The purpose of this article is to introduce into public debate in Montenegro the topic of Montenegro as a European centre of qualified senior care.
At first glance, this idea may seem ambitious. Yet in the wider European context it becomes highly relevant. Across the most developed countries of Europe, demographic, economic and social pressures are intensifying. Paradoxically, this creates an opportunity for Montenegro — not only in social policy terms, but also as a development opportunity with a clear economic and financial dimension.
The following analysis is based mainly on publicly available data concerning Germany — the largest senior care market in Europe — and, for comparison, Italy and Austria. Germany appears especially relevant because it may soon be particularly interested in alternatives to domestic senior care solutions. More than 350,000 people are currently employed in home-based senior care in Germany, mainly from Poland and other Central and Eastern European countries. However, today’s care needs are becoming more complex, especially in cases of neurological and neurodegenerative disease, and much of this labour force does not have the specialized qualifications required for such cases.
At the same time, Montenegro’s own problem of youth unemployment may be reinterpreted as an opportunity. In an economy strongly dependent on seasonal tourism and gastronomy, many young people face unstable employment and limited prospects. Senior care could offer stable, year-round employment in professions such as caregiver, elderly-care assistant, occupational therapist, activity specialist, speech therapist, or hospice caregiver.
What, then, are the main reasons for taking this topic seriously? In my view, five interconnected factors are decisive.
1. Demography
All highly developed countries of Western Europe have for years experienced similar demographic processes: falling birth rates, lower marriage rates, rising divorce rates, and a steadily ageing population. Greater prosperity has extended life expectancy, but it has also increased the number of older people living with multiple chronic diseases, both physical and mental.
In Germany, the number of people requiring care is already about 6 million. Of these, around 4 million remain in home care, 1.15 million are under ambulatory care, and about 850,000 are in institutional care. By 2040, this number is expected to rise to 8 million. Italy already has the oldest population in the European Union, with 25% of its population aged 65 and over. By 2050, this share is expected to rise to 35%. Austria is following the same path. In 2024, around 20% of Austrians were aged 65+, and by 2040 every fourth resident is expected to be a senior. Demography alone shows that demand for senior care services will continue to rise sharply over the coming decades.
2. Economics (costs)
The ageing of society drives up the cost of care through both age itself and multi-morbidity. Diseases such as circulatory disorders, type II diabetes, cancers, dementia and cognitive impairment rise strongly with age. The generation now using institutional care also largely consists of people whose lifestyles over many decades were far from health-promoting.
This cost pressure has recently been intensified by inflation. In Germany, the out-of-pocket monthly co-payment for institutional care rose from just under EUR 2,500 at the end of 2022 to more than EUR 3,200 in the first quarter of 2026. This means an increase of almost 30% in three years. This dynamic makes current care models increasingly difficult to sustain. It also creates a strong incentive to search for less expensive, but still high-quality, alternatives outside the domestic market.
3. Labour market
Rising life expectancy lowers the ratio of economically active persons to those who are retired and increasingly dependent on care. In such conditions, a shortage of labour in low-paid social professions becomes inevitable. As demand for care workers grows, wages rise, and since labour already accounts for a large share of total care costs, this pushes prices up even further.
Attempts to solve the problem through labour immigration have had limited success. Meanwhile, the shortage of staff in Germany continues to grow. Germany already lacks nearly 500,000 qualified care workers, and by 2035 institutional care alone may face a shortage of over 300,000 employees. The situation in ambulatory care is already described as severe. Work overload and relatively low wages lead many employees to leave the profession. Home care is also increasingly affected: even with rising pay, there are fewer and fewer people willing to take on such demanding work. The pool of caregivers from Poland is shrinking for both demographic and economic reasons. Occupational burnout worsens the problem further.
4. Budgetary situation
Most wealthy European countries have financed part of their prosperity through public debt. As long as growth was strong and borrowing costs were low, this was manageable. But slower growth and high inflation now force substantial savings in public budgets.
Germany offers a clear example. The federal Ministry of Health budget was cut from EUR 24 billion in 2023 to EUR 16 billion in 2024. Although the 2026 budget is somewhat higher, inflation means that in real terms it remains close to the earlier level. Yet costs connected with health promotion and care continue to rise.
The situation is particularly visible in the German long-term care insurance funds. After building up reserves for years, these funds have recently shifted into deficits. Their negative balance deepened significantly between 2023 and 2025. This reflects the broader reality: care-related demand is rising faster than the system’s ability to finance it.
5. Wealth of private households
The years 2020–2026 have negatively affected household wealth across Europe, especially through high inflation, which erodes savings. Nevertheless, German households remain relatively wealthy compared with Montenegro. This matters because private households still play a crucial role in financing senior care.
At the same time, the image of universally high pensions in Germany is misleading. The average pension is below EUR 1,600 per month, and more than half of pensioners receive less than EUR 1,300. Thus, even in a wealthy country such as Germany, many older people and their families face a growing gap between the cost of care and the income available to pay for it.
Final conclusions and summary
1.
When we compare the average out-of-pocket co-payment for institutional senior care in Germany — around EUR 3,200 per month — with the average pension of roughly EUR 1,600, the significance of the issue becomes obvious. For many people, especially those with dementia or cognitive disorders, the exact geographical location of care is less important than the balance between price and quality. In this respect, Montenegro still holds an important comparative advantage over highly developed European countries.
2.
The case is even stronger if one considers dementia. Around 2 million people in Germany currently suffer from dementia, and roughly 400,000 new cases emerge each year. By 2050, the number is expected to rise to at least 3 million. Already today, two out of three residents of institutional care facilities in Germany are dementia patients. Their average stay lasts about eight years, and care costs can exceed EUR 6,000 per month.
3.
In this situation, not only families but also German care funds should have an interest in more economical alternatives abroad. These funds are already under severe financial pressure. It therefore seems increasingly necessary to reconsider whether care-related funds should be more easily transferable across borders to centres abroad that can provide qualified care at lower cost.
4.
It seems realistic that institutional senior care in Montenegro could be provided at around EUR 2,000–2,500 per month — at least 50% less than in Germany. At that price, accommodation, food and general comfort could still remain comparable. The decisive issue would be quality, especially the qualifications of staff.
For this reason, Montenegro should consider introducing a practical vocational model for care professions. A particularly promising idea would be to create, within the framework of the Institute Dr. Simo Milošević in Igalo, both a school for senior care professions and a qualified institutional senior care unit. The Institute already possesses excellent therapeutic infrastructure and international reputation, but due to its size it also suffers from underutilisation.
5.
If we consider the five factors above together, one conclusion becomes unavoidable: this topic is neither exaggerated nor premature. On the contrary, it is just in time. Over the next 20–30 years, highly developed European countries — especially Germany — will be forced to search for effective and affordable solutions to the growing care crisis.
Of course, such a project would require a systemic approach. Montenegro would need legal solutions regulating institutional care for foreigners, financing mechanisms, and a training system for the future workforce. At the same time, staffing requirements should be based on real care needs, not rigid administrative formulas.
Only such a systemic approach can attract serious operators, investors and financiers. Yet it would already be worthwhile to begin by creating a pilot model in Igalo: a care-profession school linked with a qualified institutional senior care unit open also to residents from Germany.
In short, the conditions outlined above strongly support investment in Montenegro’s institutional senior care sector. With its natural and climatic advantages, economic potential and ambitious society, Montenegro possesses sufficient grounds to take up this challenge — and, in doing so, to respond not only to its own needs, but also to those of other European countries urgently searching for viable solutions.
