Middle East & Africa Long Term Care Market Outlook, 2031

Market Drivers

• Accelerated demographic aging and rising care dependency: The Middle East & Africa region is undergoing a significant demographic transition, with the older population in South Africa growing from 3.6 million in 2002 to 6.6 million in 2025, an increase of 3 million people over 23 years. The rise is driven by falling fertility rates, longer life expectancy, and better living conditions, with ageing indices climbing across all population groups. In the United Arab Emirates, the population aged 65 and above reached 206,350 in 2025, representing a 6.3% increase from the previous year and a 61.25% increase over a decade. Israel's population aged 65 and over is expected to grow from about 12% in 2022 to about 14% in 2040, with the proportion of those aged 80 and over who constitute about 57% of those eligible for first-tier payments expected to increase from about 3% to about 5% over the same period. The prevalence of chronic conditions, cognitive decline, and functional impairment among these rapidly growing older populations creates sustained and intensifying demand for long-term care services across all care settings.
• Policy reforms and government investment in care infrastructure: Governments across the Middle East & Africa region are implementing significant policy reforms to address the growing demand for long-term care. South Africa's Parliament has advanced the Older Persons Amendment Bill, which aims to amend the Older Persons Act of 2006 to insert new provisions relating to the monitoring and evaluation of all services to older persons, and to provide for the removal of older persons to temporary safe care without a court order. The United Arab Emirates launched the National Framework for Healthy Ageing 2025–2031, developed in collaboration with the World Health Organization, targeting individuals aged 60 and above with comprehensive healthcare alongside social and psychological support systems. The Barakatna initiative, launched by the UAE President in April 2025, aims to enhance the quality of life for senior citizens within Abu Dhabi's comprehensive community care ecosystem, with key services including temporary alternative care for senior citizens and extension of housing loan repayment periods by an additional five years to ease financial burdens on caregivers. Saudi Arabia has launched multiple initiatives designed to enhance the quality of life of the elderly and safeguard their rights, focusing on strengthening social care homes and clarifying admission requirements, alongside the specialized programs and services provided by the Ministry of Health. These policy developments are reshaping the financing, delivery, and regulation of long-term care services across the region.
• Shift toward home and community-based care: Across the Middle East & Africa region, long-term care delivery is increasingly shifting toward home and community settings, driven by the strong preference of older persons to age in place and government policies promoting community-based care. In South Africa, the National Policy Dialogue on Elder Care, convened in June 2025, examined the realities of elder care and explored practical pathways for policy reform across five key themes: social protection for family caregivers, subsidised care materials, the built environment, mental health and dignity in care, and home-based care services. In the UAE, the Barakatna initiative seeks to improve the efficiency of home care provided to senior citizens in a suitable family setting, aiming to ensure a stable, healthy, and fulfilling life for senior citizens within their families. In Israel, most long-term care services are provided in the community rather than in institutions or nursing homes, reflecting the perception that aging at home or in one's social and family environment is preferable, both socially and health-wise. Saudi Arabia's home care program is designed to ensure continuous follow-up for elderly individuals within the family environment. The convergence of demographic pressure, policy reform, and beneficiary preference is creating sustained demand for home healthcare services across the region.

