In nowadays ageing society, an increasing number of people needs long-term care (LTC): daily assistance to carry out basic self-care tasks. In support of the Commission’s analysis and forthcoming initiatives, the European Social Policy Network (ESPN) published in September a description and analysis of the national long-term provisions addressed to people aged 65 or over.
The purposes of the Study are to illustrate the main challenges and trends in national policies, the national reforms aimed at tackling them and to give an overview of national LTC indicators. The national reports examine four challenges of national governments in LTC provision: access to and adequacy of long-term care provisions, employment of carers, quality of LTC provision and jobs, and the financial sustainability of national long-term care provisions.
The main findings are not reassuring. Access to and financing of LTC systems are problematic due to the institutional and geographical fragmentation of LTC provision. Also, the quality of LTC remains a critical factor both in residential and in home care settings. The prioritization of home care is highlighted as a trend, but home care services and community-based care are the most difficult to access in many countries. The availability of residential care has been decreasing in several countries over the past 25 years and the deinstitutionalization process is highly visible in the Nordic countries that have a long tradition of residential care. At the same time, residential places have been increasing in Southern and Eastern European countries, even though the demand for care considerably exceeds its supply. In this context, the privatisation and marketisation of LTC go hand in hand with the rapid growth of a LTC commercial sector and with the increasingly important role of, often migrant, domestic workers. Only some countries have successfully implemented strategies to accompany homecare with prevention and rehabilitation strategies.
Informal care plays a substantial role which is increasing because of the lack of accessible, affordable and high quality formal LTC facilities and of the traditional model of intergenerational and familial relations. Women continue to carry out the bulk of caregiving and this negatively impacts their labour market participation. In spite of these challenges, only a limited number of countries have well-developed services such as training, counselling, respite services tailored to informal carers. These outcomes are in line with those of the COFACE report ‘Who cares? Study on the challenges and needs of Family Carers’, published in 2017, which emphasized the lack of community-based services, social protection and personal assistance which leads to isolation and financial difficulties of informal carers and their families; and calls for investment in 21st century community-based support services and family support measures, with special regard to work-life balance policies.