Earlier this year, a CNN story featured a Japanese prison that looked more like a nursing home. The story was striking: Some older adults in Japan are so lonely that they intentionally commit minor crimes to gain access to regular meals, healthcare, and companionship behind bars. This poignant example is not an anomaly. It signals a profound global challenge: how societies care for an aging population.
One strategy for meeting this gap is known as time banking. Developed in 1973 in Japan by Teruko Mizushima and in the United States in the 1980s by Edgar Cahn, time banking is built on a simple but powerful idea: Everyone’s time is equally valuable regardless of the market value of what one does.
In a time bank, members earn time credits by helping others and spend those credits to receive help in return. Time banks can be structured as formal nonprofits or as informal community-based initiatives. Both models share a few core principles:
- Asset-based thinking: Everyone has something of value to offer
- Redefining work: Time banks recognize and reward the kinds of work that often go unpaid
- Reciprocity: Giving and receiving are equally important; members both offer and request help
- Building community and social networks
By encouraging the exchange of services, these strategies have been particularly helpful for addressing the social isolation so common among adults aged 65 and above.
Time banking is built on a simple but powerful idea: Everyone’s time is equally valuable regardless of the market value of what one does.
A Global Aging Population
The demographic trends are staggering. According to United Nations’ World Population Prospects reports, by 2050 one in six people globally will be over the age of 65, up from one in 11 in 2019. By the late 2070s, the number of adults aged 65 and over is expected to surpass the number of children under 18.
These global patterns are already evident at the national level. Japan tops the list, with 29.4 percent of its population aged 65 and older. In the United States, approximately 10,000 people turn 65 every day; as of 2022, the older population totaled around 57.8 million, accounting for 17.3 percent of the total population. China, with 14.3 percent of its population over 65, has the largest number of older adults anywhere. By 2055, China’s population of people over 65 is projected to surpass 400 million.
Faced with rapidly aging populations, eldercare systems around the world are under severe strain. Traditional formal care approaches, whether institutional or market-based, are overstretched and underresourced. Demand for care already far outstrips the supply of professional caregivers. In the United States, the Bureau of Labor Statistics project that 8.9 million direct care jobs, including personal care aides, home health aides, and nursing assistants, will need to be filled.
A 2023 survey by the American Health Care Association found that approximately 77 percent of nursing homes face moderate to high levels of staff shortages, with 95 percent reporting difficulty hiring. Globally, the World Health Organization estimates a shortfall of 11 million health workers by 2030, especially in low- and lower-middle-income countries.
At the same time, the cost of care is escalating. In the United States, long-term care is becoming increasingly unaffordable. A 2022 Kaiser Family Foundation survey found that 90 percent of respondents could not afford the estimated $100,000 annual cost of nursing home care, and 83 percent said the $60,000 cost of in-home assistance was also out of reach. The Organization for Economic Cooperation and Development projects that spending on long-term care across member countries will at least double by 2050, driven by aging populations and growing expectations for quality and accessibility.
Informal care models are also in danger. Urbanization, smaller family sizes, and higher workforce participation among women have eroded the traditional model of family-centered caregiving.
In addition, many older adults face profound social isolation. In communities with dispersed families or limited transportation, it is not uncommon for seniors to go for days or even weeks without meaningful human interaction. Loneliness among older adults has been associated with cognitive decline, heart disease, and depression—it is no longer seen as merely a social concern; it has become a significant public health issue.
Time Banking and Eldercare: A Promising Match
Given its design and ethos, time banking is uniquely positioned to help address the eldercare crisis. First, in line with asset-based thinking, it’s important to understand that elder adults are not simply a vulnerable group who need services; they are active, capable, and valuable.
Within a time bank, they can continue to share their skills, time, and life experience, strengthening the network while also receiving support. This reframing allows us to see aging not as a problem, but as a new societal norm that redefines how we work, live, interact, and build community. It calls us to rethink how we govern, sustain the economy, and maintain the fabric of society.
The principle of reciprocity is central to time banking and carries special weight in eldercare. Older adults are not simply recipients of care; they contribute.
Second, as people age, the roles and status markers that once defined them often recede, and the intrinsic value of time itself becomes more visible and more widely appreciated. In this sense, time banking reflects a deeper truth: In the face of aging—and, ultimately, mortality—everyone’s time is equally precious. Recognizing this can deepen mutual respect and inspire broader participation in systems that honor the principle of “same time, same value.”
Third, time banking acknowledges that many forms of care cannot easily be monetized. Companionship, help with daily routines, or neighborhood-based transportation may seem small, but they are vital to an older adult’s quality of life. Time banking makes these informal, relational forms of care visible and valued. Importantly, time credits are not intended to replace traditional currency but to complement it, offering an alternative way to exchange services that matter deeply yet resist monetary pricing.
Fourth, the principle of reciprocity is central to time banking and carries special weight in eldercare. Older adults are not simply recipients of care; they contribute by sharing wisdom, mentorship, lived experience, and skills. This mutual exchange preserves dignity, supports independence, and reinforces a sense of purpose. It closely aligns with the World Health Organization’s concept of active aging, which emphasizes continued engagement in social, economic, cultural, and civic life.
Reciprocity also helps counter one of the most urgent issues facing older adults: social isolation. By valuing every hour equally and facilitating two-way relationships, time banks foster trust and build the kinds of horizontal ties that hold communities together.
Figure 1 presents time banking as a social innovation for eldercare by showing how each characteristic of time banking helps alleviate a specific challenge in today’s eldercare systems.
Time Banking and Eldercare: In Search of a Sustainable Model
Considering the close alignment between the principles of time banking and the nature of eldercare, it is no surprise that early pioneers of the movement had their eyes on older adults. In 1973, Mizushima, a Japanese housewife and activist, established the Volunteer Labor Bank (VLB) in Osaka.
