For many women in Chile, long-term care is not encountered first as a formal service. It appears as time. A mother needs more help after a fall. A husband develops a disabling condition. An older relative can no longer be left alone safely. Tasks are absorbed into everyday life, often without a formal decision that somebody has become a caregiver. Paid work may be reduced, journeys reorganized and personal time compressed around the needs of another person.
This is why the care economy cannot be separated from the development of Chile’s long-term care system. The country’s Aging, Long-Term Care & Community Support Knowledge Hub for Chile examines a system moving toward stronger recognition of care as a social right. Within that transition, gender matters because the starting distribution of care is not equal.
Chile’s 2023 Encuesta Nacional sobre Uso del Tiempo (ENUT) found that, among people undertaking unpaid work in the main urban areas covered by the survey, women spent an average of 4 hours 57 minutes a day on it, compared with 2 hours 52 minutes for men. Unpaid work in the survey extends beyond long-term care to domestic work, care within the household, voluntary activity and assistance to other households, so those figures should not be read as long-term care hours alone. Their significance lies in the wider pattern: women continue to carry substantially more unpaid work.
Chile’s response is increasingly explicit. Law No. 21.805, which created the Sistema Nacional de Apoyos y Cuidados (SNAC), embeds both social and gender co-responsibility in the architecture of Chile Cuida. The strategic question is therefore no longer simply whether unpaid care should be valued. It is whether formal policy, services, employment arrangements and household behavior can redistribute it.
The care economy extends beyond the formal care sector
A conventional view of the care economy can underestimate its scale because it begins with paid services: residential facilities, home-care workers, health professionals, day services and other organizations receiving public or private funding. Yet a large amount of the activity that enables people with dependency to remain at home never appears in provider accounts.
Meals are prepared. People are assisted with bathing and dressing. Medication is collected. Appointments are coordinated. Transfers are supported. Someone remains nearby because a person with cognitive impairment cannot safely be left alone. Family members negotiate with health services, municipalities and public agencies.
These activities have economic consequences even where no money changes hands. Time used for care cannot simultaneously be used for paid employment, education, rest or other productive activity. Households may purchase equipment, transport or private assistance. Employers may experience reduced hours or employees leaving work. Public systems can appear less costly because families are absorbing functions that would otherwise require formal provision.
Chile’s new legal framework recognizes this explicitly. Law No. 21.805 defines unpaid caregiving and recognizes it as work and labor with a social and family function that contributes to the country’s economic and social development. It also requires the State to use instruments including time-use measurement and valuation of unpaid care work.
This creates an important shift in how family care and care burden can be understood. Unpaid care is not outside the care system merely because it does not generate an invoice. It is one of the resources on which the system depends.
Gender inequality is visible in the distribution of time
The II ENUT 2023 provides one of Chile’s strongest evidence bases for examining this hidden economy. Conducted in the principal urban areas across all regions, it measured how people aged 12 and over allocate time across paid work, unpaid work and personal activities.
Women undertaking unpaid work averaged 4 hours 57 minutes on a typical day, while men averaged 2 hours 52 minutes: a difference of 2 hours 5 minutes. The inequality appeared across every region, and the gender gap was particularly pronounced among people aged 25 to 44.
The survey also shows why examining unpaid and paid work separately can give an incomplete picture. Among employed people undertaking both forms of activity, the average global workload was higher for women. Paid employment does not necessarily displace unpaid responsibility on an equivalent basis; women may instead experience a longer combined working day.
This matters for long-term care reform because the objective cannot simply be to increase women’s labor-force participation while leaving the domestic allocation of care unchanged. Without greater formal support and household co-responsibility, increased paid employment can become an additional layer of work rather than a redistribution of it.
Nor should the analysis imply that men do not provide care. Many do, and changing social expectations may increase their contribution. The policy issue is structural rather than individual: women collectively continue to devote more time to unpaid work, and long-term care policy operates within that unequal starting position.
