The State Audit Office has raised the alarm that Macedonia is not taking care of its elderly population - the National Strategy for the Elderly expired back in 2020, and no new document has been adopted in the following seven years.

The audit report reveals that budget transfers for pensions reached 690 million euros in 2024, with expectations to exceed this amount in 2025. The first pension pillar operates with a constant negative financial balance, requiring continuous state subsidies.

Long-term care services are accessible to less than 1% of people over 65, while home care services are entirely absent in 31 municipalities. Informal family care dominates, while formal services remain seriously underdeveloped.

The demographic projections are alarming - by 2055, people over 65 will make up more than 34% of the population, while the working-age population will decrease by approximately 470,000 people. The number of people over 80 will increase sixfold.

The State Audit Office recommends comprehensive reforms: raising the retirement age, adjusting contribution rates, diversifying investments in the second pillar, and significantly expanding care capacities for the elderly.