LTCcovid Country Profiles

Responses to 1.08. Care home infrastructure

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science.

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.



Prevalence of residential care

Overall, there has been a shift away from residential care towards more care provided in the community with the expectation that the latter is not only cheaper but also can offer better quality of care. Since the priority is often given to community-based care, consequently, the availability of residential care has been decreasing in many countries (Marczak et al. 2015; 2021 Long-term care in the EU).

Overall, over the years, countries such as Switzerland, Australia,  Netherlands, Sweden, Norway, Finland, Luxemburg and New Zealand had the highest rates of recipients of residential care at between 5- 6% of population 65 years and older. Conversely, in countries such as Portugal and Poland the rates were below 1% (Colombo et al., 2011). Residential care facilities appear to be limited in several Eastern and Southern European countries as well as in Japan (Marczak et al. 2015; Kubo et al. 2014, 2021 Long-term care in the EU).

Care home infrastructure

Care home infrastructure and design guidelines vary greatly between countries. For example, in some countries (e.g. Germany) there are quotas for single-room occupancy in care homes. Some countries have high percentage of single room occupancy (e.g. 80% of rooms in North-Rhine Westphalia region of Germany and 89% of room in British Columbia, Canada), whereas in other countries multi-bed room are predominant (e.g. in many Central and Eastern European countries).


Colombo, F., Llena-Nozal, A., Mercier, J., & Tjadens, F. (2011). Help wanted? Providing and paying for long-term care: OECD Health Policy Studies.

Kubo, M. (2014). Long-term care insurance and market for aged care in Japan: focusing on the status of care service providers by locality and organisational nature based on survey results. Australias J Ageing, 33(3), 153-157.

Marczak J, Wistow G. (2015) Commissioning long –term care in OECD, in Gori C, Fernandez JL, Wittenberg R (eds) Long-Term Care Reforms in OECD Countries: Successes and Failures, Policy Press, Bristol

International reports and sources


Colombo, F., Llena-Nozal, A., Mercier, J., & Tjadens, F. (2011). Help wanted? Providing and paying for long-term care: OECD Health Policy Studies.

Gori C, Fernandez JL, Wittenberg R (2015) Long-Term Care Reforms in OECD Countries: Successes and Failures, Policy Press, Bristol


Some information on residential care in EU countries can be found in the following reports:

European Commission (2016) Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability.

2021 Long-term care report Volume 1 and Volume 2 – Publications Office of the EU

There are approximately 845 residential care providers in Australia, operating across more than 2,720 sites. In terms of ownership (ACFA, 2021, table 6.1):

  • – 56% of providers and 55% places are in for not-for profit residential homes (ACFA, 2021)
  • – 10 % government operated
  • – 34% are for profit/private

The number  of residential aged care providers has been decreasing due to industry consolidation while the number of government-funded places (beds) in aged care has gradually been increasing.

Industry consolidation has seen a reduction of one owner/one-site facilities and a corresponding increase in large for-profit providers building large facilities across multiple sites.

Other contextual data:
  • – 245,000 people lived in aged care facilities at some point in 2019/2020
  • – 65% of residents in aged care are women.
  • – Average age of residents is 85
  • – NB: 4,900 aged care residents are aged under 65.

Data from: Aged care snapshot 2021  (AIHW, 2021, accessed 25 Oct 2021).


Aged Care Financing Authority, ACFA (2021) Report on the Funding and Financing of the Aged Care Sector.

Australian Institute of Health and Welfare, AIHW (2021) Australia’s welfare 2021, Aged care. Australian Government.

Last updated: February 15th, 2022   Contributors: Sara Charlesworth  |  Wendy Taylor  |  Lee-Fay Low  |  

In 2015, about 850 nursing homes or residential care facilities provided 75 632 inpatient care places while 12 019 persons lived in alternative housing forms. Since 2000, the number of places in nursing homes or residential care facilities increased by more than 30%, as a result of population ageing and increasing demand for long-term care (BMGF, 2017k). Also, the number of hospitals and beds in rehabilitative care increased by around 40% between 2007 and 2016. In 2020 about 90,000 people are cared for in about 870 care homes (about 50% public, 25% private for-profit, 25% non-profit) (Schmidt et al. 2020).


Schmidt, A. at al (2020), ‘The impact of COVID-19 on users and providers of Long-Term Care services in Austria’ Accessed at: Austria report

Last updated: February 2nd, 2022

Researchers from the ‘Frente Nacional de Fortalecimento à ILPI’ have published a study estimating the number of Long-Term Care Facilities (LTCFs) in the country in 7,029 facilities, noting that 64% of the 5 570 Brazilian municipalities do not have any LTCFs for older adults. (Lacerda TTB et al., 2021

Last updated: January 6th, 2022   Contributors: Patrick Alexander Wachholz  |  

There are longstanding problems in the LTC homes in Canada, which have been the subject of many reports, commissions and enquiries. A review carried out for the Royal Society of Canada Working Group on LTC found that, between 1998 and 2020, there were 80 reports making recommendations on the Long-Term Care system and LTC homes. The most common recommendations were for increased funding (66.7% of reports), standards/regulation/audits of LTC quality of care (58.3%), and regulation/reform/standardisation of education and training for staff (

Last updated: January 31st, 2022

89% of the rooms in LTC facilities are single-occupancy rooms, 7% are double-occupancy, and 4% are multi-bed rooms (3 or more beds). 76% of residents reside in single-occupancy rooms. In health authority owned facilities, 57% of residents reside in single-occupancy rooms compared to 85% in contracted facilities (source: QuickFacts2020-Summary.pdf).

