发展创新的社区长期护理系统和服务：印度尼西亚试点项目的经验教训（英）

DEVELOPING ACOMPREHENSIVELONG-TERM CARESYSTEM FOROLDER ADULTS INDONESIA Indonesia has a population of282 million, with60%of its people living in urban areas. Althoughthe country’s population is relatively young, it is alsoaging due to a declining birth rate and increasinglife expectancy. By 2045, people aged 60 years andabove are predicted to account for almostone-fifth(19%) of the total population. Services for older people exist, butthey are inadequate to meet evencurrent demand. Most care of olderpeople is provided voluntarily by familymembers, including spouses and adultchildren, with limited access to formalcare support at home, in the localcommunity, or in institutional facilities. From 2022 to 2024, a regional technicalassistance project by the Asian DevelopmentBank sought to pilot innovative community-based long-term care in selected countries,including in Indonesia, based on the principles of supporting aging in place, building on localcommunity assets, and providing integrated holistic servicesthat meet the diverse needs of older people and their familiesto deliver person-centered care. The pilot provided proof of concept that a community-based long-term care model can galvanize and build upon existing servicesand help fill the gaps. Local governments are replicating the modelbeyond the pilot sites, taking the core principles, components andservices from the pilot, and adapting them to the local context. CONTENTS Figures and Tablevi Abbreviations A Vast Country withShifting Demographics Existing Long-TermCare in Indonesia Community CareHub Activities A Community-BasedCare Pilot Training Programsfor Long-Term Care12 Conclusionand Lessonsfrom the Pilot Indicative PathsForward20 Recommendationsfor Replication andScale-Up This case study was developed under the regional technical assistance forDeveloping InnovativeCommunity-Based Long-Term Care Systems and Services, financed by the High-Level TechnologyFund, Japan Fund for Prosperous and Resilient Asia and the Pacific, Japan Special Fund, and ADB’sTechnical Assistance Special Fund-6. The document was peer-reviewed by Ye Xu, senior healthspecialist, Human and Social Development Sector Office, Sectors Department 3, ADB. The draftreport was also reviewed by Dwi Rahayuningsih, Poverty Alleviation and Community Empowerment,Ministry of National Development Planning/National Development Planning Agency (Bappenas). In this publication, “$” refers to United States dollars.On the back cover: Population aging in Asia and the Pacific creates an urgency to develop long-termcare systems and programs for older people (photo by ADB). Creative Commons Attribution 3.0 IGO license (CC BY 3.0 IGO) © 2026 ADB. The CC license does not apply to non-ADB copyright materials in this publication.https://www.adb.org/terms-use#openaccesshttp://www.adb.org/publications/corrigendaPublication Stock No. ARM250570-2pubsmarketing@adb.org Figures and Table FIGURES 1The Integrated Care Model for Older Adults52Community Care Hub Activities93Case Management Flow10 TABLE Training Programs 13 Abbreviations ADB–Asian Development BankCCH–community care hubLTC–long-term careNGO–nongovernment organization A Vast Country withShifting Demographics Indonesia is home to 282 million people, almost 60%of whom live in urban area.1Although the country’spopulation is relatively young, it is also aging, due toa slower birth rate and increasing life expectancy.2It is predicted that by 2045, people aged 60 yearsand above, will account for almost a fifth (19%)of the total population, with Java aging faster thanother islands.3The increasing aging of the Indonesianpopulation calls for greater attention to the country’s long-term care (LTC) needs. Services for older people exist, but theyare inadequate to meet even current demand. The Government of Indonesiaacknowledges this shortfall and has taken steps to address this by developingpolicies. However, like other countries in Asia and the Pacific, Indonesia isgrappling with implementation of sustainable, affordable LTC systems andservices that effectively incorporate government institutions, the private sector,civil society, communities, and older people. Existing Long-TermCare in Indonesia A 2021 diagnostic study of LTC in Indonesia conducted by the AsianDevelopment Bank (ADB) found that approximately 3.0% of older people totallydepended on others for their daily care, a further 7.2% had difficulty with activitiesof daily living or instrumental activities of daily living, and 19.7% have somedifficulty. On these, women experienced higher rates of difficulty than men.4 The Indonesia Longitudinal Aging Survey 2023,which ADB supported, found that most care ofolder people is provided voluntarily by familymembers or domestic helpers, who have limitedaccess to formal care support at home; in the localcommunity, or in institutional facilities, regardlessof the older people’s age. Daughters (31.5%),spouses (29.3%), and sons (21.7%) mak