LTCcovid Country Profile – Printable Version

1.00. Brief overview of the Long-Term Care system

The Romanian long-term care system is rooted in Law 17/2000 on Social Assistance for Older People, the first national legal act to regulate the provision of support services for older individuals with care needs. Subsequent legislation in 2003 and 2006 defined basic organization and functioning norms for home-based and residential care delivery at national level. In 2011, Law 292/2011 on the Social Assistance Framework defined the characteristics and the boundaries of Romania’s long-term care system, establishing eligibility criteria, the settings in which long-term care can be provided and the care services included in the service package. Since 2006, responsibilities for social service planning, financing and provision were transferred to local authorities, lead to increased fragmentation in care delivery and to large disparities in the geographical distribution and availability of services.

The Romanian LTC system emphasizes cash benefits to the detriment of service provision, which remain severely undersized with respect to care needs and distributed across the territory. Particularly weak is the provision of home and community based care, leading to increased demand for residential care services, in turn insufficiently developed to appropriately respond to population needs. As a result, the long-term care system overwhelmingly relies on the provision of care by family member and other informal caregivers.

While data on LTC coverage are insufficient and of poor quality, available evidence indicates long-term care coverage to be very low with respect to most European countries.


World Health Organization (2020) Romania. Country case study on the integrated delivery of long-term care. WHO Regional Office for Europe series on integrated delivery of long-term care. Copenhagen: WHO European Office. Retrieved from: WHO/Europe | Healthy ageing – Romania

Luana Pop (2018) ESPN Thematic Report on Challenges in long-term care Romania.

Update for: Romania   Last updated: February 10th, 2022   Contributors: Stefania Ilinca  |  

1.01. Population size and ageing context

The total population of Romania in 2019 was 19.4 million inhabitants, registering a decline of 0.4 million with respect to 2015, as result of low natality and external migration.

The age structure of the Romanian population bears the characteristic marks of a rapid demographic ageing process. While the total population has declines over the past 5 years, the group aged 65 and over has increased by 225.2 thousand persons over the same period, to reach 19.7% of the total population in 2019.

Current projections point to a continued decline over the next decades, with an expected total population of 17.7 million in 2030 and 15.5 million by 2050 (Source:  Proiectarea populaiei României pe regiuni de dezvoltare i judee, la orizontul 2070).

Update for: Romania   Last updated: February 10th, 2022   Contributors: Stefania Ilinca  |  

1.03. Long-term care financing arrangements and coverage

In 2016 public LTC expenditure in Romania represented 0.3% of Gross Domestic Product (source: European Commission: The 2018 Ageing Report).

Update for: Romania   Last updated: February 10th, 2022

1.05. Quality and regulation in Long-term care

The quality of LTC social and socio-medical services is regulated by the law regarding the quality assurance of social services. The Social Policies and Services Directorate is in charge of designing the minimum quality standards for social services  and the accreditation of all public and private service providers. The minimum quality standards cover residential care, community-based care and homecare. The National Agency for Payments and Social Inspection can undertake unannounced  visits and conduct inquiries when problems are voiced regarding the quality in LTC sector; however it is not responsible for systematically monitoring service providers or services (source: European Commission: 2021 Long-term care in the EU).

Update for: Romania   Last updated: February 10th, 2022

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

With 1 LTC worker per 100 older people in 2016, compared to 3.8 for the EU-27 average, Romania is among the countries with the lowest number. This situation is partly attributed to Romanian nationals migrating to work in health and social care sectors in the neighbouring, more affluent EU countries. Romania is among the top 20 countries to provide LTC workforce to OECD countries, e.g. Romanian nurses account for half of all foreign trained nurses in Italy. The COVID-19 pandemic may reverse the trend to some extent, increasing the availability of the LTC workforce, due to higher unemployment in the country (hence more people available to work in LTC sector) as well as returned migration during pandemic (source: European Commission: 2021 Long-term care in the EU).

Update for: Romania   Last updated: February 10th, 2022

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

As of December 3, 2021, there have been 1,781,957 confirmed cases of COVID-19 in Romania, and 56,684 deaths, according to the European Centre for Disease Prevention and Control, corresponding to 293.91 attributed deaths per 100,000 population.

Update for: Romania   Last updated: December 6th, 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, Romania 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: Romania   Last updated: February 5th, 2022   Contributors: Daisy Pharoah  |  

4.02. Reforms to the Long-term care financing system

An EU report noted that in 2020 the country adopted new cost standards for all social services, including residential and homecare services for both public and private service-providers.

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