Principle 18: Long-term care

The European Pillar of Social Rights

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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.

As the population ages, older persons are increasingly carrying a disproportionate burden of ill health. The percentage of EU citizens above 80 is expected to reach 13% by 2070 (in comparison to 6% in 2019). This will lead to a higher demand for long-term care, with projections indicating that the number of EU citizens in need of the long-term care will reach 38.1 million in 2050.

What does the EPSR Action Plan say?

The EPSR Action Plan sets out three 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 long-term care, 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?

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.

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What are health actors doing?

Slovenia - Long-term care as a pillar of social security 

Due to its demographic shift, Slovenia’s Ministry of Health, introduced an umbrella bill, which defines long-term care as a unique pillar of social security, connected to health, social care and pension systems.

The bill foresaw the implementation of three pilot projects in urban, semi-urban and rural settings. Financed in part by ESF+, these pilots tested an eligibility scale for long-term care, and attempted to integrate health and social services, and improve independent living and e-care.

An evaluation has highlighted the importance of investing in the skills of health professionals to protect their health, improve services, and protect the wellbeing of informal carers.

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What are health actors doing?

Sweden - Mobilising the shift towards homecare for older groups

Active ageing policies in Sweden have been integrated into various policy areas, including housing, the labour market, social care and healthcare.

With respect to long-term care, a greater focus is placed on homecare instead of residential care, and on enabling most older people to live at home.

Sweden's local and regional authorities, who are responsible for specialised housing, health care and social care for older people, promote a range of homecare services to enable people to live at home for longer. These include:

  • Care services to support with personal care and day-to-day needs, health care services to avoid hospitalisation (including recently established mobile care teams)
  • Daily ready-made food deliveries offered by most municipalities
  • Training and provision of digital monitoring devises to empower older people to monitor their health situation at home and provide self-care.
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What are health actors doing?

Health Promoting Communities in Iceland

34 municipalities, covering 93.5% of the Icelandic population, now participate in the Health Promoting Communities (HPC) Program, which is led by the Icelandic Directorate of Health.

The main aim of the programme is to support communities to create environments and conditions that promote healthy behaviour and lifestyle, and health and wellbeing for all.

Each municipality has a HPC coordinator in a full or part-time capacity. They bring together a steering group of stakeholders such as representatives from schools, older people’s organisations, and sports clubs. Together they discuss health trends in the community, with a strong focus on the key determinants of health.

The outcomes simultaneously reflect what issues in the municipality need most attention, and what can be done to improve them.

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What are health actors doing?

Austria’s Care Reform Strategy

The Care Reform Strategy aims to improve the nursing profession via bonuses, training, and extended leave, offering informal carers compensation.

The Community Nursing Project helps provide older people with low-threshold and needs-oriented care close to home. Nurses act as the central network point, linking the population with other health and social care service providers.

The project is being developed and implemented by the Federal Ministry for Social Affairs, Health, Care and Consumer Protection and the Austrian National Public Health Institute and is funded under the Austrian Recovery and Resilience Plan.

Read more about Austria’s use of EU Recovery and Resilience Facility to improve public health  and health equity in our 2022 analysis.

More information

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What are health actors doing?

The Netherlands - “Living at home for longer” care programme

This governmental programme led by the Ministry of Health, Wellbeing and Sport, encourages older people to live at home for longer by:

  • Investing in digital innovation in long-term care and e-health
  • Stimulating exchange between formal and informal care givers and the receivers of care, to enable better provision of care.
  • Mobilising funds for training and hiring of more medical specialists in elderly care to providing home health care services.

There is, additionally, an emphasis on supporting informal caregivers in various forms, including training programmes around the demands of informal care, projects to improve collaboration between formal and informal caregivers and pilot projects that aim to relieve some of the demands of formal caregivers on informal caretakers.

The government programme also aims to improve the transition from homecare to temporary residential care and back home when possible.

What are health actors doing?

Belgium - Community Health Centres approach (Nieuw Gent)

Community Health Centres (CHC) Nieuw Gent was founded in 2000 under the remit of the Department of Family Medicine and Primary Health Care of Ghent University. The CHC team comprises of several professionals, including a care coordinator — a person who is responsible for convening meetings to encourage cooperation between all professionals and disciplines.

This person makes sure that a common vision and strategy are co-created with the professionals of the team to facilitate goal-oriented care. Prevention and so-called “lifestyle medicine” are also discussed at the meetings.

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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 long-term care.

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.

The 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 Green Paper on Ageing
EU Strategy on ‘Shaping Europe’s Digital Future’
The EU ‘Rural Pact’
Social Economy Action Plan
Directive on adequate minimum wages in EU

Have your say

Does your public health institute have any promising policies or practices in place that support the implementation of this EPSR principle?

Send your thoughts to EuroHealthNet's Policy Assistant, Emilia Lindquist at

What's next?

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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