Chile has placed gender co-responsibility inside the legal design of care
Law No. 21.805 goes beyond recognizing the right to care. Its principles explicitly address the unequal distribution of care responsibilities between women and men.
The law establishes social co-responsibility, seeking a more balanced distribution of care between the State and society, including families, private actors and communities. Separately, it establishes gender co-responsibility, requiring the promotion of greater equality in the distribution of care responsibility between women and men. It also incorporates the transversal application of a gender perspective across the design, implementation, monitoring and evaluation of care policies, programs and actions.
These principles matter because they distinguish two different forms of redistribution.
- Redistribution from households to the wider care system: more formal services, community support and public responsibility can reduce the amount families are expected to absorb.
- Redistribution within households: care responsibilities can be shared more equally between women and men rather than formal support simply making an unequal family arrangement slightly more manageable.
- Redistribution across the economy: employers, public institutions, private organizations and communities can design working and social arrangements that recognize care as a shared responsibility.
These dimensions are related but not interchangeable. A household can receive additional home support while the remaining unpaid tasks still fall almost entirely to a daughter. A man can take on more family care while the household still lacks sufficient formal services. Genuine co-responsibility requires progress across several levels.
A woman can be economically active and still carry the default care role
Consider a 49-year-old woman in Santiago who works full time and supports her 78-year-old mother, who has increasing mobility difficulties and needs assistance with shopping, appointments and some personal tasks.
Her brother lives nearby and describes himself as available to help. In practice, however, she holds the organizational responsibility. The primary-healthcare center calls her. She arranges transport. She knows the medication list. When an appointment changes, she reorganizes her working day. Her brother helps when asked, but she performs the work of identifying what needs to happen and assigning it.
The difference is not captured by counting only hours of direct personal care. There is also a coordination burden: remembering, anticipating, monitoring and being the person expected to respond.
If additional formal support becomes available through the local care system, the assessment should therefore examine more than the mother’s physical tasks. It should identify how responsibility is distributed across the household and whether the intervention changes that pattern.
A home-support visit that replaces two practical tasks may reduce workload. A coordinated care plan that means the daughter no longer has to negotiate separately with multiple services may reduce the invisible administrative component as well.
This is one reason home- and community-based support should be assessed through its effect on the wider household, not merely the number of visits delivered.
Recognition is important, but redistribution is the harder policy test
Chile has made significant progress in making caregivers administratively visible. The care component of the Registro Social de Hogares allows unpaid caregivers to be identified, and the caregiver credential provides preferential access across participating services and benefits.
Visibility matters. Work that is not identified is difficult to plan for, value or support. Recognition can also challenge the assumption that care performed within families is simply a private obligation.
Yet there is a risk that recognition becomes an endpoint. A system could become increasingly effective at identifying women as caregivers while leaving the gender distribution of work largely unchanged.
The stronger policy question is therefore not simply “How many caregivers have been registered?” but “What changed after they were recognized?”
Relevant outcomes include whether formal services replaced some unpaid hours, whether the caregiver regained predictable free time, whether employment or education became more sustainable, whether care was shared more evenly with others and whether physical or emotional overload declined.
The Community Impact Report Builder offers organizations examining comparable questions a way to structure evidence about household and community effects alongside conventional service activity. It is not a Chilean policy instrument, but the underlying principle is relevant: care reform should demonstrate social impact beyond the number of people enrolled.
Long-term care services can function as gender infrastructure
Formal care services are usually discussed in terms of the person receiving support. A domiciliary worker helps an older person remain at home. A day center maintains activity and social participation. A rehabilitation intervention supports function. These are legitimate person-centered objectives.
But the same service can also change the distribution of unpaid labor.
If a worker reliably assists with personal care each morning, a daughter may be able to start paid work at a predictable time. If an older person attends a community day service twice a week, a spouse may gain periods without continuous supervision. If rehabilitation helps someone recover mobility after illness, both their own independence and the amount of assistance required from relatives may improve.
