LTCcovid Country Profile – Printable Version

1.03. Long-term care financing arrangements and coverage

In 2016 public spending on long-term care was estimated to represent 2.3% of Gross Domestic Product (European Commission, 2018).

Long-term care is part of an integrated system of health care, complemented by social service provision. Medical care is financed by the federal health insurance system, whereas personal care is organized and financed by the regional governments. Cash benefits only play a small role in the system. Co-payments are means-tested and subject to a maximum limit. Additionally, Flanders has a compulsory social insurance system specifically for non-medical help services that provides cash benefits to people with reduced self-sufficiency (European Commission, 2019).


European Commission (2018), ‘The 2018 Ageing Report. Economic & Budgetary Projections for the 28 EU Member States (2016-2070)’. Luxembourg: Publications Office of the European Union

European Commission (2019), Austria Health Care & Long-Term Care Systems. An excerpt from the Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability

Update for: Belgium   Last updated: February 3rd, 2022

1.05. Quality and regulation in Long-term care

The quality of LTC is ensured through initiatives and laws at different levels of governance and for different sectors or professionals. At federal level, healthcare professionals are regulated through the Ministry of Health and Social Affairs. Overall, quality in nursing homes is ensured through inspections, but also through set standards. In Flanders, the quality standards are related to the quality decree of 2003 setting the framework and quality criteria and indicators covering quality of care, safety, providers and organisation quality, and quality of life (European Commission, 2021).


European Commission (2021)  2021 Long-Term Care Report Trends, challenges and opportunities in an ageing society. Luxembourg: Publications Office of the European Union

Update for: Belgium   Last updated: February 3rd, 2022

1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

In Belgium, the Wallonia region allows personal care workers to perform nursing tasks when no other care options are available (OECD, 2020).


OECD (2020) Who Cares? Attracting and Retaining Care Workers for the Elderly

Update for: Belgium   Last updated: February 3rd, 2022

1.11. Role of unpaid carers and policies to support them

Unpaid carers including family members provide an important share of Long-Term Care in Belgium (EC, 2021). 


European Commission, EC (2021) 2021 Long-term care report. Trends, challenges and opportunities in an ageing society. Country profiles Vol. 2. Joint Report prepared by the Social Protection Committee (SPC) and the European Commission (DG EMPL)

Update for: Belgium   Last updated: February 16th, 2022

1.14. Pandemic preparedness of the Long-term care sector

In a 2020 report, MSF describe the situation in a nursing home in Belgium as a ‘real humanitarian crisis’. The organisation launched an emergency intervention in March 2020 in care homes in the capital city, and later in two other locations (Wallonia and Flanders). The intervention involved an initial inspection of the facilities, followed by recommendations tailored for each care home’s specific circumstances. Continued support was provided subsequently, for example through follow-up visits to train staff, if needed.

During the initial visits, a general lack of preparedness for this kind of emergency was reported by MSF: there was a lack of knowledge and understanding among staff of basic hygiene rules and protocols concerning the use of PPE and testing. Many care homes were expected to perform the duties of hospitals, but lacked the resources to do it – for example, many did not have ample masks and aprons. The reason for this poor preparedness, according to the report, was due to the complex health and social system in Belgium that is structurally underfunded and increasingly privatised. MSF reported that after their intervention, the country was in a better position to face subsequent waves of the pandemic (MSF, 2020).

Update for: Belgium   Last updated: February 11th, 2022   Contributors: Daisy Pharoah  |  

2.02. Deaths attributed to COVID-19 among people using long-term care

Belgium first reported official estimates of the number of deaths in care homes on April 11, 2020. The data is collected by Sciensano, a public research institution, which publishes very detailed epidemiological daily reports on COVID-19, including data on the number of deaths in care homes (“maisons de repos”). As of April 15, 2020, reports have also included the number of tests done within care homes. For deaths outside hospitals, Belgium reports both “confirmed” cases (through a test or, since April 1, a chest scan), and “suspected” cases where the patient had not been tested but a doctor confirmed that their symptoms were consistent with COVID-19. Deaths in nursing homes are notified by the regional authorities with a 2 day delay, and are classified according to the date of death.

As of April 22nd, 2022, there have been 31,319 deaths linked to COVID-19 in Belgium. Of these 14,216 were residents in care homes and 10,261 occurred in the institutions themselves (source: Sciensano).  Belgium has an estimated 125,000 people aged 65 and over living in care homes. The number of deaths in care homes linked to COVID-19 so far would represent 11.37% of this population (source: KCE).

Update for: Belgium   Last updated: May 3rd, 2022   Contributors: Daisy Pharoah  |  Disha Patel  |  

2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector

According to The Federation of European Social Employers (February 2022 report), Belgium has reported an increase of between 1 – 10% in staff shortages since 2021. The sub-sector most critically affected by staff shortages across the countries surveyed for this report were services for older persons. The job position most affected was nursing, but care assistants and homecare / social care workers also face real shortages. The most common reasons given for staff leaving the social care sector for another include low wages, and mental and physical exhaustion relating to the pandemic.

