Long-Term Care in the EU

​In September 2022, the European Commission presented a European strategy on long-term care. It is a question of giving a common minimum standard to all Member States, to ensure that citizens have long-term care.

​The COVID-19 pandemic has highlighted the importance of having robust formal care services to ensure continuity of care. It has exposed the pre-existing structural weaknesses of care systems and put a magnifying glass on the need to improve the resilience of these systems. Quality care services have clear benefits for all ages, and it is particularly crucial for the well-being of care receivers and caregivers, women's participation in the labor market, and the achievement of work-life balance. Despite the clear benefits of high-quality care services, for many people, they are still not affordable, available, or accessible. Inadequate care services have a disproportionate impact on women, and this affects their work-life balance and options to take on paid work. Good working conditions in the care sector are vital to the resilience and attractiveness of the sector and for gender equality. Investment in care services helps more women to join the labor market and yields more revenues for public budgets. The strategy to improve the situation for both carers and care receivers calls for boosting access to quality, affordable, and accessible care services and improving working conditions and work-life balance for carers.

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The expansion of care services is crucial to meet current and future needs for care, and it should go hand in hand with improving their quality, affordability, and accessibility. Quality encompasses not only infrastructure and services, but also the interactions and human relations between carers and the people receiving care. Early childhood education and care services must be of high quality, inclusive, and non-segregated to bring full benefits to all children. Quality long-term care promotes the well-being, dignity and fundamental rights of care recipients, including by preventing and alleviating isolation, loneliness, and their physical and psychological impacts.

Improving the affordability of care services leads to fairer access to care, as high costs are one of the most significant barriers for many people. Making care services accessible means enabling and providing the means to the people who need care (and their families) to actually make use of the services available. This may require adapting the facilities to enable physical access for care receivers and caregivers with disabilities. Rural and remote areas and regions with low population density are particularly affected by the lack or shortage of available care services, both early childhood education and care as well as long-term care, due to long distances or limited public transport options.

The our steps of preparing the European strategy.
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1. In 2017, the EU founded the EU Social Pillar, of which Principle nr 18 is part of it.
2. in 2021, the Social Platform provided its contribution to the Social Protection Committee (SPC) and European Commission in preparing a Joint 2021 Report on Long-Term Care (read the document on the side)
3. In 2021, the European Commission and the Social Protection Committee published their Joint Report on Long-Term Care.(read the document on the side)
4. In July 2022, the European Parliament voted its Resolution on a Common European action on care. Watch the recording of the debate held on Tuesday 5 July 2022, the read the adopted Report and the list of voters.

The Joint Report

In 2021, the European Commission and the Social Protection Committee presented a Joint Report on Long-Term Care.

Before, the Social Platform provided its contribution.

This is the most comprehensive overview to date of a policy area whose growing importance for all societies can no longer be overlooked.

The COVID-19 pandemic laid bare the long-standing challenges of ensuring accessible, affordable and quality care, backed up by sufficient and skilled work force and financing.

It highlighted the critical importance of long- term care systems in ensuring the well-being of people in need, preserving their dignity and access to care services, while also contributing to social cohesion and solidarity.

It further reveals gaps in social protection coverage for long-term care and the impact these could have on the living standards of older people. While quality of long-term care is a common aspiration, the report reveals a diversity of approaches to defining and measuring quality.

Despite significant job creation potential in the sector, staff shortages are quite common, also because of difficult working conditions. Finally, the report analyses long-term care financing and how it would evolve in the future, while also taking stock of the hidden costs of informal care.

The findings will provide a valuable source of evidence and inspiration to prepare the EU initiative on long-term care, announced in the European Pillar of Social Rights Action Plan. 

Together with the parallel report on pension adequacy, the 2021 Long-Term Care Report offers a unique overview of social protection for older people in our ageing societies.
The hope of this report was also inspire policy makers and stakeholders at all levels engaged in systemic reforms and investments in long-term care and its workforce to ensure the well-being of all those in need of care and a vibrant care economy and society. 

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(all languages here)

Member States and long-Term Care

In the meantime, several Member States have implemented reforms of their long-term care systems in recent years. 
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Four main reform trends can be observed:

(a) improve the situation of informal carers;
(b) improve access, affordability, and quality in relation to homecare services;
(c) improve access, affordability, and quality in relation to residential care;
(d) improve the situation of the professional long-term care workforce.
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Recent long-term care reforms

In recent years, long-term care systems have been mostly subject to parametric reforms, i.e. changes only affecting some aspects of the system.

Only Bulgaria and Germany have implemented overarching reforms of social services, which are expected to have an impact on many aspects of their long-term care systems.

As will be explained below, some of the parametric reforms may, however, have a significant impact on the supply of long-term care services, for service-providers as well as for the recipients of care.​

The first trend concerns improvements in the situation of informal carers (observed in AT, BE, CZ, DE, EE, FI, FR, HR, IE, LU, MT, NL, PL, PT, SK). These measures include introducing or raising carer’s allowances, more favourable social protection conditions, work-life balance measures and other support measures (e.g. training and respite services) for informal carers.

The second trend relates to improvements in access, affordability, and quality in relation to homecare services (BE, BG, CY, DE, DK, EE, FI, LT, LU, LV, MT, NL, PL, RO, SE, SK).

The third trend concerns improved access, affordability, and quality in relation to residential care (AT, BE, BG, DE, DK, EE, EL, FI, FR, HU, LT, LU, LV, MT, NL, RO, SE, SK). The main reforms include more favourable eligibility conditions, rules for fees and cost sharing for dependent people and their families, and increasing the availability of places in residential care facilities. Quality of residential care has been addressed by setting up quality assessments, quality-monitoring tools, and ensuring compliance with quality norms.

The fourth trend concerns improvements in the situation of the professional long-term care workforce (CZ, DE, EE, FI, HR, IE, LU, MT, NL, SE). Among the key measures taken in this respect are increased funding to recruit staff, increases in salaries, better access to training, and improved working conditions (e.g. more stable contracts).

The reforms outlined above are likely to continue in the coming years All-encompassing reforms, expected to change several aspects of the long-term care systems, are being discussed in some Member States (AT, EE, FR).

Others have tabled specific measures focusing on access and affordability (CY, DE, FI, IE, PL, SI), quality of care (CY, DE, FI, LU, SI), and strengthening the attractiveness of working conditions (DE). The COVID-19 pandemic – which has hit older people and other vulnerable groups hard, and shed light on significant shortcomings and weaknesses in long-term care systems in many Member States – will, most probably, fuel further discussions on reforms together with the already ongoing debates

The reforms include establishing new services, as well as measures reinforcing the integrated delivery of care. The latter measures mostly tackle sectoral disparities between healthcare and social care by setting up co-ordination structures. They are also aimed at improving local and regional management and enhancing co-operation between different providers of homecare.

Stay tuned to this page to be informed and updated on the Strategy presented by the European Commission by the end of 2022.

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