Services such as the Red Local de Apoyos y Cuidados therefore have economic and gender effects as well as care outcomes. The extent of those effects depends on service intensity, reliability and targeting.
A single occasional visit may provide useful support without materially altering a caregiver’s economic choices. Regular assistance at the times of greatest burden can have a much larger effect. This connects long-term care capacity with preventative value and early intervention: support provided before a caregiver leaves employment or reaches exhaustion may preserve options that become much harder to restore later.
Community care infrastructure should therefore be understood partly as enabling infrastructure for economic participation. Roads enable people to travel to work; childcare enables many parents to participate in employment; long-term care can perform a similar function for adults supporting relatives with dependency.
The economic cost of care can accumulate across a woman’s life
The effect of unpaid care is not limited to income lost during the period in which care is provided. Decisions can accumulate over a working life.
A woman may first reduce hours to care for children, later provide support to a disabled family member and eventually care for aging parents or a partner. Each episode can affect earnings, training, progression and pension contributions.
This life-course perspective is particularly important in an aging society. Longer lives are a social achievement, but they also increase the probability that families will experience periods of sustained support need. At the same time, smaller households and demographic change may mean fewer relatives are available to distribute care between.
Law No. 21.805 incorporates a life-course principle, requiring care needs to be considered in relation to the stage of life of both people receiving and providing care. Gender analysis adds another dimension: repeated caregiving episodes may interact with inequalities already accumulated through employment and income.
Long-term care reform can therefore contribute to economic autonomy by reducing the extent to which family dependency automatically translates into female labor-market withdrawal.
It cannot remove every trade-off. Some people will choose to provide substantial family care even where formal services are available. Rights-based policy should preserve that choice. The objective is to ensure that intensive unpaid care is not the only realistic option because affordable alternatives do not exist.
Leaving employment can appear voluntary when the alternatives are inadequate
Imagine a 41-year-old woman in Valparaíso whose father develops severe functional dependency after a stroke. She works in retail and has limited control over her shifts. Her sister lives in another region, and her father cannot safely remain alone for long periods.
At first she uses annual leave and exchanges shifts with colleagues. After several weeks, the arrangement becomes unstable. She considers resigning.
On paper, leaving employment would be her decision. In reality, the decision is shaped by the care options available to the household, their affordability, timing and reliability.
A coordinated response could combine rehabilitation and primary healthcare with an assessment through the relevant local care pathway, equipment and home support. If reliable assistance covers enough of the working day, remaining employed becomes possible. If only brief or irregular support is available, the formal service may not alter the economic decision.
The scenario illustrates why service capacity needs to be measured against the outcome it is expected to enable. If gender co-responsibility is an objective of the national system, decision-makers need to understand whether available support is sufficient to change the choices confronting caregivers.
It also demonstrates why system capacity and flow extend beyond hospitals and provider waiting lists. Insufficient long-term care capacity can shift costs and labor directly into households.
The paid care workforce is also gendered
Redistributing care from households into formal services does not automatically remove its gender dimension. Care work itself is commonly female-dominated, and expansion of formal services can transfer tasks from unpaid women to paid women.
That can still represent significant progress: paid employment provides income and formal recognition that unpaid family labor does not. But the quality of that employment matters.
If long-term care expansion depends on low pay, insecure hours, fragmented schedules and limited career progression, the care economy may reproduce inequality in a different form. Workforce strategy therefore needs to sit alongside caregiver policy.
Chile’s legal definition of paid caregivers recognizes contractual care across home-based, residential and remote services, while health-related care functions remain connected to the relevant professional, technical and auxiliary health roles. As SNAC expands, the boundary between general assistance, skilled care and health functions will require operational clarity.
