Country representatives emphasize the importance of evidence-based decisions in long-term care

Experts, government officials and representatives of professional associations from over 35 countries united for a workshop on integrated delivery of health and social services for older people. There, experts called for more evidence on healthy ageing to move forward with the long-term agenda, and pointed to the crucial role of an integrated approach.

The event, entitled “Leapfrogging the integration of long-term care for older people in the WHO European Region: getting it right, fast”, took place from 11 to 13 December 2018 in Almaty, Kazakhstan. It aimed to review trends in long-term care reforms in Europe, and to discuss the preliminary results of the assessment of integrated delivery of the health and social sectors of long-term care systems. Country representatives also presented policy innovations and best practices.

The context in Europe

Health indicators for older adults vary within Europe. The preliminary assessment showed that people live longer and recover more quickly when they live in societies where health and social sectors work in alignment.

The study also affirmed that expanding coverage should apply to all people across the life course, including for services to increase quality of life – from the promotion of healthy lifestyles to rehabilitation and palliation. Coverage ensures that no one becomes poor from out-of-pocket payments for health services or long-term care.

Representatives at the workshop demonstrated that countries have taken serious action to achieve these goals. However, evidence gaps remain – only 41% of European countries collect data. Data collection is crucial to the application of evidence-based policies.

The workshop tackled a number of concerns and trends related to ageing that many countries share, including:

  • coordination between primary health care and social care;
  • quality-of-care measurement;
  • the increasing number of older people cared for in their homes rather than institutions;
  • the lack of training provided for informal caregivers;
  • families confronting the disability of their relatives without support from public programmes;
  • fragmentation of social services delivery and financing that creates an urban–rural disparity;
  • financial hardship in older age due to chronic conditions;
  • inadequate workforces and prestige of professions, also due to migration; and
  • gender disparities in health services delivery and informal care.

The need for integrated health and social care

Country representatives demonstrated and discussed how clinical accomplishments cannot add value unless they are sustained by social care. Rather than a biomedical approach to solving their often-chronic conditions, older people need the chance to live actively and contribute to their communities. The social sector has a key role to play in supporting this new approach to healthy ageing.

Isabel Yordi Aguirre, Programme Manager of Gender and Human Rights at WHO/Europe, also highlighted the gender dimension of long-term care. “We must challenge the inequality between women and men in care work. Unpaid care keeps women out of the labour market and reinforces poverty in older age. At the service level, long-term care providers are predominantly women, a profession of low prestige and salary. Unpaid and informal care work is mainly performed by women and reinforces gender stereotypes that have negative direct and indirect health effects.”

Borja Arrue Astrain from the think tank AGE Platform Europe discussed the human rights approach to long-term care by sharing his perspective as an older man. “I am afraid my daughters will decide suddenly to send me to a residential care home without talking about it to me beforehand. I like living alone and I would prefer to stay at home if possible.”

Elder abuse is experienced by 3% of older people, 25% of whom have high care needs. Experts emphasized the importance of rights-based care and support, adding that ageism is the most frequently mentioned type of discrimination in Europe according to a 2015 Eurobarometer survey.

Giovanni Lamura from the Centre for Socio-Economic Research on Ageing at Italy’s National Institute of Health and Science of Ageing shared the results of his research on informal care and the migrant workforce. “Migration cannot be considered the main tool to tackle labour force shortages, as it might jeopardize development in source countries or lead to migrants’ exploitation,” he explained.

“We need a balance between integration policies in recipient countries and development programmes in source countries. It is urgent to adopt a coherent, coordinated and integrated approach to recognize and mainstream the role of informal care across all policies, especially those in the long-term care sector,” he added.

Thiyagarajan A. Jotheeswaran from the ageing and life course programme at WHO headquarters stated: “There are many ways to invest in frailty prevention – a better integration of care and specific care pathways, including for people with dementia; access to assistive devices; age-friendly, supportive cities and communities; health promotion and disease prevention; physical activity; nutrition; vaccination, etc.”

The information shared at the workshop provided a leapfrogging opportunity for many countries planning reforms on long-term care delivery systems.


The workshop was organized jointly by the WHO European Centre for Primary Health Care and WHO/Europe’s health services delivery programme (Division of Health Systems and Public Health), healthy ageing, disability and long-term care programme (Division of Noncommunicable Diseases and Promoting Health through the Life-course), and gender and human rights programme (Division of Policy and Governance for Health and Well-being).

All presentations and discussions at the meeting were documented. To request a video, please write to