Active Aging Hubs in Mongolia: Redefining Elder Care with Community Support

Mongolia, like much of Asia and the Pacific, is entering a new demographic era, and the Asian Development Bank (ADB), working with the Ministry of Family, Labour and Social Protection (MFLSP), the Ministry of Health, and with support from the High-Level Technology Fund, the Japan Fund for Prosperous and Resilient Asia and the Pacific, and the Japan Special Fund, has taken a close look at how the nation can prepare for the challenges ahead. Decades of better living standards and stronger healthcare have lengthened life spans, while fertility has steadily declined. By 2050, the proportion of Mongolians aged 60 and above is projected to more than double, from just over 7% in 2020 to more than 17%. Rural depopulation, the outmigration of younger generations, and a gender gap in life expectancy of nearly a decade, women live on average 76.9 years compared to men’s 67.6 are further straining family-based support systems. For a vast country with a dispersed population, the challenge of helping older adults age with dignity, security, and connection has become urgent.

A Bold Experiment in Community Care

For years, Mongolia’s government has experimented with social welfare services for older adults, including residential homes, elder development centers (EDCs), and limited cash support for caregivers. Yet the services remained fragmented and heavily biased toward medical care in sanatoriums. A 2020–2021 needs assessment revealed that 18% of older adults were moderately dependent, 7% severely dependent, and 5% lived with severe cognitive impairment, but there was no systematic mechanism to respond to these different levels of need. In 2021, ADB piloted a new approach: the creation of Active Aging Hubs (AAHs). Three were set up in diverse contexts: a nongovernmental residential home, a state-run EDC, and a public hospital. These hubs offered a flexible menu of services, including case management, day care, outreach home visits, rehabilitation, respite, and social activities. The goal was not only to provide care but also to build coordination among hospitals, NGOs, social workers, and community groups. Steering committees with governors, health officials, and elder associations were established in each location to guarantee cross-sector collaboration.

Screening, Support, and Social Connection

Over 18 months of implementation beginning in July 2023, the hubs screened more than 3,700 older adults. Seventy-one percent were relatively healthy but benefited from active aging activities; 18% were at moderate risk, and 11% were frail and needed comprehensive care plans. Detailed assessments were conducted for 411 people, revealing mobility problems, vision impairment, sleep disorders, and chronic pain as the most common issues. Among those, 273 people received personalized follow-up care lasting six to twelve months. Twenty-three improved enough to move to a lower risk category, 240 stabilized and felt better, and a small number were discharged or relocated. Alongside healthcare, the hubs offered social and educational activities, more than 14,000 engagements in yoga, digital literacy, language training, and recreational clubs. These initiatives not only kept older adults physically active but also reduced loneliness, built confidence, and expanded social networks.

Stories of Transformation and Resilience

The human stories from the pilot reveal how community-based care can transform lives. In Darkhan-Uul, older adults learned computer skills, discovered social media, and even began publishing their writings, reconnecting with distant family in the process. In Mandal Soum, volunteer carpenters built simple but crucial household adaptations, such as raised toilet seats, while students joined in providing practical support. A yoga instructor in his sixties became a local influencer, motivating hundreds of peers to adopt healthier routines. Retired knitters turned their skills into entrepreneurship, running workshops that created livelihoods and companionship. Frail elders living in isolation, such as an 88-year-old woman in a rural geriatric facility, experienced dramatic improvements after regular visits from case managers, family doctors, and social workers coordinated under the hub model. These stories illustrate how small interventions, whether social, emotional, or practical, can have a life-changing impact.

Policy Shifts and Future Pathways

The pilot not only reshaped local communities but also influenced national policy. In 2024, Mongolia revised its Elderly Law to embed assessment and case management as central features of elder care. The budget for services soared from $85,600 to $1.56 million, with plans to double it again, creating opportunities for contracting AAHs to deliver expanded services. The law also formalized the role of NGOs, businesses, and community groups in service delivery. Yet challenges remain. Respite care for family caregivers is scarce, transportation for remote seniors is inadequate, and the demand for case managers far exceeds the workforce supply. Record keeping and digital monitoring, despite a pilot app, remain weak. Accreditation and contracting procedures for NGOs are slow and risk undermining continuity. Still, the pilot proved that different types of institutions, whether hospitals, EDCs, or NGOs, can host hubs successfully when provided with the right training, guidelines, and governance.

Looking forward, the recommendations are clear. Mongolia needs to expand hubs nationwide using a “hub and spoke” model that connects local bagh and khoroo units to larger district or aimag centers. Dedicated transport and accredited training programs for case managers and caregivers are essential, alongside structured support systems for family caregivers such as peer groups, counseling, and financial aid. Governance at national and subnational levels must be strengthened with clear mandates and road maps, while quality management systems, monthly reporting, performance indicators, and case reviews should be institutionalized. Preventive health, from vision and dental care to mental health support, must become a priority to reduce long-term dependency.

The Mongolian pilot has shown that long-term elder care is not simply about medical treatment or financial transfers. It is about weaving together a web of health, social, and emotional support that allows older adults to live longer, healthier, and more connected lives. The Active Aging Hubs gave older Mongolians places to heal, to learn, to work, and to laugh together. They demonstrated that with thoughtful investment and community engagement, aging can be reimagined not as a burden, but as a stage of resilience and renewal.