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The new EU member states and Croatia are facing a rapidly aging population. One of the consequences of these demographic changes is the expected increase in demand among the older population for long-term care (LTC). The future demand for LTC services will be driven by two factors: first, the size of the older population (+65), especially the very old (+75) and second, the percentage of older people dependent or severely dependent, and therefore requiring help with Activities of Daily Living (ADL).

All four case study countries are facing the double challenge of an increasingly older and more dependent society. The question facing the case study countries, and many others around the world, is how the marked increase of the elderly population will impact future demand for LTC services. For case study countries it is clear that the aging and increasingly dependent population will boost demand for LTC services at the same time the tax base and supply of healthy people to provide them steadily shrinks.
Through an evaluation of the global literature on the financing and provision of long-term care services, the study develops a framework for public policy action on LTC. It applies this framework to four countries – Bulgaria, Croatia, Latvia and Poland – examining the current state of long-term care in these countries, and, by applying the framework, proposes possible options for policy-makers to consider.

Bulgaria’s LTC and social service system for the elderly has grown significantly in the past few years thanks to recent reforms aimed at deinstitutionalization and providing more community and home-based services. Yet the country’s National Report on Strategies for Social Protection and Social Inclusion 2008-2010 states “there is no long-term approach for establishing an adequate system for LTC” to match demographic forecasts.

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