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Title page

Contents

1. Introduction 2

2. Drivers of LTC reform 5

2.1. Demographic change 5

2.2. LTC workforce shortages 7

2.3. Reliance on informal carers 8

2.4. Lack of social recognition of care workers 9

2.5. Financial sustainability of formal LTC systems 10

3. Structure of long-term care systems in Europe 12

3.1. Common elements of LTC systems 12

3.2. LTC systems differ substantially across countries 12

3.3. Financing of LTC systems 16

4. Different approaches to address these challenges 17

5. Recent LTC reforms 18

5.1. LTC workforce attractiveness 19

5.2. Attracting non-EU workers 22

5.3. LTC and informal carers 22

5.4. Reforming LTC benefits 24

5.5. Financing 26

6. Takeaways from recent reform efforts to reduce the care gap 28

7. Conclusion 32

References 35

Appendix 1: More detail on residential and home care services 38

Appendix 2: Detailed information on leave provisions 40

Tables

Table 1. Definitions of main terms 4

Table 2. Cash for care (CfC) schemes in selected European countries 13

Table 3. LTC reforms, selected EU countries 18

Table 4. Minimum hourly wage overall 29

Table 5. Minimum hourly wage LTC sector 29

Figures

Figure 1. Life expectancy at 85 6

Figure 2. Share of 85+ in total population 6

Figure 3. Unmet needs among people with limitations in activities of daily living 7

Figure 4. Estimated prevalence of dementia among people aged 60 and over 7

Figure 5. Percentage of the economy-wide gross average hourly wage, 2018 8

Figure 6. Share of informal carers among the population aged 50+, 2019 (or nearest year), % 9

Figure 7. Long-term care financing in % of GDP, 2022 11

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