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Legislative frameworks for residential care facilities in Europe

2017: Standards for Residential Care Facilities

Legislative frameworks for residential care facilities in Europe

Table 3 (on the attached page) shows an overview of the regulatory framework for residential care facilities by country. In the majority of the cases, the main responsibility for regulating and monitoring the care provided in these facilities lies in the central government. However, in a number of countries (e.g. Austria, Belgium, Germany, Italy, Switzerland, Spain and Sweden) this function is de-centralised.

In some countries (e.g. Czech Republic, Finland, Latvia, Lithuania, Slovakia, Slovenia and Sweden), the main regulatory requirements that residential care facilities have to meet are covered by legislation for health and social services. Likewise, in the UK (England), the standards apply to all services registered with the Care Quality Commission (CQC) that carry on regulated activities (e.g. residential care facilities, hospitals, hospices and community support facilities). Nevertheless, in many other countries, there is a regulatory framework which is specific for residential care facilities. Belgium (Wallonia), has different requirements for care homes for older people with lower dependency needs and nursing homes for older people with higher levels of dependency.  Likewise, in the UK (Northern Ireland), two different sets of standards exist i.e. Minimum Standards for residential care homes and Care Standards for nursing homes [8]. Both sets of standards in Northern Ireland were written under the provisions of Article 38 of the Health and Personal Social Services (Quality Improvement and Regulation) (Northern Ireland) Order 2003.


8 In Northern Ireland, nursing homes are for people who have a disability or illness that means the person needs nursing care on a frequent basis.

Table 3: Regulatory framework by country


Country                    Relevant legislative framework and national standards


  • —In Austria, residential care is not under the competence of the Federal Government, but under the competence of the Länder (there are 9 Länder in Austria). Each of them has different pieces of legislation, laws and care standards for residential care facilities. In addition, the Federal Ministry of Health and the Federal Ministry of Social Affairs developed the Austrian Dementia Strategy in 2015.

Belgium (Flanders)

  • —The Special Act of 6 January 2014 provides for the Flemish Community to be given responsibility for various healthcare and welfare services, among other services the provision of residences for older people and long-term care.
  • —Residential Care Decree of 13 March 2009.

Belgium (Wallonia)

  •  —Code of Wallonia for Social and Health Care.


  • —Social Assistance Act and its regulation. Currently, a new law abut social services is being drafted.


  • —People with dementia were mentioned for the first time in documents relating to nursing homes in 2009 (Ordinance NN64/2009 art. 82 to 86). Since 2014, and as stipulated by Law of Social Welfare NN157/13 art. 185, public nursing homes are allowed to take care of people with dementia. In 2015, additional and more concrete descriptions of the conditions for providing social services were developed. These are according to changes and additions to the Rule Book on the minimum conditions for providing social services NN 66/2015 (Ministry of Social Policy and Youth).


  • —Law of 1991 for the operation of residential care facilities for senior citizens and disabled persons, and its 2000 updated regulations. Amended 2011.


Czech Republic

  • —Social Services Act. No. 108/2006 Coll. 2006 (effective from 1. 1. 2007).
  • —Health Care Services Act No. 372/2011 Coll.
  • —Decree No. 505/2006 (Quality standards for social services).
  • —Decree No. 398/2009 Coll. on general technical requirements ensuring the barrier-free use of buildings.
  • —Decree No. 6/2003 Coll. which sets the hygienic limits of chemical, physical and biological indicators for the indoor environment of the living rooms of some buildings.
  • —ČSN 73 0802:2009 Fire safety of buildings.
  • —ČSN 73 4301 Residential buildings.

Finland [9]

  • —Act on Supporting the Functional Capacity of the Older Population and on Social and Health Care Services for Older Persons (2012).
  • —The Recommendations for the Quality of Elderly Services (Ministry of Social Affairs and Health) Social Welfare Act 710/1982, 2013, updated 2017.
  • —Health Care Act 1326/2010.
  • —Act on the Status and Rights of Social Welfare Clients (812/2000).
  • —Act on the Status and Rights of Patients (785/1992).
  • —Act on Private Social Services (922/2011).
  • —Private Health Care Act (152/1990).