Market Challenges

• Limited formal care infrastructure and heavy reliance on unpaid family caregiving: The Middle East & Africa region's long-term care infrastructure remains severely underdeveloped relative to the scale of the aging population, with a heavy reliance on unpaid family caregiving. In South Africa, despite progressive legislation, most long-term care for older persons is provided quietly within households, carried largely by unpaid family members and under-resourced community organisations, and the country's elder-care policies exist but implementation is fragmented, uneven, and underfunded. Households headed by older persons rose from 19.3% in 2002 to 20.6% in 2024, with extended-family homes making up more than 50% of these households, well above the national average of 31.7%. In the UAE, the National Framework for Healthy Ageing 2025–2031 represents a significant step forward, but the country's relatively young demographic profile means formal care infrastructure is still developing. In Israel, the private long-term care insurance market has faced significant challenges, with insurance companies not submitting proposals to renew group policies for members of the Clalit health fund in December 2024, raising concerns about the continuity of coverage for policyholders. This infrastructure deficit, combined with the heavy burden on families, creates significant access barriers and quality challenges across the region.
• Severe workforce shortages and precarious working conditions: The Middle East & Africa region faces a critical shortage of trained long-term care workers, with the demand for caregivers projected to increase substantially across all countries. In South Africa, the care workforce is characterised by precarious working conditions, limited training opportunities, and a disproportionate burden on women. The report of the National Policy Dialogue on Elder Care highlights the urgent need for stronger support for caregivers and community services, arguing that recognising caregiving as a public good is essential if older persons are to age with dignity. In Israel, long-term care spending is the fastest-growing public health expenditure, driven by the aging process, rising service costs (particularly caregiver wages), and increased demand for higher quality services due to improved living standards. In the GCC states, the reliance on migrant labour for caregiving creates additional vulnerabilities, with the workforce facing challenges related to recruitment, retention, and professionalization. The lack of professionalisation, low wages, and limited career development opportunities contribute to high turnover and recruitment challenges across the region.
• Rising care costs and financial sustainability pressures: The cost of long-term care continues to rise across the Middle East & Africa region, creating significant financial sustainability challenges for both governments and households. In Israel, national expenditure on long-term care amounted to approximately NIS 24 billion in 2022 (about 1.25% of GDP), with about 70% being public expenditure and the rest private. The rapid increase in payments by the National Insurance Institute and insurance companies in both the public and private tiers has raised concerns about the financial sustainability of the system, with the Capital Market, Insurance, and Savings Authority intervening in 2023-2024 to tighten the conditions for recognizing insurance claims and reduce payouts. In South Africa, grants are the main income source for 60.1% of older-person-headed households, followed by salaries and wages at 21.0%, while medical aid coverage among older people edged up to 21.9% in 2024, still higher than the national rate but leaving the majority dependent on public hospitals and clinics, which are used by 68.5% of older persons. These cost pressures are compounded by limited public reimbursement rates, rising labour costs, and the absence of dedicated long-term care financing mechanisms across most countries.

Market Trends

• Technology adoption and digital transformation: Middle East & Africa countries are increasingly adopting technology to address workforce shortages and improve care quality. In the UAE, the National Framework for Healthy Ageing 2025–2031 includes the "Ambassadors of Healthy Ageing" programme, developed in partnership with the Abu Dhabi Public Health Centre and the Ministry of Sports, which recruits socially active, middle-aged individuals who embody healthy lifestyles to serve as community advocates promoting positive health messages and serving as real-life examples of ageing with vitality, dignity, and wellbeing. The campaign specifically targets early detection of functional, physiological, and cognitive changes associated with ageing, whilst creating supportive environments that combat social isolation and promote mental health. In South Africa, the Department of Social Development is implementing community-based care models and proposed solutions including improved caregiver training and public awareness campaigns, alongside policy changes to simplify the Grant-in-Aid application process. In Israel, the National Insurance Institute and health maintenance organizations are exploring digital platforms for care coordination and remote monitoring, though the private insurance market faces significant challenges with the sustainability of group policies.
• Growth of private sector investment in senior living: Private sector investment in senior living and long-term care is growing across the Middle East & Africa region, driven by favourable demographics and the recognition of long-term care as an investable asset class. In South Africa, formal housing among older persons increased from 75.8% in 2002 to 91.3% in 2024, and access to electricity, sanitation, and internet advanced sharply, with internet access reaching 86.6% in 2024. In the UAE, the Barakatna initiative brings together multiple government entities including the Department of Community Development, the Family Development Foundation, the Abu Dhabi Housing Authority, the Department of Municipalities and Transport, the Department of Government Enablement, and the Abu Dhabi Real Estate Centre, creating a comprehensive ecosystem for senior living and care services. In Saudi Arabia, the government is strengthening social care homes and providing assistive devices such as wheelchairs, medical beds, and hearing aids, alongside the home care program designed to ensure continuous follow-up for elderly individuals within the family environment. The "silver economy" is being recognised as a significant growth opportunity across the region.
• Expansion of community-based care models and integrated service delivery: The shift toward community-based care is accelerating across the Middle East & Africa region, driven by beneficiary preference, government policies, and the relative cost-effectiveness of home care. In South Africa, the National Policy Dialogue on Elder Care brought together government departments, civil-society organisations, researchers, service providers, and caregivers to examine the realities of elder care and explore practical pathways for policy reform, with discussions across five key themes revealing a central challenge: South Africa's elder-care policies exist, but implementation is fragmented, uneven, and underfunded. In the UAE, the Barakatna initiative aims to reinforce family ties and cohesion by developing an integrated system of community services designed to ease everyday life, empower individuals to care for their senior relatives effectively, and help caregivers achieve a balance between their personal, professional, and social responsibilities. In Israel, the Long-Term Care Insurance Law establishes key principles of universal insurance-based coverage for eligible individuals, family support rather than replacement, and in-kind service provision through home caregivers rather than cash benefits. The convergence of government policy support, private sector investment, and technological innovation is creating the foundation for more comprehensive long-term care ecosystems across the region.

