This paper aims at pointing out the need for a more equitable, internationally driven approach to solve elder care staff shortages, on the background of the implications deriving from the widespread phenomenon of employing migrant care workers in the Italian elder care sector. The paper describes at first how this form of care provision has become so popular in this country to face the long term care needs characterising its ageing population. Main reasons are identified, on the one hand, in the decreasing availability of informal care, due to the increasing female participation in the labor market, a longer working life and a reduction in the support provided by social networks. On the “formal” side, a major role has been played also by the lack of appropriate long term care services, such as residential and public home care, as well as by a chronic shortage of nursing staff and a shorter length of hospital stays. The traditionally “cash-oriented” profile of the Italian welfare system – more based on cash-for-care measures rather than in-kind services – has ended up with perpetuating familistic tendencies stimulating the employment of foreign migrant care workers, often on a live-in, undeclared basis. The paper’s conclusions focus on the analysis of the main opportunities and challenges raised by this phenomenon, trying to catch all involved parties’ perspectives: the older care recipients’ families; the migrant care workers; the receiving and the sending societies. This approach allows to identify core advantages of this solution in the possibility to increase ageing in place opportunities (thus reducing institutionalisation rates) and to provide a more personalised home care at reasonable costs. On the other hand, drawbacks can occur in terms of low quality of care, risk of widespread undeclared labour conditions, possible exploitation of foreign migrants and abuse of older people, as well as “brain and care drain” effects in sending countries. A more neutral, internationally driven governance is therefore suggested in order to minimize these risks and promote equitable solutions to solve care provision shortages in some countries without “plundering the future” of other nations.