  • —Code of Social Action and Families (2017).
  • —Code of public health, code of construction and housing, general code of local authorities (2017).
  • —Law No. 2002–2 renewing social and medico-social activities and implementing decrees.
  • Law No. 2002–303 on the rights of patients and the quality of the health system.
  • —Law No. 2005–102 for equal rights and opportunities, participation and citizenship of persons with disabilities.
  • Law No. 879 on hospital reforms and relative to patients, health and territories and implementing decrees (2009).
  • —Law No. 2015–1776 on the adaptation of society to ageing and implementing decrees.
  • —Law No. 2016–87 creating new rights for patients and the end-of-life.


  • —Law on Long-Term Care Insurance (LTCI) Code of Social Law XI (1995).
  • —There are institutional care laws and regulations at federal state level regarding construction and staffing.
  • —There are national expert standards for different topics [10].


  • —Law N.2716/99 and FEK n.661/2000 (hospices for people with mental health problems) [11].
  • —FEK 455/1996 and FEK 1136/2007 (private Care Units for older people).


  • —Act on Social Regulations and Social Assistance (1993/III.)
  • —Act on Health (1997/CLIV).
  • —Act on the informational autonomy and freedom of information (2011/CXII).
  • —Regulation of the Minister for Social and Family Affairs 1/2000 on the tasks of social institutions providing personal care and the conditions of their operation.
  • —National Standards for Physical Environment, Employment in Dementia Care for Residential Facilities for Older People.


  • —S.I. No. 293/2016 Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) (Amendment) Regulations 2016.
  • —National Standards for Residential Care Settings for Older People 2016.
  • —Guidance on Dementia Care for Designated Centres for Older People 2016.



  • —Law 328/2000 Framework Law for the Implementation of the Integrated System of Social Services.
  • —Ministry Decree 308/2001 Minimum Structural and Organizational Requirements for Authorization to Perform Services in residential and semi-residential structures, pursuant to Article 11 of Law No. 328.
  • —This regulation lays the main principles which are then further developed in regional laws.

Latvia [12]

  • —Law on Medical treatment.
  • —Law on the Rights of Patients.
  • —Law on Social Services and Social Assistance.
  • —Regulation No. 291 of the Cabinet of Ministers on “Requirements for social service providers”.


  • —Social care norms Order No. A1–46 of the Minister of Social Security and Labour (2007).
  • —Law on Social Services.
  • —Working time standards for social care staff Order No. A1-317 (2006).


  • —Grand-ducal regulation concerning the approval for providers of services for older people (1999).
  • —Law 24 July 2014 related to the rights and obligations of patients.
  • —Law 19 June 1998 introducing the dependency insurance. In 2018, a new law on dependency insurance will be in place.


  • Homes for Older Persons (Care Quality Standards) Authority Act, 2016.
  • —National Minimum Standards (Care Homes for older peop—le) 2015.


  • —Quality Framework for Nursing Home Care (2017).[13]
  • —Law on Long-Term Care (2014).
  • —Law Quality, Complaints and Disputes in care (2015).
  • —Law Occupations in the Individual Health Care (1993).
  • —Tax regulations.


  • —The Act on Municipal Health and Care Services (2011, last updated 2017).
  • —Regulations for nursing homes and special dementia units (1989, last updated 2013).
  • —Patient and Users Rights Act (2001, last updated 2017).


  • —Social Assistance Act 2004. Amended in 2012.
  • —Minister of Family, Labour and Social Policy Decrees on social assistance homes 2012 and 2017.
  • —Old Persons Act 2015.
  • —Minister of Health Regulation on guaranteed nursing and care services for long-term care of persons with chronic diseases.


  • —D.L. No. 64/2007 on the legal framework for licensing and supervision of the provision of services.
  • —Order (Portaria) No. 67/2012 on the conditions of organization, operation and installation to which residential establishments for older persons must comply.
  • —Order (Portaria) No. 196-A/2015 on the criteria, rules and forms of the specific model of cooperation between the Social Security Institute and the Private Social Solidarity Institutions.
  • —Order (Portaria) No. 100/2017 creating the “Program to Celebrate or Extend the Cooperation Agreements between the Social Security Institute and the Private Social Solidarity Institutions”.


  • —Order No. 2126/05.11.2014 regarding the approval of the minimum quality standards for the accreditation of social services for the elderly, the homeless, young people who have left the child protection system and other categories of adults in need, and for services provided in the community, services provided under the integrated social and Cantonese, published in the Official Gazette of Romania, Part I, No. 874/12.02.2014.
  • —Order of MMFPSPV No. 3123/2015 amending the Order of the Ministry of Labour, Family, and Social Protection and the Elderly of Romania No. 2126/2014.
  • —Order No. 67/21.01.2015 regarding the approval of minimum quality standards for the accreditation of social services for adults with disabilities.


