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Relevance of the topic and European policy context

Population ageing is a long-term trend which began several decades ago in Europe (Eurostat, 2017). According to current estimations the EU-28’s population will continue to age. Another aspect of population ageing is the progressive ageing of the older population itself, the share of people aged + 80 years will double between 2016 and 2080 (Eurostat, 2017). This overall increase in life expectancy across Europe is a very positive trend. However, demographic change is also seen as a challenge for many policy areas, including social protection systems, and health and long-term care[3] in particular. According to the European Commission (2014), the ageing of the population is expected to put pressure on governments to provide more formal long-term care benefits. Long-term care is a broad concept and it encompasses both informal and formal care. Only some aspects of the latter (i.e. long-term care provided in residential care facilities) are addressed in this report.

In the European Union (EU), it is estimated, that the number of people who may potentially need long-term care services will increase by 30% between 2013 and 2060 (Commission Services and Economic Policy Committee, 2016). Whilst, older people are not the only citizens who may need long-term care, they are more likely to need it due to potential frailty and co-morbidities. The growing number of people living with dementia is also another factor that is often mentioned in this context.

Within the EU, the provision of long-term care is a Member State responsibility (Social Protection Committee and the European Commission, 2014). However, the topic of long-term care, as part of the social inclusion and social protection strand[4] is addressed at EU level in different ways.

As part of the political cooperation, the Commission works together with Member States through the Social Protection Committee using the Open Method of Coordination[5] in the areas of social inclusion and social protection. This provides a framework for national strategy development for social protection and investments, as well as for coordinating policies between EU countries on, among other issues, health and long-term care. In this context, Member States have agreed on three common objectives: (1) guarantee access for all to health and long-term care, (2) promote quality in health and long-term care and adapt care to the changing needs and preferences of society and individuals, notably by establishing quality standards reflecting best international practice and by strengthening the responsibility of health professionals and of patients and care recipients and (3) ensure that health and long-term care remain affordable and sustainable.

The European Semester[6] allows countries to discuss their economic and budget plans and monitor progress throughout the year. As part of this work, the Commission issues an Annual Growth Survey which presents the Commission’s view of EU policy priorities for the coming year. The 2017 Annual Growth Survey refers to long-term care and highlights that Member States need to ensure access to quality services including long-term care, and also, in order to slow the rise in expenditure in long-term care services, recommends policy action to enable individuals to stay healthy for longer and make health systems more effective, accessible and resilient. In 2016, 19 Member States referred to challenges linked to long-term care, 11 in their national reports referred to scarce provision and coverage (ENNHRI website[7]). 

In 2016, the European Commission introduced the European Pillar of Social Rights. The Pillar reaffirms rights that are already present in the EU and complements them to take account of new realities (European Commission website). The principles and rights enshrined in the Pillar are structured around three categories: (1) equal opportunities and access to the labour market, (2) fair working conditions and (3) social protection and inclusion. Chapter III (article 18) refers to the right to affordable long-term care services of good quality.

Despite this work, the cost, sustainability and quality of long-term care systems remain a challenge for most EU Member States (Commission Services and Economic Policy Committee, 2016; Social Protection Committee and the European Commission, 2014). The OECD/European Commission report concluded that “the measurement of quality in long-term care lags well behind the health sector. More effective monitoring of long-term care quality, and the development of robust, comparable measures, should be a priority for OECD countries” (2013:16).


[3] Long-term care can be defined as “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”.

[4] The European Commission supports and complements the Member States' policies in the fields of social inclusion and social protection.

[5] The Open Method of Coordination on Social Protection and Social Inclusion was launched in 2000 and is a method of soft governance and part of the implementation of the process of coordination of social policies. It is used by Member States to support the definition, implementation and evaluation of their social policies and to develop their mutual cooperation. The method supplements the legislative and financial instruments of social policy (EU website).

[6] In the framework of the “Europe 2020” strategy, the European Commission (EC) put in place a process of economic reforms and surveillance to support Member States in achieving the planned objectives and the targets. This process is known as the European Semester. The European Semester is an annual cycle during which information is exchanged between the EC and the Member States and economic reforms in the fields of employment, education and poverty reduction are planned. In November of each year, the EC sets out its priorities in the Annual Growth Survey. On the basis of these priorities the EU Heads of State issue policy guidance to Member States. This policy guidance is then meant to be reflected in the drawing up of National Reform Programmes and Stability/Convergence Programmes by each Member State. These programmes are assessed by the EC which then draws up a number of Country Specific Recommendations which are considered and finally adopted by the European Council (Azzopardi-Muscat et al., 2015).


European projects addressing long-term care

A number of European projects and initiatives have looked at different aspects of long-term care in Europe and have tried to address some of these challenges. Some examples of this work include:

  • ANCIEN project : Assessing the needs of Care in European Nations (2009-2012).
  • ENNHRI: Human rights of older persons in long term care project (2015-2017).
  • Interlinks: Health systems and long-term care for older people in Europe. Modelling the interfaces and links between prevention, rehabilitation, quality of services and informal care (2008-2011).
  • PACE: Palliative Care for Older People in care and nursing homes in Europe (2013-2018).
  • WeDO Project: European Partnership for the wellbeing and dignity of older people (2010-2012): As part of this work the European Quality framework for long-term care services was developed.






Last Updated: Friday 31 January 2020


  • Acknowledgements

    This Dementia in Europe Yearbook received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
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