This discussion paper highlights approaches to develop quality and affordable long-erm care in Europe, with a special emphasis on the definition and assessment of needs, the development of services in the community, including new semi-residential services, and the integration of health and social care. It provides the policy context, comparing the diversity of care arrangements in Europe to long-term care services. A series of national developments and approaches are described and discussed in regard to enhanced access to services and benefits, possible inequalities and cost-effectiveness.