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.
Policy responses
Responsibility for the design and delivery of long-term care services lies primarily with Member States.
The Council Recommendation on affordable high-quality long-term care was adopted by the Council on 8 December 2022:
- it invites Member States to take action to improve access to affordable, high-quality long-term care for all people who need it
- it addresses the adequacy of social protection for long-term care, the availability and quality of long-term care services, the challenges faced by formal and informal carers as well as long-term care governance
- it invites Member States to have in place a long-term care coordinator or another appropriate coordination mechanism supporting the implementation of this Recommendation at national level as well as to share the measures taken or planned to implement it, within 18 months from the adoption.
See national implementation reports
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.
A wide range of EU-level actions are being rolled out to support the implementation of policy reforms and investments in long-term care. These include:
- Strategic partnerships with the World Health Organisation (WHO) and the OECD to support the assessment of national long-term care systems and measure the effectiveness of social protection for long-term care
- A large-scale skills partnership for long-term care, under the pact for skills, to improve skills and training in the sector and skills intelligence to anticipate needs in the sector
- A Sectoral Social Dialogue Committee for social services to ensure better working conditions and improve affordable high quality social services
- Mutual learning and exchange of best practices, such as recently on quality of long-term care and social protection for long-term care
- Monitoring and analytical work, such as the 2021 Long-term care report of the Commission and the Social Protection Committee which provides an analysis of the common long-term care challenges in the EU
- 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.