Professionalization can include:
- clear competencies for different care roles;
- accessible training and certification;
- supervision appropriate to the complexity of support;
- career pathways that allow progression rather than trapping workers in low-status roles;
- scheduling that recognizes travel and continuity in home-based care; and
- employment conditions capable of attracting and retaining workers as demand increases.
These issues connect with wider aging workforce and care-team design. Expanding formal care without building a sustainable workforce would limit the system’s ability to reduce unpaid burden.
Professionalization should not create a new expectation that women simply become paid caregivers
Chile’s recognition of caregiver skills creates potential pathways from unpaid experience into training, certification and employment. For some women, this could create genuine economic opportunity.
Someone who has supported a relative for years may have developed substantial practical capability. Formal recognition can prevent those skills from being treated as economically invisible.
But policy needs to avoid a circular assumption: because women have historically provided unpaid care, their natural labor-market destination is paid care.
Economic autonomy requires choice across the economy, not merely movement from unpaid caregiving into low-paid formal caregiving. Training policy should therefore enable caregivers to translate experience into care-sector employment where they want to, while also supporting routes into other occupations.
This is particularly important after long periods outside paid employment. Returning workers may need digital skills, updated qualifications, confidence-building, flexible training or employment support unrelated to care.
The principle of co-responsibility should ultimately expand women’s options rather than define them through the caregiving roles they have previously performed.
Men’s participation is part of long-term care reform
Reducing the gender imbalance in care cannot be achieved only by providing more services to women who already carry it. Household and social expectations also need to change.
Law No. 21.805 requires public and private bodies, within their areas of competence, to promote social, gender and parental co-responsibility among workers, alongside reconciliation of personal, family and working life, rest and self-care.
This creates a broader policy environment in which men’s participation in care can be treated as normal rather than exceptional.
Employment arrangements matter. A man who expects negative career consequences for changing hours to support an older parent may leave the responsibility to a sister whose employment is already more flexible. Household decisions then reproduce labor-market inequalities, while labor-market expectations reinforce household decisions.
Formal services alone cannot resolve this feedback loop. Neither can cultural change alone compensate for insufficient care infrastructure.
The stronger model combines both: sufficient services to reduce total unpaid demand and social arrangements that distribute the remaining family contribution more equally.
That distinction is central to Chile’s concept of gender co-responsibility. The goal is not to make women more resilient at carrying an unequal load. It is to change the load itself.
Rurality can intensify the relationship between gender and care
National gender principles operate within very different territorial realities. In rural and remote areas, formal support may be harder to reach because of distance, workforce availability, transport and lower service density.
Where the formal care network is thin, families absorb more coordination and travel. A daughter may accompany an older parent to appointments many kilometers away. A caregiver may be unable to use a community service because transport takes too long. Home-support providers may have difficulty offering frequent short visits when workers spend significant portions of the day traveling.
These are service-access issues, but they can become gender issues where women are the people expected to compensate for the gap.
A uniform national service model would not necessarily produce equitable results. Territorial planning may require mobile support, stronger local capacity, transport solutions, appropriate digital services and different workforce models.
The Digital Twin Scenario Modeler can help organizations exploring comparable capacity questions test how geography, workforce supply and service intensity interact. Applied conceptually to Chile, the important point is that rural and underserved communities need to be assessed by practical access and outcomes, not simply whether a program nominally exists in the territory.
Technology can reduce coordination work, but it can also relocate it
Digital development creates opportunities to reduce some of the administrative burden surrounding care. Shared information can reduce repeated form-filling. Remote consultations can remove travel. Teleassistance can provide reassurance. Digital scheduling can make formal support more predictable.
These benefits are particularly relevant to the invisible coordination work frequently carried by family caregivers.
Yet technology does not automatically reduce workload. A new portal may require the caregiver to become the person responsible for uploading information, monitoring alerts and coordinating multiple digital channels. Remote care may eliminate a professional journey while leaving a family member responsible for setting up the consultation and remaining present throughout it.
