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."
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).
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.
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 EuroHealthNet's 2022 analysis.
Further reading: Read more about Austria's initiative in EuroHealthNet's policy précis on health-promoting care.
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.
Read more about Iceland's Health-Promoting Communities in EuroHealthNet Magazine.
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
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.
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.
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.
Adverse childhood experience (ACE) support hub
The Adverse Childhood Experiences Hub, established in 2017, is funded by the Welsh Government and hosted by Public Health Wales. The hub aims to transform public services, organisations, and communities to become aware of ACEs and to be trauma informed in practice, breaking the inter-generational cycle of ACEs, adversity, and trauma across the life course.
The ACE Hub has worked with a range of sectors, including housing, policing and criminal justice, youth work services and sport. From the outset, one of the priorities has been to support the development of a Whole School Approach to Mental Health and Wellbeing, and to ensure that every school in Wales is ACE aware, inclusive and can confidently respond to trauma, helping children to flourish and have the best start in life.
This inclusive approach has garnered impressive results, including increased pupil attendance and less exclusions and has also been adapted for use in pre-school settings. In efforts to transfer the educational system, the Hub has also produced a Trauma and ACE (TrACE) Informed Organisational Toolkit to encourage organisational self-assessment, identification of existing good practice and action plans around areas for strengthening.
More information
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.
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.
Available resources
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 d.sienkiewicz@eurohealthnet.eu.
What's next?
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