Policies

• South Africa's Older Persons Act of 2006 (Act No. 13 of 2006) provides the legal framework for long-term care, with the explicit objective of shifting the emphasis from institutional care to community-based care to ensure that older persons remain in their homes and communities for as long as possible. The Act regulates the registration, establishment, and management of residential facilities for older persons and provides for the combating of elder abuse. The Older Persons Amendment Bill, recently passed by Parliament, aims to insert new provisions relating to the monitoring and evaluation of all services to older persons, and to provide for the removal of older persons to temporary safe care without a court order.
• The United Arab Emirates' National Framework for Healthy Ageing 2025–2031, developed by the Ministry of Health and Prevention in collaboration with the World Health Organization, targets individuals aged 60 and above and offers comprehensive healthcare alongside social and psychological support systems. The framework harmonises with the WHO's Global Strategy and Action Plan on Ageing and Health, positioning the UAE as a regional leader in elderly care innovation, and aligns strategically with the UAE's forward-looking national agendas including UAE Centennial 2071.
• The Barakatna initiative, launched by UAE President His Highness Sheikh Mohamed bin Zayed Al Nahyan in April 2025, aims to enhance the quality of life for senior citizens within Abu Dhabi's comprehensive community care ecosystem. Under the supervision of the Department of Community Development, the initiative seeks to improve the efficiency of home care provided to senior citizens in a suitable family setting. Key services include the Temporary Alternative Care Service for Senior Citizens in cases where family members are unable to fulfil caregiving responsibilities, and the Extending the Term of Housing Loans service to extend housing loan repayment periods by an additional five years to ease financial burdens on caregivers.
• Saudi Arabia's Ministry of Human Resources and Social Development provides comprehensive care for the elderly, covering health, social, and psychological aspects, through 12 social care homes across the Kingdom. The Ministry extends financial and in-kind assistance to needy elderly persons and their families through the Social Security Agency, and provides assistive devices such as wheelchairs, medical beds, and hearing aids. The home care program is designed to ensure continuous follow-up for elderly individuals within the family environment. The Kingdom also offers the Taqdeer service, launched by the Civil Affairs Agency, to facilitate distinguished services tailored to the needs of the elderly.
• The World Bank has published a phased approach for long-term care development in the Middle East and North Africa, organised around four pillars: governance, financing, workforce, and service delivery. The approach requires establishing national LTC strategies, standardized needs assessment tools, and cross-sectoral coordination mechanisms, alongside progressively introducing quality regulation as formal services develop. The paper draws on international evidence from countries such as Germany, South Korea, China, and Chile.
• The South African National Policy Dialogue on Elder Care, convened in June 2025, brought together government departments, civil-society organisations, researchers, service providers, and caregivers to examine the realities of elder care and explore practical pathways for policy reform. Discussions across five key themes social protection for family caregivers, subsidised care materials, the built environment, mental health and dignity in care, and home-based care services revealed a central challenge: South Africa's elder-care policies exist, but implementation is fragmented, uneven, and underfunded. The report highlights the urgent need for coordinated national leadership, sustainable financing, and stronger support for caregivers and community services.