It'd be remiss to not note most of the time in culture where multi generational family units are the norm, responsibility lands on women in the home or household support in extended families and the economy doesn't often require two incomes to be middle class.
This. But would also add 1) live in socialist countries that provide home care, or 2) or live in countries where there is extremely cheap labor due to endemic poverty (much of the third world), low rates of labor participation, or imported labor (HK/Singapore/Gulf states)
This is typically true for the elderly who can take care of themselves or require minimal help.
Once you need round the clock dementia care, it is more than extended family can provide — unless one or more adults take themselves out of the workforce for years.
I wonder about the generational demographics of different cultures and how that impacts things. Many western cultures have fewer children to bear the burden of taking care of the elderly. The populations are shrinking for native born.
Also people tend to live lot longer and specially lot longer with limited capabilities. So there is more of those needing support and lot more support needed.
