Principle 18

Long-term care

"Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services."

- Principle 18 of the European Pillar of Social Rights

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Long-term care as a determinant of health

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Long-term care services help people live as independently and safely as long as possible when they can no longer perform everyday activities on their own. This involves being able to actively participate in society and benefit from services that maximise a person's ability to grow, learn, and enjoy all human rights.

When work becomes an overwhelming part of life, it can put additional time and emotional pressure on those with caring responsibilities and become an unmanageable burden. Conflicts between work and family responsibilities may trigger stress, burn-out, maladaptive coping mechanisms, and overall mental health decline.

What does the EPSR Action Plan say?

The EPSR Action Plan sets out a few key goals for EU Member States:

  • Investing in health and care workforce, to improve their working conditions and access to training.

  • Boosting the digitalisation of their health systems and tackling health inequalities.

  • Implementing the European Care Strategy (adopted 2022), including the Council Recommendation on access to affordable, high-quality long-term care (adopted 8 December 2022). It is the main EU policy vehicle guiding reforms on affordability, availability, quality, workforce and governance in long-term care. 

  • Strengthening LTC governance and reporting: the Council Recommendation invites Member States to put in place a national long-term care coordinator (or equivalent mechanism) and to share measures taken or planned to implement the Recommendation. By 2025, the emphasis was on follow-through, peer learning and monitoring. 

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Where are we now?

The Social Scoreboard measures progress on the principles of the EPSR. Linked to the principle of minimum income, the Scoreboard outlines that in the EU:

  • Self-reported unmet need for medical care, as a percentage of population above 16, fell slightly to around 1.7% in 2023, after peaking in 2020–2021, but remains higher than before the pandemic. 

  • General government expenditure in social protection and healthcare continues to stabilise after the pandemic spike: social protection stood at around 21.4% of GDP in 2023, while healthcare expenditure accounted for about 7.6% of GDP, both remaining above pre-COVID levels.

  • Healthy life years at age 65 remain well below the EU target of ten years: in 2023, women could expect 10.0 healthy life years, and men 9.8, showing only marginal recovery since 2020.

  • Healthy life years for men at age 65 dropped by 0.7 percentage points between 2019 and 2020 (10.2 in 2019 to 9.5 in 2020).

* Data from 2024

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What are public health actors doing?

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The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 18.

Click on a country to learn about initiatives taking place.

EU tools that help implement Principle 18

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 18 on minimum income

More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.

European Care Strategy

Within the context of long-term care, the 2022 European Care Strategy outlines EU-level measures to strengthen Member State action and reform of social care. Among others, it encourages Member States to:

  • Strengthen social protection for long-term care and improve the adequacy, availability, and accessibility of long-term care services.
  • Put forward a set of quality principles and quality assurance guidance.
  • Improve working conditions and upskilling and reskilling opportunities in the care sector, while highlighting the significant contribution made by informal carers and their need for support.
  • Set out several principles of sound policy governance and sustainable financing.
  • Tap into digital solutions when designing, implementing, and monitoring policies and related funding for care, together with social partners and civil society.

Under the accompanying Council Recommendation on access to affordable, high-quality long-term care (adopted 8 December 2022), Member States were invited to appoint national long-term-care coordinators and present national measures to implement the Recommendation. 
By 2025, several Member States have designated focal points and launched national care-reform strategies, with progress monitored through the European Semester and the Social Protection Committee’s follow-up. 

Council recommendation on affordable high-quality long-term care
Green Paper on Ageing
EU Strategy on 'Shaping Europe's Digital Future'
EU Rural Pact
Social Economic Action Plan
Directive on adequate minimum wages in EU

Have your say

Would you like to share promising policies or practices carried out by your public health institute, which support the implementation of this EPSR principle?

Feel free to reach out to our EuroHealthNet colleague Silvia Ganzerla.

About EuroHealthNet

Building a healthier future for all by addressing the determinants of health and reducing inequalities.

EuroHealthNet is the Partnership of public health agencies and organisations building a healthier future for all by addressing the determinants of health and reducing inequalities. Our focus is on preventing disease and promoting good health by looking within and beyond the health system.

Structuring our work over a policy, a practice, and a research platform, we focus on exploring and strengthening the links between these areas.

Our approach focuses on integrated concepts to health, reducing health inequality gaps and gradients, working on determinants across the life course, whilst contributing to the sustainability and wellbeing of people and the planet.

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