Why Some Countries Expect Families to Care at Home, and Why the United States Built Assisted Living

Do you think they love their mothers more than we do?

By Neil Solomon · 3 min read

Picture a couple named Abner, 70, and Olive, 68. They are thinking about a move to Spain. Olive's mother is 91 and lives in an assisted living community in the United States. She likes the dining room and the Tuesday card game.

On a video call, a Spanish neighbor of their friends told them her own mother lives in the back bedroom of her apartment.

"Do you think they love their mothers more than we do?" Olive asked afterward.

"I don't think so," Abner said. "I think the apartments and the families are put together differently."

They looked up how.

(Eurostat household survey. "Living with others" adds two of Eurostat's categories: a couple living with other people, and other household types, which include a parent living in an adult child's household. Rows are rounded.)

The United States looks different from Spain. In 2021, 18% of Americans lived in a household with more than one adult generation, up from 7% in 1971 (Pew Research Center). A Pew study of data from 2010 to 2018 found that 27% of Americans aged 60 and older lived alone, against 16% across 130 countries. It found 6% living in extended-family households, against 38% worldwide. Another source, the United Nations population database as reported by the Latin American demographic agency CEPAL, puts Mexicans aged 65 and older who live alone at 12.6%.

Care follows the same pattern. Across 31 countries in the Organisation for Economic Co-operation and Development, 12% of people 65 and older received long-term care in 2023, and in 23 of those countries 70% of the people receiving it got it at home. In 19 countries, about 60% of older people who received care got only informal care, meaning help from family or friends. In the United States, about 1,016,400 people lived in assisted living communities in 2022.

The sources give no one agreed history, so what follows is a reading and not a finding. Where several generations share a home, someone is already in the house when help is needed. Where most older people live alone or as a couple, and children live a plane ride away, a place with meals, staff and neighbors answers a real need. The United States built assisted living for families in that position, and a great many use it.

Care at home has a price too. Across the countries studied, 61% of informal carers are women (53% in Spain, the lowest).