Care has an economic value even when nobody receives a wage for providing it. Across Costa Rica, women prepare meals, supervise relatives with cognitive impairment, assist people with disabilities, accompany older family members to appointments, manage households and reorganize paid work around somebody else's support needs. Much of this activity never appears as expenditure within the formal long-term-care system, yet households and public services depend upon it every day.
Costa Rica's own time-use evidence makes the imbalance visible. The 2022 Encuesta Nacional de Uso del Tiempo found that women spent substantially more time than men on unpaid domestic work. Care of people with dependency is part of that wider inequality, connecting the development of long-term care with women's employment, income, social-security participation and economic autonomy. These relationships are central to understanding the country's evolving system through the Costa Rica Aging, Long-Term Care & Community Support Knowledge Hub.
The Política Nacional de Cuidados 2021–2031 recognizes this connection explicitly. Costa Rica's policy ambition is not simply to increase services for people in situations of dependency. It also seeks a more equitable social distribution of care and greater opportunity for women to participate in formal employment. That makes care reform simultaneously a long-term-care issue, an equality issue, a workforce issue and an economic-development issue.
The central challenge is not to put a monetary price on every family relationship. It is to stop treating women's unpaid availability as though it were an unlimited and economically neutral resource.
Time is one of the hidden currencies of care
Economic discussions about long-term care commonly begin with public expenditure: how much government spends, what services cost and whether funding will remain sustainable as the population ages. Those questions matter, but they capture only part of the resources already supporting people with dependency.
Households contribute time.
The Instituto Nacional de Estadística y Censos (INEC) uses the Encuesta Nacional de Uso del Tiempo to measure activities that conventional labor statistics can miss. Its 2022 results showed women undertaking an average 32 hours and 4 minutes of unpaid domestic work each week, compared with 15 hours and 44 minutes for men. Women therefore spent around twice as much time on this work.
The category is broader than long-term care, covering unpaid household activities as well as direct care. That distinction matters: the figures should not be presented as though all 32 hours represented care of older or disabled people. Yet the survey also demonstrates the gendered distribution of direct caregiving. Among its findings, women providing care to totally dependent people aged 12 and over recorded particularly substantial weekly time commitments.
Time spent caring has an opportunity cost even where no financial transaction occurs. An hour supporting a dependent relative cannot simultaneously be used for paid employment, education, rest or another activity. When those hours become numerous and recurring, their cumulative economic significance can be considerable.
This is why family care and care burden need to be understood as questions of resource distribution rather than only personal wellbeing.
Costa Rica has placed gender equality inside care policy
The Política Nacional de Cuidados 2021–2031 provides an important foundation for this analysis because it does not describe care only as assistance to people with dependency.
The policy identifies the unequal distribution of unpaid care as a constraint on women's personal and economic autonomy. It argues that effective equality requires reorganization of care responsibilities between the state, market, families and communities rather than continued reliance on women within households.
Its stated objectives include reducing gender gaps in employment and creating additional care alternatives that enable women to connect with formal work. The policy also considers social-security coverage for paid caregivers and, in particular circumstances, monetary support for women in extreme poverty whose caregiving responsibilities prevent participation in paid employment.
This is an important conceptual shift. The policy question becomes not simply, "Who will look after a person with dependency?" but also, "What happens to the person expected to provide that care?"
Those two questions are inseparable.
A long-term-care arrangement cannot be considered socially sustainable merely because the dependent person's immediate needs are being met. If the arrangement requires another person to leave employment, lose income and assume intensive unpaid responsibility without meaningful choice, the cost has been redistributed rather than eliminated.
Operational scenario: reducing working hours to keep care functioning
A 48-year-old woman works full time and lives close to her 79-year-old mother. Following several falls and increasing difficulty with personal care, her mother begins needing help every morning and evening.
At first, the daughter adjusts her schedule informally. She arrives at work later on some days, uses leave for medical appointments and prepares meals at weekends. As her mother's needs increase, the arrangement becomes harder to sustain. She eventually reduces her paid hours.
