On request of the European Commission, the European Social Policy Analysis Network wrote a comparative analysis on long-term care (LTC) settings for people aged 65+.

The report covers the 27 Member States, the nine (potential) candidate countries (Albania, Bosnia and Herzegovina, Moldova, Montenegro, North Macedonia, Serbia, Türkiye, Ukraine and Kosovo), and Iceland and Norway.

The report:

• assesses the different forms of LTC (residential, home, community-based), describing their characteristics, regulatory frameworks, and main structural barriers;
• reviews recent and ongoing reforms;
• discusses person-centred care services and how this model affects a person’s freedom;
• provides policy recommendations.

Main points of the report

Residential care is defined as all LTC services delivered in facilities providing 24-hour accommodation, with varying levels of support tailored to individual care needs.

While residential care remains common, all Member States now provide home care. Traditional models are giving way to innovative hybrid systems that blend residential, home, and community-based care. These new approaches prioritise autonomy and person-centred support:

• Residential alternatives. Smaller, community-integrated housing that reduces isolation while preserving independence.
• Home-based support. Professional services, including training and insurance, that complement family caregivers.
• Community care. Multidisciplinary partnerships integrating health, social, and preventive services locally.

Despite advancements, disparities remain. While some countries develop community services, others struggle with underdeveloped infrastructure and LTC provision remains unevenly distributed between regions. These barriers keep informal care a significant component of EU LTC systems.

(Potential) candidate countries

In these countries, the LTC landscape is characterised by a heavy reliance on institutional care, consisting primarily of medium- to large-scale facilities, with capacities often exceeding 50 or even 100 residents per site.This model constrains personal choice and reinforces dependence on informal care, which is still very central.

Day centres, particularly, are a foundational component of the LTC system. They provide social, recreational, and basic care support. In Moldova and Serbia, day centres have evolved to include essential services like social canteens and laundries.

Further reforms aim to improve the capacity and quality of residential care. Several countries have introduced measures to address challenges faced by professional LTC workers, focusing on recruitment, working conditions, and training like Albania.

Significant reforms are underway to diversify services. Home care is the foundational component of community-based care and is present in all countries. Still, in Albania, Moldova, and Montenegro, while those services are legally recognised, they are too dependent on project-based funding or municipal capacity. In addition, according to the report, Ukraine does not currently offer any form of community-based care services.

Finally, in those countries, non-state actors play a key role in providing care services, notably NGOs. This is particularly the case in Moldova, Montenegro, and Kosovo.

Policy recommendations

The following recommendations are put forward to improve LTC settings for older people:

• Expanding and diversifying service provision.
• Strengthening governance, enhancing quality and improving the evidence base.
• Enhancing affordability of LTC provision.
• Supporting and developing the workforce.
• Addressing funding challenges and regional disparities.
• Modernising LTC through technology and innovation.

Read the full report to learn about the overall EU trends, reforms in the candidate countries and to have more specific information on your country of interest.