The right question is therefore not simply whether care has become digital, but whose work the technology removes and whose work it creates.
Privacy and autonomy matter as well. Monitoring technologies in the home should support the person receiving care rather than becoming an automatic condition of reducing family supervision. Consent, proportionality and digital exclusion remain relevant.
Organizations examining these trade-offs can use the Digital Transformation, AI and Cybersecurity Readiness Assessment to structure consideration of digital capability, governance and risk. It does not determine what is appropriate within Chile, but it reinforces the need to examine technology through operational and human consequences rather than novelty.
This is the more useful interpretation of technology-enabled care: technology should increase autonomy and reduce unnecessary work, not simply digitize existing inequalities.
A care plan should make the distribution of responsibility visible
Consider an older couple living with their adult daughter in a municipality participating in Chile Cuida. The father has moderate dependency, while the mother provides most direct assistance during the day. Their daughter works but manages appointments, shopping and administrative tasks.
A conventional assessment focused only on the father could conclude that he has a functioning support network: two relatives are available, meals are provided and appointments are attended.
A gender-sensitive assessment reaches a different level of understanding. The mother is herself aging and has begun experiencing pain when assisting her husband. The daughter is using evenings and working breaks to coordinate services. A son living elsewhere contributes financially but performs little practical care.
The household is not unsupported, but its stability depends on concentrated female labor.
A stronger plan could introduce formal assistance for the tasks creating the greatest physical burden, rehabilitation to preserve the father’s function, predictable respite for his wife and clearer sharing of administrative responsibilities among family members where they agree.
Follow-up would then examine whether the intervention changed the distribution of care rather than merely adding another service around it.
This illustrates the value of reablement and restorative approaches. Improving the independence of the person receiving care can itself be a form of caregiver support because every function regained can reduce ongoing assistance.
Funding decisions determine whether co-responsibility becomes real
Gender co-responsibility has a financial dimension. Transferring a meaningful share of care from households to formal services requires public and private resources.
If a policy recognizes unpaid care but formal support remains limited, households continue financing the system through time. If publicly supported services expand but require substantial household payments, families with lower incomes may still rely heavily on unpaid provision. If service rates cannot sustain a reliable paid workforce, nominal provision may not translate into usable capacity.
The care economy therefore exposes a limitation in conventional budgeting. A lower public expenditure figure does not necessarily mean care is being provided at lower social cost. Some expenditure may simply have been displaced into unpaid household labor.
Conversely, increased spending on home care, community services, respite or rehabilitation may create benefits beyond the care budget. It can support employment, protect household income, reduce caregiver-related health problems and delay deterioration in unstable care arrangements.
This does not mean every expansion automatically produces savings elsewhere. Long-term care requires sustained resources, and demographic aging will increase demand. The stronger case is that financing decisions should evaluate who currently bears the cost and what outcomes are produced by shifting that burden.
This connects the care economy directly with budget impact and affordability. Fiscal sustainability and gender equity should not be treated as unrelated policy questions when unpaid households are already financing a significant part of care through time.
Measurement can turn gender co-responsibility into an accountable objective
One of the strengths of Chile’s approach is that the legislation does not treat gender solely as an aspirational statement. Gender perspective is expected to inform design, implementation, monitoring and evaluation.
The challenge is choosing evidence capable of showing whether redistribution is occurring.
National time-use surveys remain essential because they reveal changes that administrative service data cannot. Registration data can show how many caregivers are identified. Service records can show who received support. Employment statistics can reveal wider labor-market patterns.
Used together, a stronger evidence framework could examine:
- changes in unpaid care and domestic-work time by sex;
- caregiver burden and hours before and after receiving formal support;
- the proportion of identified principal and secondary caregivers who are women and men;
- employment, training and education participation among caregivers;
- use of respite, home support and community services by territory;
- gender composition, pay, continuity and progression within the paid care workforce; and
- whether service expansion narrows or reproduces socioeconomic and territorial inequalities.