Update for: Belgium   Last updated: February 5th, 2022   Contributors: Daisy Pharoah  |  

3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation

MSF Intervention

Medicines Sans Frontiers (MSF) set up emergency interventions in nursing homes in Brussels, Wallonia and Flanders in early 2020. Part of the intervention was to train staff and provide learning tools – such as posters, webinars, and training courses – for care home staff on COVID-19. More than 3000 members of care home staff received support. The materials were also made available online so that facilities not receiving the intervention could also benefit (MSF, 2020).

Update for: Belgium   Last updated: February 5th, 2022   Contributors: Daisy Pharoah  |  

3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings

There was never a blanket policy to refuse admission of nursing home residents in hospitals, the decisions to admit and discharge was left to the hospitals and healthcare professionals.  In the first few weeks of the pandemic there were no active measures in place to support nursing homes. Some hospitals took measures to support nursing homes in their area, mostly through sharing expertise in infection prevention and control and management skills, sharing staff and even PPE, equipment and medication. Nursing Homes who had an established functional relationship with a hospital were more likely to receive support.

Update for: Belgium   Last updated: October 31st, 2021

3.07.03. Visiting and unpaid carer policies in care homes

The use of antigen rapid tests for visitors is done under the responsibility of and in consultation with the local medical authorities. The use is optional and depends on the epidemiological situation. Factors that may influence a decision include: an increased (local) prevalence; the circulation of more contagious variants; to protect residents and staff who have not (yet) been vaccinated or have not built up sufficient immunity (

Visits are allowed for all residents. The number of visitors is limited to four close contacts (hug contacts) who don’t have to wear a face mask. Additionally, they are allowed unlimited visitors with surgical face masks, although the number present at the same time is limited in accordance with precautionary measures, such as keeping distance and the number of people that can be present in a room at the same time. Visitors are not restricted by time (

Update for: Belgium   Last updated: November 2nd, 2021

3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

For vaccinated residents with symptoms, only a PCR test can be used to detect a possible infection. An antigen rapid test can only be used for non-vaccinated symptomatic residents (symptom duration of maximum five days) and for residents with symptoms just after the first vaccination (

Update for: Belgium   Last updated: November 2nd, 2021

3.10. Use of technology to compensate for difficulties accessing in-person care and support

In Belgium the James robot (by ZoraBot) was deployed to help in nursing homes during COVID lockdowns to help residents keep in contact with their family through video calls, using only voice commands (Getson and Nejat, 2021). The robot is able to measure body temperature, count people in a room, check if people are wearing masks properly and can be operated for disinfection duties (Raje et al., 2021).


Getson C, Nejat G. (2021) Socially Assistive Robots Helping Older Adults through the Pandemic and Life after COVID-19. Robotics; 10(3):106.

Raje S., Reddy N., Jerbi H. et al. (2021) Applications of Healthcare Robots in Combating the COVID-19 Pandemic. Applied Bionics and Biomechanics.

Update for: Belgium   Last updated: February 11th, 2022

3.11. Vaccination policies for people using and providing Long-Term Care

After an initial pilot in care homes, the official COVID-19 vaccination campaign started on 5th January 2020. By 31stMarch 2021, 1,868,577 doses had been administered, by that date, 73% of people aged 85 or more had had at least one dose and 26% had both doses. Care home residents and staff were prioritized for vaccination ( On the 23rd March 2021 it was reported that 95% of care home residents in Flanders had been vaccinated, as well as 87% of staff ( On the 5th March that 94% of all care home residents in Brussels and 92% in Vallonia had been vaccinated (

In long-term care, management may not simply ask if someone has been vaccinated. For many people, vaccination does appear in a medical record (

Update for: Belgium   Last updated: September 7th, 2021

4.04. Reforms to improve care coordination

An EU report shows that in 2017 the federated region of Flanders was divided into ‘primary care zones’ to improve the governance of homecare services. These zones are responsible for coordinating the different primary and social care partners within the zone, and are central mechanism for coordinating homecare among different stakeholders. Moreover, a federal programme has been implemented to improve care for people with chronic diseases, including older people. Since 2018, 12 projects have been set up at local level, testing a series of measures to improve care integration.

During the crisis, setting up a strong collaboration model and integrated care between nursing homes and hospitals has enabled nursing homes to manage specific and complex care in their own environment. A published report shows that integrated care is possible and that both the hospital and the nursing homes benefit from such a system. They suggested that investments in people, resources, training and guidance concerning transitional care, and knowledge exchange between hospitals and nursing homes, are necessary to guarantee a more efficient and robust approach to (pandemic) crises in nursing homes.


Deschacht, M., Malfait, S., & Eeckloo, K. (2021, May 1). Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way. International Journal of Older People Nursing. John Wiley and Sons Inc.

Update for: Belgium   Last updated: March 3rd, 2022   Contributors: William Byrd  |  

4.02. Reforms to the Long-term care financing system

An EU report (2021) noted that the federated region of Wallonia recently reformed the financing mechanism for residential care facilities and established a regulation for the daily fee.

Update for: Belgium   Last updated: November 23rd, 2021

4.06. Reforms to improve support for unpaid carers

An EU report noted that from 2019 the country has provided extended leave for workers to provide informal care under specific conditions (including provision of at least 50 hours care per month or 600 hours per year).

Update for: Belgium   Last updated: November 23rd, 2021