ILLUSTRATION: SHUTTERSTOCK
NEPAL HAS found a nasty trick: export its working-age population and import much of the cash they earn. The arrangement has helped millions of households pay for food, medicines, education and housing. It has also bred a disaster: the people sending money home are often the exact same people their ageing parents will need beside them—and they are thousands of miles away.
The numbers are grim enough. Nepal’s 2021 census counted 2.98m people aged 60 or above, about 10.2% of the population. Almost one household in four had at least one member living abroad. The average household had shrunk to 4.37 people, down from 4.88 a decade earlier. The traditional arrangement, in which adult children live with parents and provide care, is rotting away.
This is an economic catastrophe disguised as a family matter. A son sweating in Qatar can send money for his father’s medicines. A daughter in Australia can pay for a nurse to visit her mother. But money cannot reliably replace someone who notices an elderly parent has stopped eating, drags them to a clinic or helps them out of bed.
Remittances are a powerful financial cushion. The World Bank puts inflows at 35.8% of GDP in the fiscal year ending July 2026, among the highest levels on the planet Earth. More than half of Nepali households lean on remittances, according to the IMF. Yet these transfers are built around the needs of households and the earning lives of migrants. They rarely land as a dedicated budget for long-term care.
The cost of ageing is also different from the cost of an ordinary household bill. A monthly transfer can cover groceries and electricity. Care involves unpredictable, ugly expenses: a hospital visit, regular medicines, rehabilitation after a stroke, or someone to help with daily tasks. As chronic illnesses pile up, the need for support can drag on for years. Families pay as problems erupt, rather than plan for a long, grinding period of dependence.
The state offers a pathetic floor. Nepal’s senior-citizen allowance pays Rs4,000 a month to eligible older people, with eligibility generally beginning at 70 and at 60 for specified groups, including Dalits and residents of the former Karnali zone. The payment helps with everyday expenses but cannot finance sustained personal care. Nepal’s pension system also covers some workers through contributory schemes, though many people who spent their lives in informal work have zero employment-based retirement income.
That leaves families to assemble their own care system—a ramshackle, ad-hoc mess. A relative may move in with an older parent. A neighbour may check on them. A migrant may pay a local person to help with shopping or household work. These arrangements can work but they are informal and wildly uneven. The burden often falls on women left behind in the village, including daughters-in-law and older daughters, whose unpaid work rarely appears in household accounts.
The economic cost is easy to overlook and brutal to bear. A woman caring for an elderly parent may cut her own paid work. A family may sell land to meet medical bills. Migrants may take extra shifts or postpone returning home because the money they send has become essential. The same migration that raises household income creates fresh expenses and obligations back home.
There is a market opportunity here, though Nepal has yet to build much of a market. Home nursing, day-care centres, assisted living and reliable transport to medical appointments could create paid work while making care more accessible. But such services demand trained staff and a way for ordinary households to afford them. A private care home in Kathmandu is useless to an older person in a remote hill district whose children live overseas.
The government has begun to smell the problem. A draft National Policy on Senior Citizens released for consultation in July proposes keeping families as the first line of support while giving local governments a larger role in community-based care. It envisages day-care centres, home healthcare, rehabilitation and services designed around older people. The policy also treats institutional care as a last resort. Its central challenge is implementation: local governments vary wildly in money, staff and capacity.
The country needs to start measuring care as an economic service rather than treating it as a private family duty. Local governments could identify older residents living alone, organise regular health checks and maintain registers of people who need daily assistance. Training care workers would create employment at home, potentially giving some young Nepalis an alternative to fleeing. Social protection could also be designed around the costs of disability and long-term care, rather than relying on a flat monthly allowance that barely covers the basics.
There is a further question for migrants and their families: how should money sent home be divided between immediate household needs and the future cost of care? Savings plans, insurance and pension products could help, but only if they are affordable and accessible to workers abroad and their parents at home. A remittance transfer is a poor substitute for a care plan.
A country that depends on its children working abroad must build services for the parents they leave behind. Otherwise the household receives the income from migration while absorbing its most personal cost. ■