From the perspective of formal care expenditure, this can look inexpensive. The mother continues living at home without a large publicly funded support package. But the economic cost has not disappeared. Part of it is now carried through the daughter's reduced earnings, weaker pension accumulation, lost career opportunities and increased exposure to financial insecurity.
A stronger response would consider whether home-based assistance, transport, day support or another suitable service could protect the mother's independence while allowing the daughter to maintain more of her employment. The daughter may still choose to provide substantial support, but that contribution becomes one component of the arrangement rather than its financial foundation.
The scenario illustrates why care-system outcomes should include more than whether institutional admission was avoided. If aging at home is achieved by forcing another household member out of paid work, the system needs to understand that trade-off.
The economic effect accumulates across a lifetime
The financial consequences of caregiving are rarely confined to the period in which intensive support is provided.
Reducing working hours immediately lowers income. Leaving employment can interrupt skills development and professional progression. Returning after several years may mean entering at a lower level or accepting work compatible with continuing family responsibilities rather than work that reflects experience or qualifications.
Formal employment also connects workers to social-security protections. Costa Rica's Caja Costarricense de Seguro Social (CCSS) plays a central role in health insurance and pensions, making sustained participation in formal employment economically important beyond the monthly wage.
Caregiving can therefore create a long economic shadow.
A woman may provide unpaid care in middle age, experience reduced earnings at the time and reach older age with weaker independent economic security. Population aging then creates an important intergenerational question: some of the women supporting today's older population will themselves become part of tomorrow's older population.
The relationship between long-term system impact and care policy consequently extends across decades. A model that depends heavily on women's unpaid work today can influence future pension adequacy, household resilience and demand for social assistance.
Poverty makes unpaid care more consequential
The opportunity cost of care is not equal across households.
A higher-income family may be able to purchase private assistance, domestic support or transport. A worker with flexible employment may adjust hours without leaving the labor market. Families with several available relatives can distribute tasks.
Lower-income households often have fewer options.
For a woman already living close to poverty, losing even a small amount of paid work can be significant. Purchasing private care may be impossible. Informal employment may provide little protection when absences are needed. Transport costs can make accessing services more difficult. The household may also have less suitable housing for supporting somebody with mobility or functional needs.
Costa Rica's National Care Policy recognizes this intersection between dependency, poverty and gender. Its design includes mechanisms intended to prioritize care support where women have potential to enter formal employment and contemplates income support in circumstances where women in extreme poverty cannot realistically combine intensive caregiving with paid work.
Implementation determines whether those ambitions change everyday experience. Eligibility rules, available service capacity, geographic coverage and the reliability of support all affect whether a woman can actually take or retain employment.
This makes care an important component of inequality and access. Two people with equivalent dependency may generate very different economic consequences according to the resources available within their households.
Formal care can operate as economic infrastructure
Childcare is increasingly understood internationally as infrastructure supporting labor-market participation. Long-term care deserves similar analysis.
A reliable home-care visit can enable somebody to start work on time. A day service may allow a family member to remain employed during the week. Respite can make sustained caregiving possible without requiring complete withdrawal from economic and social life. Personal assistance can reduce dependence on relatives while strengthening the autonomy of the person receiving support.
The value of these services therefore extends beyond the immediate care task.
Costa Rica's developing Sistema Nacional de Cuidados y Apoyos para Personas Adultas y Personas Adultas Mayores en Situación de Dependencia (SINCA) is important in this context. The wider care architecture envisages home services, personal assistance, day provision, tele-assistance and other forms of support rather than relying on a single institutional model.
When such services are accessible and reliable, they can release time previously absorbed by unpaid care. What happens to that time becomes an important outcome: it may enable employment, education, rest, family life or community participation.
Organizations examining comparable community programs can use the Community Impact Report Builder to structure evidence about effects extending beyond direct service activity. It is not a Costa Rican policy-evaluation instrument, but it can help illustrate why a care service's impact may include household and community outcomes as well as hours of care delivered.
