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

"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 five 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.


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, has increased between 2017 to 2021, from 1.6% to 2%.

  • General government expenditure in social protection and healthcare, as a percentage of GDP, have both significantly increased (social protection: from 19.2 percentage points in 2018 to 21.9 in 2020; healthcare: from 6.9 in 2018 to 8.0 in 2020).

  • Healthy life years for women at age 65 dropped by 0.3 percentage points between 2019 and 2020 (10.4 in 2019 to 10.1 in 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).

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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

Consult our flashcard on "Principle 9 - Work-life balance" for more supportive policy instruments on the topic.

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.

The proposal also encourages Member States to draft their own national action plans on long-term care and appoint corresponding focal points.

The European Care Strategy was accompanied by two proposals for Council recommendations, one being on affordable high-quality long-term care. A Council recommendation on affordable high-quality long-term care was adopted on 25 November 2022.

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 Protection Committee
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 Dorota Sienkiewicz via

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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