Background <p>Botswana is undergoing a profound demographic and epidemiological transition marked by increasing life expectancy, declining fertility, shrinking household sizes, and rising chronic diseases. These shifts are reshaping the landscape of long-term care (LTC), exposing the limitations of traditional family-based caregiving and prompting urgent policy and infrastructure reforms. Yet, the relative contribution and interaction of demographic and socioeconomic factors remain underexplored in Botswana’s context.</p> Methods <p>This study employed a mixed-methods design, integrating quantitative and qualitative approaches. Quantitative data were drawn from the 2022 Population and Housing Census, the 2017 Botswana Demographic Survey, and international databases. Key indicators, including the Ageing Index, Total Fertility Rate, life expectancy, disability prevalence, and chronic disease burden were computed to assess demographic and health transitions. Qualitative data were collected through in-depth interviews with 18 older adults with disabilities in the Serowe/Palapye District. Thematic analysis was conducted using ATLAS.ti software to explore lived experiences and structural barriers to care.</p> Findings <p>The results revealed a rising Ageing Index (from 11.8 in 1981 to 18 in 2022), a steep fertility decline (from 6.5 in 1981 to 2.9 in 2022), and increased life expectancy (now at 69 years in 2022). These demographic shifts, compounded by increased female labour force participation and an escalating burden of multimorbidity and disability, are straining Botswana’s fragile, informal LTC systems. The prevalence of cognitive disability rose sharply from 6.4 to 22.2% between 2017 and 2022. Qualitative findings underscored systemic health inequities, economic exclusion, weak geriatric infrastructure, and the erosion of intergenerational caregiving norms. Importantly, education and prior employment emerged as key life-course determinants of ageing outcomes.</p> Conclusion <p>Botswana faces a growing mismatch between the rising demand for complex eldercare and its limited capacity to deliver integrated, equitable, and person-centred LTC. Demographic and socioeconomic forces intersect in ways that both reinforce vulnerability and undermine care sustainability. Without timely intervention, the country risks widening health disparities and overwhelming existing support systems.</p> Recommendations <p>A coordinated national LTC strategy is urgently required, grounded in inclusive financing mechanisms, professional caregiver training, and integrated community-based services. Policy recommendations include the development of LTC insurance schemes, investment in home- and community-based care, promotion of public-private partnerships, and creation of elder-focused infrastructure. Implementation must be context-specific, accounting for urban-rural disparities and informal sector dynamics, and should be supported by improved data systems and participatory policymaking that includes older adults as key stakeholders.</p>