Operational scenario: a service creates more than a care outcome
A woman in her early sixties supports her husband, who has significant physical disability following a neurological condition. She has gradually become responsible for personal assistance, household tasks, transport and coordination with health services.
She operates a small business from home but has increasingly reduced the work she accepts because her husband's needs are unpredictable.
A formal support package is introduced for several scheduled periods each week. Its immediate purpose is to assist her husband with activities he cannot complete independently. The direct outcome might therefore be recorded as hours of home support and improved continuity.
But several additional effects occur. His wife can accept more work. Household income improves. She attends her own medical appointments more reliably. The couple report less tension because some intimate care tasks are no longer concentrated entirely within their relationship.
None of those outcomes means the wife stops caring. She remains closely involved and continues providing support at other times. The formal service has changed the balance rather than replaced the relationship.
If evaluation records only service hours, much of its value remains invisible. A stronger evidence framework asks whether formal care increased the disabled person's autonomy, stabilized the household and expanded the caregiver's own choices.
This broader interpretation is particularly relevant to Costa Rica because the country's care policy explicitly connects service expansion with women's economic independence.
Care jobs can reduce inequality or reproduce it
Formalizing care does not automatically eliminate gender inequality. It can move care from unpaid women within households to low-paid women within the labor market.
This distinction is critical.
The expansion of home care and other community services creates employment. It can professionalize work that has historically been undervalued and provide families with alternatives to unpaid care. Yet if paid caregivers have insecure employment, weak social-security coverage, limited training and little opportunity for progression, the care economy can reproduce some of the inequalities it is intended to address.
Costa Rica's National Care Policy acknowledges the importance of training and formalization, including greater social-security coverage for people undertaking paid care work. The country's developing care workforce therefore sits at the intersection of two objectives: expanding support for people with dependency and creating decent, sustainable employment.
This requires attention to care-team and workforce development, not simply increasing headcount.
Training, supervision, working conditions, travel time, employment status and career pathways influence whether formal care becomes a durable occupation. They also affect quality. A service model built on unstable labor may formally reduce dependence on unpaid family care while creating unreliable support that pushes responsibility back onto families whenever workers leave or visits cannot be covered.
Redistribution has to happen inside households as well as through services
Public investment alone cannot address every gender imbalance associated with care.
Costa Rica's policy language around corresponsabilidad — shared or co-responsible care — points toward a broader distribution of responsibility. The state and formal services have a role, but so do men, employers, communities and households.
This matters because additional services can reduce the total unpaid workload without necessarily changing who performs the unpaid care that remains.
If a household receives ten hours of formal support but a woman continues undertaking nearly all remaining care while male relatives contribute little, the gender distribution has changed less than the service statistics might suggest.
Care reform therefore has both an external and an internal dimension. Externally, responsibility can shift from households toward formal services and community infrastructure. Internally, unpaid responsibilities can be shared more equitably among family members.
Public policy cannot dictate the intimate organization of every household. It can, however, avoid reinforcing assumptions that daughters, wives and mothers are the default carers. Assessment processes, public information, caregiver training and professional practice can address the whole family rather than automatically directing care discussions toward women.
Employment policy and care policy increasingly intersect
For care reform to improve women's economic autonomy, the availability of services and the structure of employment need to work together.
A home-care service scheduled unpredictably may not enable somebody to take a job with fixed hours. A day service that closes substantially before the working day ends can leave a gap that families must cover. Frequent cancellation can make employment impossible even where nominal service hours appear sufficient.
Reliability therefore becomes an economic outcome.
The Política Nacional de Cuidados envisages interinstitutional involvement including IMAS, the Instituto Nacional de las Mujeres (INAMU) and the Ministerio de Trabajo y Seguridad Social (MTSS). That is significant because no single institution controls all the conditions determining whether care and employment can coexist.
IMAS has an important role within the developing care system and social support. INAMU has a national mandate around women's rights and economic autonomy. MTSS brings the employment dimension. CCSS connects formal labor with social protection while also providing healthcare to people whose dependency may interact with chronic illness or disability.
Effective cross-system coordination therefore needs to extend beyond traditional health and social-care boundaries.
