European policy options for long-term care

Supporting a possible EU initiative on long-term care



Kai Leichsenring


Kai Leichsenring, Selma Kadi


EFTHEIA, Belgium


Long-term care (LTC) has gained considerable momentum in European policy-making over the past decade. At the same time, challenges related to access, quality of LTC and the LTC workforce (formal and informal carers) have increased in importance. The COVID-crisis and its dramatic consequences have only exacerbated these issues. The European institutions often remind the Member States of the need to increase the cost-effectiveness of LTC systems but have recently also underlined the social rights of citizens regarding access to quality LTC.


The overarching purpose of this Study was to help design a potential future proposal on an initiative of LTC. To attain that goal, the Study aimed at filling the knowledge and analytical gaps in the area of LTC to identify policy relevant issues, and at supporting the design of a future EU initiative on access and quality of LTC by developing options and assessing their impact.


Desk research, literature review, expert interviews, modelling scenarios and impact analysis


  • Inception report (2/2021)
  • Interim report (4/2021)
  • Draft final report (8/2021)
  • Final report (12/2021)


The final report addresses knowledge and analytical gaps in the area of long-term care (LTC) to support the identification of policy-relevant problems and provide evidence for the design of a future EU initiative in the context of Principle 18 of the European Pillar of Social Rights (EPSR) stating that “Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services”. Part 1 complements four aspects of the existing evidence base through an estimation of the job creation potential in the LTC sector, an analysis of the different levels and approaches to ensure the quality of LTC services in the Member States, the identification of strategies to increase the cost-effectiveness of LTC and an overview of the state of play of national rules on pension credits for informal carers in statutory public pension systems. For instance, projections show that most Member States will have to increase the number of long-term care workers by more than 15 per cent until 2030, and eight countries by 30 per cent or more in the coming 10 years. Respective scenarios identify a need to add 140,000-150,000 long-term care workers to the current EU-27 long-term care workforce each year for the next 30 years. To improve access to formal LTC through greater availability and affordability, and to improve the quality of long-term care, Member States will have to increase workforce not only quantitatively but also qualitatively by improving skills, qualifications and working conditions, and by improving support for informal carers. Among the 14 policy options proposed, there is also a focus on implementing common quality principles in LTC and on improving quality assurance mechanisms. The impact of these policy options has been assessed for a range of social and economic outcomes relative to a baseline scenario, as well as with respect to fundamental rights. The scale of the problem demands focused and coherent efforts to address the challenges in long-term care in a comprehensive manner through multi-policy approaches. The value added of the announced EU Care Strategy will be to provide an overview and outline possible synergies in existing actions, while proposing new avenues at EU level. In that way, further action at EU level provides the possibility of building on existing good practices developed in several Member States, as well as supporting upwards convergence to advance together towards better outcomes, benefiting the EU as a whole.

The European Centre for Social Welfare Policy and Research supports the Sustainable Development Goals

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UN SDG Good Health and Well-Being
UN SDG Gender Equality
UN SDG Reduced Inequalities


European Commission, DG Employment, Framework Contract VT/2016/027 for the provision of services related to the implementation of the better regulation guidelines


01/2021 – 12/2021