Care is intensely personal, so measurement should remain proportionate and protect privacy. The purpose is not to prescribe how individual families divide their lives. It is to determine whether a national policy committed to gender co-responsibility is changing structural patterns.
The Quality Dashboard Builder can help organizations structure multidimensional oversight across activity, capacity and outcomes. Within Chile, the indicators themselves would need to align with official definitions and national monitoring arrangements.
Governance needs to see both service performance and economic consequences
Responsibility for the gender dimension of care cannot sit with one institution alone. The Ministerio de Desarrollo Social y Familia coordinates SNAC, while Law No. 21.805 gives the Ministerio de la Mujer y la Equidad de Género a specific role in promoting the coordination, consistency and coherence of gender-related policies, plans, services and benefits connected with support and care. Employment, education, health, housing, regional governments and municipalities also influence whether caregiving is sustainable.
This cross-government architecture is necessary because the consequences of care cross administrative boundaries.
A municipality may see demand for home support. A health service may see an exhausted caregiver. An employer sees reduced availability. The pension system may experience the long-term consequences of interrupted employment. A national time-use survey reveals the aggregate inequality that none of those institutions can see alone.
Good governance needs to connect these signals.
If women remain overwhelmingly represented among high-burden caregivers despite expanding coverage, decision-makers need to understand why. If services reach households but do not reduce unpaid hours, service intensity may be insufficient. If women move into paid care employment but turnover is high because conditions are poor, workforce policy becomes part of the gender response.
The objective is not to make every institution responsible for everything. It is to establish clear ownership while ensuring that evidence crosses institutional boundaries.
International learning: a care system can reproduce inequality even while expanding
Chile’s experience highlights a challenge relevant far beyond Latin America. Expanding long-term care provision does not automatically create gender equality.
A system can add services while continuing to assume that families fill every gap. It can professionalize care while maintaining low-status employment dominated by women. It can introduce caregiver benefits while expecting women to remain the default recipients because the household distribution of responsibility does not change.
The transferable lesson is therefore less about Chile’s particular institutional mechanisms than about the design test created by co-responsibility.
Care reform can be examined through three questions: how much responsibility remains with households, how that responsibility is distributed within households, and under what conditions formal care workers perform the responsibilities transferred to the paid sector.
Different countries will answer these questions through different combinations of taxation, social insurance, municipal services, employment rights, family benefits and provider systems. Chile Cuida is shaped by Chile’s own social-protection architecture and cannot simply be reproduced elsewhere.
What can travel is the analytical principle. A long-term care system should not be judged only by how many people receive a service. It should also be judged by whether the distribution of care becomes more sustainable, equitable and compatible with the lives of those who provide it.
Conclusion
Chile’s care reforms create an opportunity to address a form of inequality that has often remained hidden inside households. Women’s greater contribution to unpaid work is visible in national time-use evidence, but its consequences extend beyond hours. Care can influence employment, income, pensions, health, relationships and the range of choices available across an entire life course.
Law No. 21.805 gives this issue unusual policy clarity by embedding social and gender co-responsibility within the Sistema Nacional de Apoyos y Cuidados. The implementation test is now whether those principles alter the practical distribution of responsibility. Recognition and caregiver credentials matter, but redistribution requires reliable home and community services, respite, rehabilitation, employment support, sustainable paid-care roles and enough capacity to make alternatives to intensive unpaid care genuinely available.
The gender objective should not be to remove families from care or devalue relationships built around mutual support. Nor should it prescribe identical choices for every household. It should ensure that dependency does not automatically create an expectation that a woman will absorb whatever care the formal system cannot provide.
For Chile Cuida, that makes gender equality an operational measure of system maturity. A stronger care economy is one in which care remains socially valued while its time, costs, risks and opportunities are shared more fairly between women and men, families and public institutions, and unpaid and paid work.