The practical test is whether these institutional connections alter pathways for individual women. A policy objective about employment has limited value if somebody cannot obtain sufficiently reliable care to accept a job. Conversely, care services may not deliver their full social value if employment support does not help women re-enter the labor market after years outside it.
Returning to employment is not automatic when care becomes available
It can be tempting to assume that creating formal care immediately releases women into employment. The real pathway is more complex.
Someone who has been outside paid work for several years may need updated skills, confidence, job-search support or flexible entry routes. Previous employment may no longer exist. Care responsibilities may have reduced without disappearing. Age discrimination or local labor-market conditions can also affect opportunities.
This means care availability is necessary for some women but may not be sufficient.
The transition needs to connect care provision with employability and economic-autonomy measures where appropriate. That is one reason the National Care Policy's emphasis on interinstitutional action matters operationally.
There is also a sequencing problem. A woman cannot confidently accept employment based on a service that has not yet begun, while some support programs may prioritize households partly because employment potential exists. Processes need enough flexibility to prevent families becoming trapped between the two systems.
The strongest pathway creates confidence that care will remain available once employment starts. Continuity, not merely initial access, determines whether the change is sustainable.
Operational scenario: formal care opens a door, but employment support completes the pathway
A 44-year-old woman has spent four years providing substantial daily support to her father following a stroke. Before becoming his principal caregiver, she worked in an administrative role. She has since undertaken occasional informal work but has no stable employment.
Her father's dependency is assessed and a combination of home support and community-based assistance becomes available. For the first time in several years, she has predictable periods during which she is not responsible for his direct care.
That does not automatically restore her previous economic position. Her digital skills need updating, her employment history contains a substantial gap and she remains anxious about accepting work because she expects to be called whenever her father's support changes.
A coordinated response treats these as connected issues. The care arrangement needs sufficient reliability and contingency planning to allow her to make commitments outside the home. Employment support can then focus on skills, job matching and a realistic route back into formal work.
If she obtains employment but repeatedly has to leave because care visits are cancelled, the outcome should not be interpreted simply as an individual failure to sustain work. It is information about the dependability of the care infrastructure.
Over time, monitoring can examine whether women receiving this combination of support remain in employment and social-security coverage. That provides a stronger measure of policy implementation than counting how many households were initially referred.
Economic autonomy also matters when paid employment is unrealistic
Not every intensive caregiver can enter employment, even with additional support.
Some people provide extremely high levels of care. Others have their own health conditions, live in areas with limited employment opportunities or face several disadvantages simultaneously. Policies focused exclusively on labor-market activation risk overlooking these households.
Costa Rica's National Care Policy recognizes this distinction. It contemplates monetary transfers for women in extreme poverty who care for people with dependency where entry into paid employment is not realistically achievable.
The principle is important because unpaid care has value even when it cannot be transformed into labor-market participation.
Income support does not resolve every problem associated with intensive caregiving. It does not provide respite, replace formal services or guarantee independent economic security. But it can acknowledge that households should not be driven deeper into poverty because somebody is undertaking essential care.
The broader funding question is therefore not simply whether to pay family caregivers. Different mechanisms address different problems: income support addresses financial hardship; formal services reduce workload; respite protects sustainability; training can improve confidence and safety; employment support helps people re-enter paid work.
A coherent system needs to understand which problem it is trying to solve rather than treating one intervention as a substitute for all the others.
Care data needs a gender lens
Costa Rica already has an important evidence asset in its national time-use surveys. INEC's measurement makes work visible that would otherwise remain largely outside conventional economic and service statistics.
The next analytical opportunity is to connect different types of evidence without losing appropriate privacy protections.
Care-system data can show who receives formal support and at what level of dependency. Time-use evidence can show how unpaid work is distributed. Employment data can illuminate labor-market participation. Social-security information can reveal formalization. Geographic analysis can identify territories where access to services or employment differs.
Together, these sources can help answer questions that no single dataset can resolve:
- Does expansion of formal care reduce unpaid care time for women?
