What is long-term care?
Long-term care includes a range of services and support for people who, due to mental and/or physical frailty and/or disability over an extended period of time, depend on help with daily living activities and/or need permanent nursing care.
Support may cover:
The need for long-term care increases with age, as people are more likely to experience a decline in functional ability. More than a quarter of EU citizens aged 65 and over report severe difficulties in personal care or household activities.
Long-term care and the European Pillar of Social Rights
The European Pillar of Social Rights recognises access to care and support as a key element of social protection.
Principle 18: Long-term careEveryone has the right to affordable long-term care services of good quality, in particular home care and community-based services
Principle 9: Work-life balancePeople with caring responsibilities have the right to:
- suitable leave and flexible working arrangements
- access to care services
- equal opportunities for women and men to special leaves of absence to fulfil caring responsibilities, while being encouraged to use them in a balanced way
Why long-term care matters: key challenges
Long-term care systems differ across the EU in their design and level of development, but all face common challenges.
Rising demand for careAs Europe is ageing, the demand for long-term care is rising. The number of people in the EU in need of long-term care is projected to increase from 30.8 million in 2019 to 38.1 million in 2050.
Demographic and social trends are putting pressure on traditional care models based on informal carers, as:
- people have fewer children
- families live further apart
- more women participate more in the labour market
Gaps in availability and affordabilityLong-term care needs of many people are unmet due to:
- lack of long-term care services or awareness about them
- limited social protection coverage to help meet care costs
- insufficient quality of care
Socio-economic and territorial inequalities in access to careAccess to quality long-term care varies across regions and population groups.People coming from a disadvantaged socioeconomic background or living deprived/rural areas often face greater barriers to accessing appropriate services.
Care workforce shortagesRetaining and attracting care workers is often difficult, leaving the job creation potential of the care economy partly untapped. Labour shortages, caused by difficult working conditions and low wages, are expected to worsen in the future.
Challenges for informal carersInformal carers are confronted with multi-faceted challenges ranging from insufficient access to support measures to difficulties in reconciling care with paid work.
Gender care gapCare has a strong gender dimension:
- women represent the majority of both people providing and in need of care
- women make up nearly all of the formal care workforce
- care responsibilities keep much more women than men out of the labour market
- women are more likely to need long-term care, but are less able to afford it
Financing sustainable care systemsLong-term care is the fastest-growing area social expenditure in the EU. Spending is projected to increase from 1.7% of GDP in 2019 to 2.5% of GDP in 2050, with marked variations across the EU.
Despite growing needs, under-investment in this area has led to considerable structural weaknesses in long-term care systems that need to be urgently addressed.
Policy responses
Responsibility for the design and delivery of long-term care services lies primarily with the EU countries.
Council Recommendation on affordable high-quality long-term care
The Council Recommendation on affordable high-quality long-term care was adopted on 8 December 2022.
It calls on EU countries to:
- improve access to affordable, high-quality long-term care for all people who need it
- strengthen social protection coverage for long-term care
- improve the availability and quality of long-term care services
- address the challenges faced by formal and informal carers as well as improve long-term care governance
The Recommendation also invites EU countries to establish a long-term care coordinator or another appropriate coordination mechanism. This is meant to support the implementation at national level as well as to share the measures taken or planned to implement it, within 18 months from the adoption.
Monitoring progress on long-term care
The Commission and the Indicators Sub-Group of the Social Protection Committee worked developed a monitoring framework for the Long-Term Care Recommendation in 2023 and 2024.
The framework translates the different objectives of the Recommendation into measurable and actionable indicators and policy levers and will be updated on a regular basis.
A first version was adopted in May 2025 by the Social Protection Committee. It contains a theoretical framework and three types of indicators (performance indicators, policy levers and context information).
It provides a basis against which progress can be evaluated.
European Care Strategy
The European Care Strategy, presented by the Commission on 7 September 2022, aims to support EU countries in ensuring that care services are:
- of high quality
- affordable
- accessible
The goal is to improve the situation for both care receivers and the people caring for them, professionally or informally.
EU-level actions
A wide range of EU-level actions are being rolled out to support the implementation of policy reforms and investments in long-term care. These include:
