A society based on individual agency and transactional dynamics is foundationally incapable of communally taking care of elderly people as they lose their faculties. Some family member or other personally-invested party has to be involved to represent the interests of the elderly person, many times even clashing with the immediate whims of the person themselves. Leaving this dynamic to third parties in the biz creates too many moral hazards to opt for the easy choices, financially drain the person, and then just walk away. The culmination of this dynamic of course being the modern nursing home, where "patients" lay around getting bed sores while management gets hypersubscribed workers to check boxes on forms that say they're being taken care of.

I moved to Japan 13 years ago. My mother developed early-onset Alzheimer's in 2021, and I'm her only child. I relocated her to Japan. It has been immensely stressful but I know she's getting better care and this also avoided the US healthcare system completely bankrupting our family and robbing us of our chance to build multi-generational wealth.

But living in a country with an outsized elderly population/terrible demographics, I can clearly see how the problem will eventually cripple most economies without significant technological augmentation. Large multi-generational families living in very close proximity at least provides for essentially unpaid labor who can share the burdens to prevent caregiver burnout.

If your own kids are not going to care for you, why should someone else's kids?