  • —Act No. 448/2008 Coll. on Social Services and on amending of the consolidated.


  • —Social Security Act 2008 (last updated 2017) No. 540-01/91-5/46
  • —Health Care and Health Insurance Act 1992 (last updated 2013) No. 1992-2711-0044.
  • —Mental Health Act No. 1999-2711-0006.
  • —Health Services Act 1992 (last updated 2013) No. 1992-01-0460.
  • —Patient Rights Act 2008 (last updated 2017) No. 2005-2711-0080.


  • —Law 39/2006 on the promotion of Personal Autonomy and Care for Dependant People.
  • —Agreement partially amending the Agreement approved by the Territorial Council of Social Services and the System for Autonomy and Care for Dependency on 2008 on accreditation of centers and services of the System for Autonomy and Attention to Dependency[14] 2015.
  • —The above law (2006) and agreement (2015) establish the main principles and minimum standards which are then further developed by regional law (Comunidades Autónomas).


  • —Social Services Act 2001.
  • —Health and Medical Service Act.
  • —Regulations and national guidelines published by the National Board of Health and Welfare.


  • —The main responsibility for health care (Gesundheitsversorgung) lies within the cantons. All cantons have legislation for residential care facilities.


  • —There are two separate sets of regulations, i.e. for public residential facilities and for private facilities.

UK (England)

  • —Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 [15].
  • —Care Quality Commission (Registration) Regulations (Part 4) 2009.

UK (Northern Ireland)[16]

  • —Health and Personal social services Order (2003).
  • —The Residential Care Homes Regulations (Northern Ireland) 2005; Residential Care Homes – Minimum Standards (2011).
  • —The Nursing Homes Regulations (Northern Ireland) 2005;Care Standards for Nursing Homes (2015).

UK (Wales)

  • —Current regulation: Care Homes Regulation 2002 (all care homes), Minimum Standards for Care Homes for Older People 2004.
  • —Regulation and Inspection of Social Care (Wales) Act 2016.[17]

UK (Scotland)

  • —National Care Standards (NCS) (due to be replaced by the National Health and Care Standards (NHCS) from April 2018), deriving from the Public Services Reform (Scotland) Act 2010.


9   The Act provides the general requirements, the more specific details are further developed in various acts, norms and guidelines. The Ministry of Social Affairs and Health has published recommendations for the Quality of Elderly Service which are very influential but not mandatory.

10   An expert group is developing standards for the care of people with dementia. The standards apply to care in general (i.e. not specific for residential care settings).

11   These laws set the relevant requirements for hospices for people with mental health problems. These type of hospices are few, funded by the state and accept people over 56 who need psychogeriatric assistance. There is an ongoing consultation by the Ministry of Health on making specific additions to these laws for the five new Hospices-Palliative Care Units for people with dementia at the late stages of the condition that are planned to operate in different cities in Greece.

12   These laws address some aspects of the care that should be provided in these facilities, however more specific details can be found in the internal documents and regulations of each residential care facility.

13    Based on the quality requirements which are in the Law on Long-Term Care.

14 In addition to this agreement, there are regional laws for each Comunidad Autónoma. For example, in Madrid: Law 11/2002 on the organization of the activity of the centers and services of social action and of improvement of the quality in the provision of social services in the Comunidad Autónoma of Madrid. Order 612/1990 by which Decree 91/1990 is developed, relating to the authorization regime of social action centers and services.

15   Section 23 of the Health and Social Care Act 2008 (HSCA 2008) stated that the Care Quality Commission (health and social care regulator) must produce guidance to help providers to comply with the regulations made under this Act. The guidance has been in force since April 2015 and was designed to implement Robert Francis’s recommendations from his report about Mid Staffordshire NHS Foundation Trust.

16  In Northern Ireland, “a residential care home provides residential accommodation with both board and personal care for persons in need of personal care by reason of old age and infirmity; disablement; past or present dependence on alcohol or drugs; or past or present mental disorder. They do  not provide nursing care. A nursing home is any premises used, or intended to be used for the reception of, and the provision of nursing for persons suffering from any illness or infirmity. Some homes are registered to care for both people in need of residential or nursing care” (RQIA website).

17    Not yet into force.






Last Updated: Friday 31 January 2020


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    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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