Long term care

Long-term care consists of a range of services and assistance for people who, as a result of mental and/or physical frailty and/or disability over an extended period of time, depend on help with daily living activities and/or are in need of some permanent nursing care.

These daily living activities may be self-care activities such as bathing, dressing, eating, getting in and out of bed or a chair, moving around, using the toilet, and controlling physiological functions.

Alternatively, they may be related to independent living activities such as preparing meals, managing money, shopping for groceries or personal items, perform light or heavy housework and using a telephone

The risk of developing long-term care needs is higher towards older age, when people are more likely to experience functional ability decline. A little over a quarter of EU citizens aged 65+ report severe difficulties in personal care or household activities.
Principle 18 of the European Pillar of Social Rights stresses:

the right to affordable long-term care services of good quality, in particular home-care and community-based services

Principle 9 of the European Pillar of Social Rights stresses:

the right of people with caring responsibilities to suitable leave, flexible working arrangements and access to care services
the right of women and men to have equal access to special leaves of absence in order to fulfil their caring responsibilities, while being encouraged to use them in a balanced way

Challenges

Long-term care systems differ across the EU in terms of their design and maturity, but all face common challenges:

As Europe is ageing, the demand for long-term care is rising. The number of people in the EU in need of long-term care is projected to increase from 30.8 million in 2019 to 38.1 million in 2050. Other demographic trends, such people having fewer children, family members living further apart and more women in the labour market undermine the sustainability of traditional long-term care models relying heavily on informal carers (usually family members, most often women).
Already today, long-term care needs of many people are unmet due to the lack of long-term care services or awareness about them, limited social protection coverage to help meet care costs and insufficient quality of care. In 2019, only around a quarter of people with severe difficulties with personal care or household activities were receiving home care.
Retaining and attracting formal care workers is often difficult, leaving the job creation potential of the care economy partly untapped. Labour shortages, caused by difficult working conditions and low wages, are expected to worsen in the future.
Informal carers are confronted with multi-faceted challenges ranging from insufficient access to support measures to difficulties in reconciling care with paid work.
There are social inequalities and territorial gaps in long-term care. Coming from a disadvantaged socioeconomic background or deprived/rural areas is often a barrier to accessing quality long-term care.
Care has a strong gender dimension, as most people providing and in need of care are women. Women make up nearly all of the formal care workforce. Care responsibilities keep much more women than men out of the labour market. Women are also more likely to need long-term care, but are less able to afford it.
Long-term care is the fastest-rising social expenditure in the Union. It is projected to increase from 1.7% to 2.5% of GDP between 2019 and 2050, with marked variations across the EU, while under-investment in this area has led to considerable structural weaknesses that need to be urgently addressed.

EU responses

Responsibility for the design and delivery of long-term care services lies primarily with Member States. However, EU delivered two documents to help Member States in implementing High level Care Strategies and High-quality Long-term Care.

The Commission - The European Care Strategy put forward by the Commission on 7 September 2022 aims to support Member States ensure quality, affordable and accessible care services across the European Union and improve the situation for both care receivers and the people caring for them, professionally or informally.
The EU Council - A Reccomendation on Access Affordable High-Quality long-term care was adopted on 8 December 2022. The recommendations address several aspects related to long-term care, including social protection, access to care, quality standards, support for caregivers, and governance. The Reccomendation highlights the need for long-term care to be timely, comprehensive, and affordable, with a balanced mix of care options and care settings that cater to different needs. The recommendations also stress the importance of establishing high-quality criteria and standards for all long-term care settings, improving the professionalization of care work, and providing support to informal caregivers. Finally, the Reccomendation calls for effective coordination mechanisms to design, deploy, and monitor policy actions and investments in long-term care.

Other EU legislative acts or initiatives also touch upon different aspects of long-term care.

For example, the Work-Life balance Directive aims to better support work-life balance for parents and carers, encourage a more equal sharing of parental leave between men and women, and address women’s underrepresentation in the labour market.

Furthermore, the EU supports policy developments and reforms in this area by guidance, analytical and monitoring work, mutual learning and exchange of best practices, as well as financial support. This notably includes:

The 2021 Long-term care Repor t of the Commission and the Social Protection Committee which provides an analysis of the common long-term care challenges in the EU. It also includes a description of the long-term care systems of each of the 27 Member States. The key conclusions of the report were endorsed by the EU Council and discussed with policy makers, social partners, civil society, academics and researchers at the conference Long-Term Care and Pension Adequacy in an Ageing Society
Country analysis and guidance within the European Semester economic coordination cycle
Financial support to boost social policy innovation in the area of long-term care via EASI social innovation projects, as well as support to national reform measures through ESF+, ERDF, from the Recovery and Resilience Facility and the Technical Support Instrument.

In 2023, European Centre of Expertise (ECE) in the field of Labour Law, Employment and Labour Market Policies, published the Thematic Review 2022: Gender Equality and Work-Life Balance policies during and after the COVID-19 crisis. This Review explains that the unequal distribution of unpaid care work between men and women is a major contributor to gender gaps in the labor market, with women having less access to and permanency in the workforce.

This creates vicious cycles where gender gaps in the labor market reinforce the unequal division of unpaid care work in households. Work-life balance policies, such as affordable and quality childcare and long-term care services, parental and paternity leave, and flexible working arrangements, are important for achieving gender equality in the labor market. Cultural and social norms also play a role in the gender division of unpaid work, but policy measures can help promote equal sharing of care tasks in households.

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