At VLB, members exchanged services using a time-based complementary currency called “love currency.” Participants earned credits for hours spent helping others, which they could save for future use or transfer to family members. Although not designed exclusively for eldercare, most members receiving services were elderly. Over three decades, VLB grew into a national network with 4,000 members across 300 branches in Japan.
In the United States, early time banks often centered on older adults helping each other. Some later broadened eligibility to allow younger participants to support older members. In New York City, the Metropolitan Jewish Health System runs the Member to Member (M2M) program, enabling Elderplan members participating in a Medicare long-term care plan to earn credits by assisting others. These credits can be redeemed for services like friendly visits or help with errands. Similarly, Lehigh Valley Health Network’s Community Exchange program in Allentown, PA, uses time banking to reduce social isolation among elder adults.
Reciprocity must be intentionally designed into the system, not only to honor the principle of exchange but also to engage a wider population.
China has also experimented with time banking as a response to its aging population, although China’s efforts have been largely government-driven. After small-scale experiments in the late 1990s, growth accelerated when the Ministry of Civil Affairs first included time banks in its 2018 National Pilot Reform Program for Home- and Community-based Eldercare. Shanghai was the first major city to adopt the model in 1998 with the Elderly Life Care Mutual Aid Association, now known as the Shanghai Changning Elderly Service Time Bank. This program encourages residents of all ages to provide nonprofessional eldercare services in exchange for “time coins” that can be saved for future use. The initiative supplements Shanghai’s multilevel eldercare system and has inspired other cities to launch similar, sometimes app-based, platforms.
Despite this progress, many challenges remain, from sustaining participation to ensuring fairness and adequate resources. To better align time banking models with eldercare needs, nonprofit and community leaders may consider five key features when designing a time bank: services exchanged, membership size and composition, the balance between in-person versus digital services, whether or not the time bank host is part of a larger nonprofit, and setting rules for when banked hours might be convertible into cash. These issues are explored below:
- Services Exchanged
In theory, a time bank’s services are as broad as its members’ talents. In practice, a successful eldercare-focused time bank must reflect elder adults’ needs. This includes physical assistance, such as help with mobility, groceries, and home maintenance; as well as health-related support like medication reminders, appointment scheduling, and accompaniment to medical visits. Social and emotional support is also essential, including companionship visits, telephone check-ins, and help attending community events. Increasingly, technology support is critical, from help with smartphones and email to navigating online services.
Activities that are too physically demanding or unrelated to daily living, such as dance classes or craft lessons, may attract less interest. The goal is to curate a mix of services that meet essential eldercare needs while preserving dignity and encouraging participation. Reciprocity must be intentionally designed into the system, not only to honor the principle of exchange but also to engage a wider population. Although older adults may receive more than they give, opportunities for contribution should be built in. Many older adults are willing and able to tutor youth, share language skills, or provide life coaching.
- Size and Composition of Membership
The optimal size and composition of a time bank depend on the range of services exchanged within it. A wider variety of services requires more members and a greater diversity of skills. However, a very large membership can dilute the trust and sense of connection that sustain participation. Trust is easier to build in smaller, close-knit communities. At the same time, time banks that are too small may struggle to match members with the services they need. The challenge is finding the “right size”—large enough to ensure a healthy flow of exchanges, yet small enough to feel personal.
- Physical or Digital?
Time banks have always been rooted in local communities. The local dimension connects the time bank to a specific geographic area and reflects its historical and cultural context. So, it seems natural for a time bank to maintain a community-facing presence. In recent years, digital time bank tools have proliferated. Online platforms and mobile apps allow members to share information, request services, and log hours at low cost. However, some older adults remain digitally excluded. The solution isn’t to choose between the two but to combine them. A successful time bank might offer a physical location like a neighborhood drop-in center and incorporate senior-friendly technology, such as voice-based apps, large-font interfaces, smartwatches, and health trackers, to make participation simple.
- Stand-Alone or Embedded?
A time bank can be structured as an independent entity or embedded within an existing organization. While stand-alone time banks are common, eldercare-focused programs often benefit from being housed within established organizations. Embedding a time bank in a healthcare system, senior center, local government agency, or faith-based organization can provide stability and easier access to participants.
- Redeemability of Time Credits
As noted earlier, one of the central principles of time banking is that all hours are valued equally, regardless of the market value of the work performed. This principle protects the ideas of reciprocity and equality that make time banking distinct. At the same time, it raises a recurring question: Should time credits ever be converted into cash? Allowing members to redeem credits for cash could boost participation. Yet monetization risks shifting the focus from mutual aid to financial transactions, which could weaken the sense of connection and shared purpose. Is there a middle ground? One option is to keep most time credits strictly nonmonetary, while a limited portion of credits might be redeemable for transit passes, meal vouchers, or event tickets.
A Path Forward
Our research begins with a simple conviction: The global eldercare crisis cannot be solved by markets or governments alone. What is needed is a shift in values and systems toward care that is mutual, relational, and rooted in community. Time banking shows how this shift can happen by turning care into a shared responsibility and giving every person a role to play.
Its success depends on finding the “sweet spot,” matching members’ time and talents with needs that conventional systems leave unmet. Markets and government programs will always have their place, but time banking adds what they cannot: trust, reciprocity, and connection. In that space where time is the new currency, eldercare becomes more than a service; it becomes a way to strengthen the very fabric of community.
This article is part of a larger study partially supported by Penn Global’s PWCC Residency Grant, University of Pennsylvania. We thank Audrey Liu and Ivy Yang for their excellent research assistance.
