In the 21st century, many developed countries have faced rapid population aging as mentioned in “Immigration and Caregiving: Who Will Care for Aging Boomers?” (Center for Retirement Research 2025-09-18). Particularly in Europe, Japan, and North America, the proportion of elderly people has exceeded 20–30%, and the number of seniors requiring care is increasing. At the same time, caregiving is often physically and mentally demanding work with relatively low wages, making it difficult to secure domestic labor. In response, many countries have come to rely on foreign workers—immigrants—as essential providers of elderly care. The following examples focus on Germany, Italy, Canada, and Japan, highlighting institutional frameworks, on-the-ground realities, and social debates.
Germany: Eastern European Care Workers
Germany is experiencing significant aging, making the shortage of caregiving staff a major social concern. In nursing homes and home-based care, many workers come from Poland, Romania, and the Czech Republic. Especially in the “24-hour caregiver” system, immigrant women live with elderly clients, providing personal care, household chores, and shopping, forming a crucial part of Germany’s eldercare infrastructure.
While these workers are indispensable, the system has been criticized for long working hours and insufficient labor protection. In 2021, the Federal Labor Court ruled that 24-hour caregivers must receive minimum wage, highlighting ongoing efforts to improve protections for immigrant caregivers. This illustrates both the necessity and the vulnerabilities of immigrant labor in elderly care.
Italy: Domestic Care Workers (“Badanti”)
In Italy, foreign caregivers, called “badanti,” are deeply integrated into eldercare. Most come from Eastern Europe, Latin America, or the Philippines and often live in the homes of the elderly, performing care, cleaning, and meal preparation.
Italy’s family-centered culture and relatively limited public care facilities have made the presence of immigrant caregivers widely accepted. Statistics indicate that a majority of immigrant women in Italy are employed in care and domestic work, without whom elderly care would be unsustainable.
However, many badanti work as informal or irregular laborers. Government programs in 2012 and 2020 allowed some undocumented caregivers to regularize their status, reflecting official recognition that immigrant caregivers are essential for social functioning.
Canada: Immigrant Caregiver Programs
Canada, as a country with high immigration, actively integrates immigrants into elderly care. The well-known Caregiver Program allows foreign workers to engage in eldercare or disability care, with the possibility of applying for permanent residency after several years. Filipino women, in particular, have been a major beneficiary group, supporting household and institutional care.
This program provides immigrants with a pathway to permanent residency, while simultaneously addressing Canada’s labor shortages. Nonetheless, challenges such as restrictions on live-in arrangements and insufficient worker protections prompted program reforms in 2019, including enhanced rights and family accompaniment options.
Japan: Technical Intern Training and Specified Skilled Worker Programs
Japan faces some of the most severe aging challenges globally, with chronic shortages of care workers. In response, the Technical Intern Training Program expanded in 2017 to include care occupations, and in 2019, the new “Specified Skilled Worker 1” visa was introduced. Young workers from the Philippines, Indonesia, and Vietnam now fill critical roles in nursing homes and home care facilities.
Initially, challenges included Japanese language proficiency and training gaps, but foreign caregivers have become indispensable, especially in smaller facilities in rural areas. According to the Ministry of Health, Labour and Welfare, tens of thousands of foreign workers are now employed in elderly care, and this number is expected to grow. Unlike other countries, Japan’s system does not easily allow permanent residency or family accompaniment, highlighting a gap between workforce supply and long-term integration.
Comprehensive Analysis
These cases demonstrate that immigrants are not merely supplemental; they form an essential foundation of elderly care. In Germany and Italy, immigrants complement family caregiving; in Canada and Japan, they are integrated through formal programs. Without immigrant labor, eldercare systems in these countries would face significant disruption.
However, common challenges remain. First, labor conditions are often unstable, with live-in work, long hours, or informal employment putting immigrants in vulnerable positions. Second, discrepancies exist between institutional frameworks and reality, including language and cultural barriers. Third, countries differ in whether they treat immigrant caregivers as temporary labor or as long-term social members.
Given the human dignity at stake in elderly care, it is essential not only to utilize immigrant labor but also to protect their rights and ensure sustainable integration into society.
Conclusion
Whether it is Eastern European workers in Germany, badanti in Italy, caregivers in Canada, or Technical Interns and Specified Skilled Workers in Japan, immigrants are integral to frontline elderly care. They are no longer merely auxiliary but form the backbone of eldercare systems. At the same time, challenges related to labor protections, institutional design, and social acceptance remain. As population aging accelerates, building sustainable eldercare systems in partnership with immigrant workers is an urgent policy priority for all these countries.