- Are women previously constrained by caregiving entering or remaining in formal employment?
- Do benefits differ by income, age or territory?
- Are paid care jobs themselves becoming more formal and economically secure?
- Does improved support reduce caregiver exhaustion without weakening the autonomy of the person receiving care?
- Are men assuming a greater share of unpaid care as the system develops?
These are implementation questions, not merely research questions. If the policy objective includes redistribution of care and women's economic autonomy, governance needs evidence showing whether those outcomes are occurring.
Organizations developing comparable evidence frameworks can use the Quality Dashboard Builder to structure a balanced set of indicators rather than relying solely on activity measures. It is not a Costa Rican national dashboard, but the principle is relevant: what leaders measure influences which consequences become visible.
Geography can intensify gender inequality
The economics of unpaid care also vary territorially.
Women in rural or more dispersed areas may face a combination of fewer formal services, longer travel times and narrower employment opportunities. A family may theoretically qualify for support but still find that the available service model does not provide enough predictable coverage to enable employment.
Transport can be decisive. If a woman spends substantial time accompanying a relative to healthcare or community services because suitable local options are unavailable, that travel becomes part of the unpaid care workload.
Digital services can reduce some journeys and simplify coordination, but only where connectivity, accessibility and digital capability are sufficient. They cannot replace hands-on support for somebody who requires physical assistance.
This means national expansion should be assessed through practical accessibility rather than geographical presence alone. A service technically available across a territory may have very different effects according to travel, staffing and scheduling capacity.
For women in rural and underserved communities, care reform and economic participation may therefore require locally adapted solutions rather than replication of urban delivery models.
Technology can redistribute administrative work—or add to it
Caregiving involves administrative labor as well as physical and emotional support. Families schedule appointments, communicate with services, organize transport, remember medication changes and repeatedly explain circumstances to different professionals.
Women often absorb this coordination work alongside direct care.
Digital development within Costa Rica's care system creates opportunities to reduce some of that burden. Better information exchange can prevent repeated form filling. Digital scheduling can provide greater certainty. Tele-assistance can offer reassurance where appropriate. Accessible information can make services easier to navigate.
But technology does not automatically redistribute work.
A platform that requires a family caregiver to enter information into several systems can increase administrative labor. Monitoring technology can shift responsibility onto relatives if they become the default recipients of alerts. Online-only processes can disadvantage people with limited connectivity or digital confidence.
Organizations considering similar changes can use the Digital Transformation, AI and Cybersecurity Readiness Assessment to examine implementation capability and information governance. In a gender-aware care model, an additional question should always be asked: whose work does the technology actually reduce?
This is a useful test because technological efficiency at organizational level can coexist with increased unpaid work at household level.
Operational scenario: digital convenience creates an invisible coordinator
An older man with several chronic conditions and moderate functional dependency receives support from health and community services. His daughter does not live with him but coordinates much of his care.
Several services introduce digital communication. In principle, this should simplify coordination. In practice, his daughter receives appointment messages, tele-assistance notifications and requests to update information through different channels. She also keeps her own spreadsheet because no single view shows what has been arranged.
Each individual digital process appears efficient. Collectively, they have turned her into the unpaid interoperability layer between organizations.
A better design begins with the person's consent and asks what information genuinely needs to be shared, which organization holds responsibility for follow-up and who should receive alerts. The daughter can remain involved where her father wants that involvement, but coordination should not depend on her manually reconciling several systems.
If digital development later connects services more effectively, the benefit can be measured partly through reduced administrative burden on the family. Fewer duplicated contacts, clearer responsibility and closed-loop referrals become person and caregiver outcomes as well as technical improvements.
The scenario demonstrates why information accountability has a human dimension. Fragmented data does not simply create inefficient administration; somebody often has to compensate for it.
Governance should test whether care reform is genuinely redistributive
The Política Nacional de Cuidados establishes a strong policy rationale for redistributing care. The governance challenge is demonstrating whether implementation changes the underlying distribution of responsibility.
Service expansion alone is not conclusive evidence.
