One year ago, the UN Human Rights Council decided to establish an intergovernmental Working Group to prepare a draft UN convention on the human rights of older persons. This was an important step towards the first legally binding, specific international treaty protecting the rights of older people. For ESN, the right to access long-term care (LTC), and specifically community-based care and support, should be a key element of the upcoming treaty. 

The European Social Network (ESN) is actively promoting deinstitutionalisation in long-term care and fosters the creation of community-based LTC systems. In our latest publication, Financing Long-Term Care – A Social Services Perspective, we discuss how properly financing LTC can help make the shift to community-based care and support of older people. The findings are based on a Long-Term Care Workshop held in April 2025 in Warsaw, Poland. 

Employing financing to incentivise system change 

“Financing incentives can be powerful instruments to drive change,” said Adelina Comas-Herrera, Director, Global Observatory of Long-Term Care, Care Policy and Evaluation Centre at the event. Indeed, ESN’s report examines among others how financing flows can be geared towards person-centred, community-based care to ensure that people accessing services have the choice to remain in their homes and communities, even as their needs increase. 

In many countries, residential care often becomes the default choice due to the lack of home-based alternatives. In Croatia in 2024, 1,891 older people received home care, whereas 11,825 older people lived in publicly funded residential care facilities. Similar patterns can, for instance, be observed in Romania, Slovenia and Poland based on the most recent data made available in ESN’s European Social Services Index.  

Empowering the local level to establish community-based services 

According to OECD data, sub-national governments spend about 30% of total public expenditure on long-term care. At the same time, they directly fund about 25% of expenditure from their own resources. Community-based LTC services are often provided at the local level. For instance, in Greece, 281 of 332 municipalities provided home help services for older people and/or people with disabilities, partially funded through the national government. To strengthen community-based care, funding systems should enable local governments and agencies to adopt a population-based approach to planning and delivering preventive health and social care services that support people in ageing well and respond to changes in their needs and circumstances.  

Avoiding unequal access through suitable local-level funding  

If such funding is not properly steered, it can lead to distortions and inequality in terms of access, as it would depend on the financial capacity of local authorities to provide long-term care. Against this backdrop, ESN CEO Alfonso Lara Montero is calling for dedicated funding teams at the local level:  “National governments should create a dedicated, sustainable long-term funding stream for LTC, which is often under the responsibility of local authorities, so the ecosystem isn’t piecemeal and can fund prevention and access before needs escalate.” 

Investment in local community-based long-term care can lead directly to cost-effectiveness. LTC policy experts across the board agree that we can expect rising costs for long-term care.  Therefore, it is crucial to set up the system in the most cost-effective manner. However, this cannot happen without a full rollout of community-based services. Asked at the ESN LTC workshop about advice on improved cost-effectiveness, Stefania Ilinca, Technical Officer for LTC, WHO Regional Office for Europe, recommended: 

“Invest in community-based services because they are more cost-effective than institutional care and reduce future demand for high-cost services.” Indeed, in Poland, where the ESN LTC Workshop took place, a recent study concluded that investing in home care support could reduce reliance on nursing homes by up to 30%.  

The ongoing intergovernmental discussions on the UN Convention on the Human Rights of Older Persons need to place a strong emphasis on access to community-based care. Experts in LTC say not only that it should become a right, but also that it is the most effective way to set up long-term care systems.  

• More recommendations on financing long-term care in the community can be found in ESN’s newest publication, “FINANCING LONG-TERM CARE: A Social Services Perspective”. 

• People interested in the debate on LTC and social services financing should attend ESN’s European Social Services Conference in Malta on 17-20 May this year, where we will, among other things, discuss ‘How to Build Sustainable Social Protection’.  

• Read here our interview with conference speaker Cassandra Simmons from the World Bank on data-based social service financing.