A Village-Based Solution for Indonesia’s Growing Long-Term Care Challenge

Indonesia is aging rapidly, and a pilot led by the Asian Development Bank shows that community-based care hubs can successfully coordinate health, social support, and active aging services at village level. The model offers a practical path for helping older Indonesians age with dignity in their own communities while easing pressure on families and public systems.

Indonesia is often described as a young country, but that image is quickly becoming outdated. Research led by the Asian Development Bank (ADB), in collaboration with Indonesia’s Ministry of National Development Planning (Bappenas) and informed by national aging surveys, shows that the country is aging faster than many realize. With a population of about 282 million, Indonesia will see nearly 19% of its people aged 60 and above by 2045. Longer life expectancy and falling birth rates are driving this shift, especially in regions such as Java and Bali, creating growing pressure on systems that were never designed to support large numbers of older adults.

Care That Falls on Families

Today, most older Indonesians depend almost entirely on their families for care. Daughters, spouses, and sons provide daily support, usually without training, financial help, or formal backup. While many older people still live with extended families, a growing number, particularly older women, live alone and face social isolation. Formal long-term care services are limited and uneven. Private care is largely available only to wealthier households, while public social assistance focuses narrowly on the poorest older people without family support. Rehabilitation, dementia care, and coordinated home-based services remain scarce, and about one-third of older Indonesians have no health insurance at all. Responsibility for long-term care is spread across multiple government agencies, leading to gaps, overlaps, and confusion.

A Community-Based Experiment

To explore a better way forward, ADB launched a pilot program between 2022 and 2024 to test community-based long-term care in Indonesia. The idea was to move care closer to where people live and to build on existing community strengths rather than create expensive new institutions. The pilot introduced Community Care Hubs, or CCHs, designed to help older people age in place, stay connected to their communities, and receive care that addresses both health and social needs. Five pilot sites were selected, three in Yogyakarta and two in Bali, areas with rapidly aging populations and strong local community networks.

How Community Care Hubs Work

Each Community Care Hub operates at the village level and serves as a local coordination point for care. Instead of offering a single service, the hubs connect families, community volunteers, health clinics, social services, and local governments. A key feature is case management. Older people are first screened in the community, then grouped according to their level of need. Those at higher risk receive a detailed assessment and a personalized care plan, which is monitored and adjusted over time.

The hubs focus on four main areas. Active aging programs encourage older people to stay healthy and socially engaged through activities such as exercise, traditional dance, music, handicrafts, and cooking classes. Care and support services help older people with limited family assistance, offering help with daily tasks like bathing and meals, as well as home visits to reduce isolation. Information and referral services guide families through health insurance, social assistance, and administrative processes. All of this is supported by Indonesia’s Elderly Information System, known as SILANI, which helps track needs and services and links to the national One Data Indonesia platform.

What the Pilot Achieved, and What Comes Next

By the end of 2024, the results were striking. Nearly 7,000 older people had been screened across the pilot communities. More than 1,200 were identified as high risk, and over 400 were referred to health centers or hospitals. In total, the hubs reached more than 9,000 users and organized over 2,300 active aging activities. Training played a major role, with government staff, health workers, and community cadres learning about long-term care, case management, and common conditions affecting older people. Cadres already active in villages proved especially important, as they were more likely to stay in their roles over time if properly trained and compensated.

The pilot also revealed clear challenges. Volunteers cannot carry complex responsibilities indefinitely without pay, and shortages of transport, assistive devices, and home modifications limit effective care. Governance remains a key issue, as no single national agency is yet responsible for long-term care. Still, the model has shown enough promise that local governments, particularly in Yogyakarta, have begun replicating and adapting it.

As Indonesia grows older, the question is no longer whether long-term care is needed, but how it should be delivered. The Community Care Hub model offers a simple but powerful answer: care that is local, coordinated, and rooted in community life, allowing older Indonesians to age with dignity, support, and connection where they belong.