Nepal has a concept called "SEWA" for building community. "SEWA" carries the sense of looking after others and is a custom deeply rooted in Nepalese society. In Nepal, where family bonds have traditionally been strong, SEWA culture developed naturally. Home-based care has been the norm for elderly care, and a family-centered society has been the ideal for Nepalese people.

Meanwhile, as modernization progresses in Nepal as well, ordinary people's ways of life are gradually changing. Family structures that place importance on the family are also shifting with the times, and the rise in nuclear-family and elderly-only households—from extended families—shows that Nepal too is moving toward an aging society.

Recently, modern elderly welfare facilities have been gradually increasing, and new forms of care other than home care have begun to be introduced. Compared with traditional care that has become customary, however, ordinary people's awareness has not yet reached the point of actively using rational facility-based care. For both older adults and their families, facility care still requires time for emotional preparation and financial readiness.

Introduction of Nepal's Social Welfare System

The increase in modern elderly welfare facilities shows that contemporary Nepal is advancing toward an aging society, and proposals for a shift from conventional family care to new forms of care are beginning to emerge.

In 2006, Nepal enacted its first Senior Citizens Act and introduced a social welfare system for older adults.

Care for older adults in Nepal is grounded in community with family and neighbors, but the enactment of the Senior Citizens Act has also made it possible to operate elderly welfare facilities more widely.

There are 70 elderly welfare facilities and nursing homes in Nepal (from the 2010 Senior Citizens Status Report). Facilities are operated by the government, medical foundations, the private sector, individuals, volunteers, and others.

Eligibility for admission to elderly welfare facilities is age 60 or older, targeting older adults who have suffered physical or mental abuse and those without employment. Fees may be free, donation-based, or membership-based, and some residents pay costs covering them through the end of life.

Awareness of elderly welfare facilities has spread among some affluent users, parents of Nepalese living abroad who remain in Nepal, and Nepalese who have experienced care work overseas, and facility-based care is becoming another option for supporting older adults.

Toward New Lifestyles: Changes in Family Structure

Behind the increase in elderly welfare facilities in Nepal is a major influence from changing attitudes, mainly among younger people and Nepalese with international connections, amid modernization.

The new lifestyle desired by Nepal's younger generation is not traditional but a Westernized consumer lifestyle. Young people leave their family homes and move from rural areas to cities, while Nepalese with strong aspirations for life abroad head from Nepal overseas.

Young Nepalese aiming overseas as foreign workers have two major reasons: the goal of earning money, and breaking free from traditional Nepalese society—they keep moving outward in pursuit of a new ideal.

As younger generations leave Nepal, the traditional extended-family structure is shifting toward nuclear families. With more older adults left without family and unable to receive care at home, the spirit of SEWA culture is gradually being lost.

Nepal's "SEWA" Culture

"SEWA" is a long-standing concept that supports community in Nepalese society, meaning something like "looking after" others, similar to the Japanese sense. In Nepal's strongly religious society, it is a way of thinking about living in coexistence and mutual prosperity—in care and support, and in social relationships between people.

Nepal's traditional lifestyle is living from birth to death by supporting one another within the extended-family community. As a natural result, elderly care has been passed down as something done by the family rather than by facilities.

Also, in Nepalese communities there is an environment and custom of casually checking in on those nearby, so in elderly care as well, help can come not only from family but from interaction with neighbors—here Nepal's "SEWA" culture is strongly reflected.

Population Distribution Forecasts and Nepal's Aging

Changes in Nepalese society surrounding older adults also appear in shifts in Nepal's population distribution. In figures used to forecast aging, Nepal's elderly rate is 5.91%, and it is not currently classified as an aging society.

However, looking at past trends in Nepal's population distribution, a relatively balanced structure was maintained through the 1990s, but from 2000 the youngest age groups declined, and by 2010 middle-aged and older groups increased while the number of children began to fall—signs of a future aging society.

◆ Nepal's population distribution in 2021

・Total population 29,674,920 100%

・Youth population 8,328,170 28.06%

・Working-age population 19,592,653 66.02%

・Elderly population 1,754,097 5.91%

◆ Definitions of an "aging society" by the World Health Organization (WHO) and the United Nations

A society with an aging rate exceeding 7% is an "aging society"

A society exceeding 14% is an "aged society"

A society exceeding 21% is a "super-aged society"

In closing

In an era when rational methods are more readily chosen than traditional thinking, care likewise demands rationality, functionality, and efficiency. Yet the fundamental concept essential to care—"looking after others"—remains unchanged.

In Nepal today, many older adults still spend their final years under family care, and the era in which SEWA culture remains continues.

Looking ahead, as facility-based care becomes more widespread in Nepal as in developed countries, the question is how care that retains the Nepalese spirit of looking after others will be built—maintaining SEWA culture and care that feels true to Nepal is hoped for.