A new home-care program could increase formal service hours while women continue providing almost the same amount of unpaid support because overall dependency has increased. A training program could improve caregiver skills while inadvertently strengthening expectations that women will continue caring indefinitely. More paid care jobs could expand employment while leaving workers in insecure conditions.
Governance therefore needs to examine outcomes across several dimensions simultaneously: people receiving care, unpaid caregivers, the formal workforce and the wider household economy.
The Governance Maturity Assessment can help organizations working on comparable cross-sector issues examine responsibility, evidence and escalation. Applied conceptually to care reform, the important question is whether accountability reaches beyond delivery volumes to the social objectives the policy is intended to achieve.
This is where outcomes frameworks become particularly important. Measures should reveal whether women have greater choice over their time, whether formal employment becomes more feasible and whether people with dependency experience greater independence and continuity.
The next phase is redistribution, not simply substitution
Costa Rica's future care system will need substantially more formal capacity as population aging increases demand. Yet the strategic objective should not be understood as transferring every task currently performed by families into publicly funded services.
That would be neither realistic nor necessarily desirable. Family relationships will remain an important source of emotional, practical and reciprocal support.
The stronger objective is redistribution.
Some responsibility can move from unpaid households into formal services. Some can be distributed more equitably between women and men. Technology can remove administrative tasks where it is designed well. Employers can create greater flexibility. Communities can provide social and practical infrastructure. Public policy can protect income where caregiving and employment cannot reasonably coexist.
This approach also recognizes the rights of the person receiving care. Formal services should expand autonomy rather than merely free another household member for employment. A disabled or older person should not become an instrument of labor-market policy. Their preferences, dignity and control over support remain central.
Care policy works best when these objectives reinforce one another: the person gains greater independence, the caregiver gains greater choice and the formal workforce gains sustainable employment.
International learning from Costa Rica's approach
The gendered distribution of unpaid care is not unique to Costa Rica. Many countries depend heavily on women's unpaid work while measuring the sustainability of long-term care primarily through public budgets and formal workforce numbers.
Costa Rica's policy framework offers a useful analytical lesson because it explicitly connects dependency support with economic autonomy and the social redistribution of care.
The institutional mechanisms cannot simply be transferred elsewhere. Costa Rica's social-protection institutions, CCSS, IMAS, INAMU, labor market, family structures and developing SINCA architecture create a particular context.
The transferable principle is broader: a long-term-care system cannot be fully understood by looking only at the person receiving formal services.
Governments need to understand who provides the remaining care, how much time it requires, what opportunities that person gives up and whether those effects are distributed equitably. National time-use surveys are particularly valuable because they expose economic activity that conventional expenditure statistics can miss.
The same principle applies to evaluating reform. Expanding services is important, but the deeper question is whether additional capacity changes people's choices. That connects care reform with wider social and community impact rather than treating it solely as a cost center.
Conclusion
Costa Rica's unpaid care economy demonstrates why long-term-care sustainability cannot be separated from gender equality. Women contribute large amounts of time to domestic and caregiving work, and that contribution supports people, households and public systems. But unpaid care also carries opportunity costs through reduced employment, income, social-security participation, rest and future economic security.
The Política Nacional de Cuidados 2021–2031 provides an important basis for changing that relationship. Its emphasis on shared responsibility, women's economic autonomy, formal care expansion and coordination across institutions recognizes that dependency is not only a private family matter. SINCA can strengthen that approach as Costa Rica progressively develops more organized care and support.
The decisive test will be implementation. Services need sufficient reach, reliability and quality to create genuine alternatives. Paid care work needs to become sustainable employment rather than another location for undervalued female labor. Employment and social-protection policies need to connect with care provision, while national evidence needs to show whether women's unpaid workload and economic choices are actually changing.
The objective is not to remove care from family life. It is to ensure that caring relationships do not depend on inequality. As Costa Rica's population ages, a stronger care economy will be one that distributes responsibility more fairly while protecting the autonomy of both the person receiving support and the person who might otherwise be expected to provide it without pay.