominate older-age morbidity, leading to mobility loss, sensory impairment, cognitive decline, and dependence in daily living. Table 1 of the report shows that up to 45% of older adults have difficulty performing essential daily tasks, yet formal LTC systems remain fragile, fragmented, and heavily reliant on unpaid family labor. Women, who are both the primary caregivers and the most common recipients of care, experience disproportionate burdens. Services tend to be reactive and poorly integrated; health centers may treat hypertension while social welfare offices separately manage cash assistance, leaving many older people unheard and unseen. Governments have begun responding through new national strategies and legal reforms, but the report makes clear that the region needs community-based solutions that are proactive, preventive, and affordable.

Three Pilots, Three Contexts, One Vision for Aging in Place

ADB’s pilot projects illustrate how community-based LTC can thrive when health and social sectors operate in unison. In Indonesia, five community care hubs (CCHs) were embedded in village offices in Bali and Yogyakarta, providing active aging classes, home visits, respite care, and digital case management using the SILANI national data system. In Mongolia, three active aging hubs (AAHs) run by an NGO, an elder development center, and a general hospital showcased an integrated blend of rehabilitation, exercise, day care, home care, and outreach. Meanwhile, Vietnam strengthened its tradition of grassroots engagement by forming village-level case management teams across 12 villages, combining commune health staff, elder association members, and trained volunteers to conduct door-to-door risk screening and individualized care planning. Despite differing structures, all three models shared a commitment to early detection, coordinated support, and aging in place, a principle older adults overwhelmingly prefer.

Case Management and Community Workforce: The Heart of the System

Case management emerged as the backbone of each country’s LTC model. Using tools such as the Clinical Frailty Scale and comprehensive biopsychosocial assessments, older adults were stratified by risk and given tailored care plans addressing functional limitations, chronic diseases, mood disorders, loneliness, environmental hazards, and financial strain. Multidisciplinary case conferences linked nurses, social workers, doctors, and volunteers, ensuring timely adjustments and seamless referrals. A notable example is Sareng, an 87-year-old woman from Bali whose untreated hypertension, pain, and isolation were addressed through coordinated home visits, medication management, volunteer companionship, and caregiver training, dramatically improving her well-being. The pilots also revealed that a sustainable LTC workforce must blend professionals, trained community workers, volunteers, and family caregivers, supported through structured training, mentoring, and appropriate incentives.

Technology, Impact, and Lessons for the Future

Digital innovation played a crucial enabling role. Indonesia’s SILANI platform, Mongolia’s mobile apps, and Vietnam’s digital referral tools helped standardize assessments, monitor care plans, and generate data for policymaking, though challenges such as low digital literacy and rural connectivity remain. The pilots produced tangible benefits: improved access to health and social services for frail seniors, reduced caregiver stress, stronger coordination between sectors, and new policy directions at national levels. They also revealed essential lessons: active aging delays dependency; home-based services are indispensable, women disproportionately rely on services; volunteers require structured management; and integrated systems outperform isolated programs. The report ultimately offers a forward-looking vision: with coordinated systems, trained workforces, digital tools, and empowered communities, Asian countries can build LTC models that allow older adults not just to live longer, but to live well, with dignity, security, and connection.