Long-term care includes a broad range of personal, social, and medical services and support that ensure people with, or at risk of, a significant loss of intrinsic capacity (due to mental or physical illness and disability) can maintain a level of functional ability consistent with their basic rights and human dignity.
Long-term care is provided over extended periods of time by family members, friends or other community members (also called informal caregivers) or by care professionals (also called formal caregivers).
Formal long-term care aims to prevent, reduce, or rehabilitate functional decline and it can be provided in different settings, such as home care, community-based care, residential care, or hospital care.
Long-term care services are essential for individuals who experience, or are at risk of developing, significant loss of intrinsic capacity and diminished functional ability due to mental or physical illness and disability. People of all ages can develop long-term care needs but, as the world population ages, adults aged 60 years or above account for a larger share of long-term care users.
Globally, an estimated 142 million older people are unable to meet their basic needs independently and two out of three older people are likely to need care and support at some point during their lives. Women, people living alone, and those with lower health and socioeconomic status are more likely to require long-term care services.
The need for long-term care services can extend beyond the individual with care needs, to their informal caregivers. These caregivers are mostly women, often older and experiencing declines in functional ability themselves. The detrimental mental and physical health effects associated with frequent and intensive caregiving disproportionately affect women and have become more accentuated during the COVID-19 pandemic.
Most long-term care is provided informally and by family members, neighbors, friends, or community members who are often not paid. Estimates suggest that informal care accounts for as much as 80% of all long-term care provided in Europe while formal care services account for the remaining 20%. In countries where long-term care systems are not as well-developed or resourced, the amount of care provided informally is likely to be even higher.
A large majority of caregivers are women. Women represent nearly two thirds of informal caregivers in Europe and are more likely than male caregivers to engage in high-intensity care tasks and provide frequent care. In the formal long-term care workforce in Europe, including both social care and healthcare professions, women outnumber men almost 9 to 1.
Long-term care work can be physically and emotionally straining and is often made more difficult by task overload, shiftwork, irregular and long working hours, low earnings and a high prevalence of irregular work contracts. Similarly, informal caregiving, especially when sustained over long periods or at higher intensity, can negatively affect the wellbeing, physical and mental health and socio-economic opportunities of caregivers.
Sustained public investment and commitment is needed to protect, support, strengthen and optimize the long-term care workforce, both formal and informal. This includes actions to protect their health and wellbeing, to improve access to training and education, to expand the use of digital technologies and to build leadership capacity for better workforce governance and planning.
You can read more about how to support the formal and informal long-term care workforce in the report Health and care workforce in Europe: time to act and the factsheet on Caregiving impacts on unpaid informal carers’ health and well-being.
Long-term care allows people who experience significant declines in intrinsic capacity to maintain their quality of life and continue to do things that are important to them, as independently and as safely as possible, while ensuring their basic rights, fundamental freedoms, and human dignity are respected.
Access to long-term care services can delay and slow down the loss of intrinsic capacity, allowing people to live independently for longer. This is often the case for age-related declines in function, which tend to happen slowly over time, providing opportunities for appropriate interventions that can prevent or delay capacity losses.
Strong long-term care services benefit the wellbeing of people with long-term care needs, as well as their families and communities. Access to respite care, support services, training and information helps to protect the mental and physical health of informal caregivers, while accessibility and affordability of long-term care services can ensure households are not burdened by undue financial pressures and can take full advantage of economic opportunities.
Strengthening long-term care delivery is also an investment in the sustainability and performance of health and social protection systems. It promotes the efficient allocation of scarce resources, avoids the costly duplication of tasks, and facilitates the delivery of care in the most appropriate settings. Absent or insufficient long-term care services place an increased burden on informal caregivers, limiting their ability to participate in the labor market and consequently reducing potential for economic growth at national level.
Although the need for long-term care is increasing rapidly in the WHO European Region, the readiness of health and long-term care systems to respond to existing and growing needs remains limited in many countries. Most people with long-term care needs rely on families and informal caregivers for support, while long-term care services remain under-developed, particularly in community-based settings. On average, less than one in four Europeans aged 65 and over with care needs can access home-based care services. In some countries this is as low as one in twenty.
When long-term care delivery is fragmented or insufficiently developed, people with care needs must rely on inappropriate and costly hospital or institutional care, or on their informal caregivers. This places significant strain on families and on health care systems and leads to high societal costs through loss of economic opportunities and inefficient allocation of limited financial resources.
The importance of investing in stronger long-term care systems and services is recognized across the European region. In 2020, 46 out of 53 countries in the region had a national policy on long-term care, addressing home-based, community-based and residential care delivery. However, much still remains to be done to implement the vision of these strategies and to address important gaps in the accessibility, affordability and quality of care services.
You can read more about how countries are responding to growing long-term care needs, and how long-term care systems can be strengthened, in the UN Decade of Healthy Ageing baseline report, the policy brief: Rebuilding for sustainability and resilience: strengthening the integrated delivery of long-term care in the European Region and the Framework for countries to achieve an integrated continuum of long-term care.
WHO recognizes long-term care services as an essential part of an integrated continuum of care and crucial to achieving universal health coverage, within the context of population ageing. Investment in integrated and person-centered health and long-term care services that respond to the diverse needs and preferences of people experiencing declines in functional ability is necessary to reach the Sustainable Development Goal 3 – “ensuring healthy lives and promoting well-being for all at all ages”.
In 2016, the World Health Assembly agreed that every country needs an equitable and sustainable long-term care system that can adequately meet the care and support needs of their populations. The same call to action has been echoed in the WHO Global Strategy and Action Plan on Ageing and Health and the WHO-led United Nations Decade of Healthy Ageing (2021–2030), which recognizes access to long-term care for older people who need it, as one of its four action areas.
To aid countries working to develop and strengthen their long-term care systems, WHO Europe provides technical support for the development, implementation and monitoring of relevant policies and services; and designs tools and guidance for improving the financing, organization, delivery and quality of long-term care services and systems.
These efforts focus on national health and long-term care or social protection systems, as well as responses to emergencies, to ensure a coordinated and sustainable approach to service delivery and the availability of long-term care services to anyone who needs them. In response to the COVID-19 pandemic and its disproportionate impact on older people, particularly those living in residential care settings, WHO has published tools and guidance on preventing and managing COVID-19 across long-term care services, as well as strengthening infection prevention and control in long-term care facilities.
WHO Europe has also redoubled efforts to create platforms for knowledge exchange and learning between and within member states, with a view to supporting innovation and sharing good practices in long-term care systems. WHO Europe is a strategic partner of the European Commission in the implementation of the European Care Strategy, working with regional, national and local partners to strengthen assessment and monitoring of long-term care systems, and supporting the design and implementation of reforms to improve access to affordable high-quality long-term care.