LTCcovid Country Profile – Printable Version

1.02. Long-Term Care system governance

LTC consists of a wide range of medical and social services and is subject to a number of social and healthcare regulations. LTC under social services are provided in the community and in specialized institutions. LTC services are also regulated by the Health Act and are provided by different types of specialized medical institutions (Salchev, 2017).


Salchev, P. (2017), Bulgaria: Emerging policy developments in long-term care. CEQUA country report.

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

1.03. Long-term care financing arrangements and coverage

In 2016 public LTC represented 0.4% of Gross Domestic Product in Bulgaria (European Commission, 2018). People in need of care are covered by social assistance, which is managed at municipal level and by disability benefits (e.g. as a supplement to pensions for older people). The country was reported in need to develop governance, financing and regulatory framework for LTC (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), Bulgaria Health Care & Long-Term Care Systems. An excerpt from the Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability

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

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

Bulgaria established excellence programmes in LTC for nurses (OECD, 2020). However, the country, alongside other Eastern European countries, experiences so called  “care drain’ where many LTC workers moved to work in other EU countries, mostly because of better salaries and better working conditions (European Commission, 2021).


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

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: Bulgaria   Last updated: February 3rd, 2022

1.11. Role of unpaid carers and policies to support them

Care for older and disabled people has historically been the responsibility of family members in Bulgaria, although there is little information on actual numbers. Informal carers are supported by a range of measures which include leaves of absence from work to care for a dependent person. Carers are entitled to a paid leave of up to ten days per calendar year to providing care to a sick, adult, family member  which may include accompanying them for medical procedures. Unpaid leave may also be requested for longer periods, however whether its granted is subject to employer’s approval (Salchev, 2017).

Since 2019, informal carers may be also selected by the person with needs to act as personal assistants,  by approval from  the municipality, assistants can receive training by the municipalities. In line with the Social Services Act (SSA) informal family members who provide informal care for people with permanent disabilities may  receive free support and training services.  The SSA also established the right to respite care for informal carers (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)

Salchev, P. (2017). Bulgaria: Emerging policy developments in long-term care. CEQUA LTC Network 

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

2.01. Impact of the COVID-19 pandemic on the country (total population)

As of December 2, 2021, there have been 697,162 confirmed cases of COVID-19 in Bulgaria, and 28,542 deaths, according to the European Centre for Disease Prevention and Control, corresponding to 412 attributed deaths per 100,000 population.

Update for: Bulgaria   Last updated: December 5th, 2021   Contributors: Disha Patel  |  

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

According to a recent report (February 2022) by The Federation of European Social Employers, Bulgaria has experienced a strong increase of over 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: Bulgaria   Last updated: February 5th, 2022   Contributors: Daisy Pharoah  |  

4.04. Reforms to improve care coordination

An EU report (2021) noted that a new model for high-quality integrated social services was established in 2020. The reform is aimed at establishing an integrated network of homecare services for people with disabilities and older people.

Update for: Bulgaria   Last updated: November 24th, 2021

4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

An EU report (2021) noted that a new social services law in Bulgaria established the right to training for LTC workers and the right to supervision.

Update for: Bulgaria   Last updated: September 13th, 2021