Last updated: February 11th, 2022

There an estimated 25,000 older people living in registered care homes (1.4% of the population aged 65 or older). Of the 994 registered care homes, 16 are public, 181 are not-for-profit (with public subsidies) and the rest are for-profit (operating under supervision of the Ministry of Health) (Browne et al., 2020).

There are many unregulated care homes operating in an informal manner, probably as many as there are in the regulated sector. Prior to the COVID-19 pandemic there were no regulations or mechanisms to survey the Infection Prevention and Control capabilities of care homes (Browne et al., 2021).


Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile., International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Browne, J., Palacios, J., Madero-Cabib, I., Dintrans, P.V., Quilodrán, R., Ceriani, A. and Meza, D., 2021. Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile. Journal of Long-Term Care, (2021), pp.114–123. DOI:


Last updated: January 6th, 2022

There are 930 nursing homes in Denmark’s 98 municipalities (source:

In 1984 it was made illegal to construct multiple bed residential services, therefore all newly built nursing homes (plejebolig) are private rooms with personal space, kitchenette and living space. Denmark is the only country in the EU in which the construction of traditional old-age and nursing institutions has been legally banned.  Still, a number of residents still today live in nursing homes built under the old scheme, but most have been updated and offer private facilities.

There are five types of residential care facilities for older people: traditional nursing homes (plejehjem); more modern nursing home facilities (plejebolig), sheltered housing (beskyttet bolig); housing for older people (almen ældrebolig); and private for-profit nursing homes (Friplejebolig). The choice of specific type of accommodation depends on individuals’ preferences and needs, those choosing to live with their spouse or partner must be offered a facility suitable for two people (WHO, 2019).

The number of people in residential facilities has declined in both absolute and relative numbers in the last decade. In 2021 in absolute numbers there were 38.863 beneficiaries of long-term residential care services aged 67 years or older which equals to 5% of the population. In addition, 22.752 persons 67+ lived in housing for older people adapted to the needs of persons with limited functional ability while 1.190 persons 67+ lived in a for-profit Fripleje nursing home (source:

In recent years, the number has dropped. In particular the proportion of people aged 90 and over living in residential care facilities has fallen drastically, as 42 percent lived in LTC facilities and housing for older people in 2010 while the number fell to 32 percent in 2021 (source:


WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at:

Last updated: May 24th, 2023

Of the 7,502 LTCFs for older people, 50% are public, 31% are not-for-profits, and 24 are for-profit. In 2020, the National Assembly noted that the home care infrastructure is largely outdated, often with shared rooms (source:

Last updated: January 6th, 2022

Responsibility for care homes

Regulation of the care home infrastructure is under State authority since it was devolved from the Federal level in 2006. Hence, minimal building and operational requirements as well as definitions as to what constitutes as care home (as opposed to more self-directed small-scale living arrangements for example) differ between the 16 Laender.

Demand of care homes

A report by the University of Cologne suggests that the increasing demand for residential care requires establishing additional as well as maintaining existing resources (Kochskämper & Pimpertz, 2015).

Care home providers

According to Federal reporting, the majority of care homes in 2019 (8,115 homes, 521,720 spaces) were owned by not-for-profit organisations, followed by private providers (6,570 homes; 393,308 spaces) and public providers (695 homes, 54,525 spaces) (Gesundheitsberichterstattung des Bundes, 2022).

Types of rooms & requirements

Following the implementation of single room quotas in care homes put in place in many of the Länder over a decade ago (which gave providers 10-15 years to make the necessary changes), care homes in several Laender have to provide a certain percentage of single rooms (e.g. 80% in North-Rhine Westphalia, 100% for new builds; Berlin 60%; Lower Saxony no quota). In Baden-Württemberg, every single room needs to have its own bathroom. Older buildings with shared bedrooms and without individual bathrooms should only be used for short-term stays. While this increases privacy of residents it also reduces the number of spaces. People who choose to live together (e.g. couples) can share double rooms of sufficient size (Deutschlandfunk, 2020;, 2019;  Wiedemann, 2019)

The requirements in terms of room-size and accessibility vary between the Laender. In Bavaria, for example, according to a newspaper article, single rooms should be at least 14 square meters, double rooms, 20 square meters. In addition, 25% of rooms need to be wheelchair accessible and have wheelchair accessible bathrooms (Wörmann, 2016).

Location of care homes

Research conducted by the Bertelsman group found that residential care across Germany are in good geographical proximity to other care homes: the longest average distance between care setting identified amounted to 8.2km. Within urban areas distances between care settings can be as small as 0.5km, while in rural areas distances may be larger (Hackmann et al., 2016).

References (2019) Baden-Württemberg lockert Einzelzimmervorgabe für Pflegeeinrichtungen. Available at: (Accessed 31 January 2022)

Deutschlandfunk (2020) Einzelzimmer in der Pflege/ Mehr Privatsphäre, weniger Plätze? Available at: (Accessed 31 January 2022)

Gesundheitsberichterstattung des Bundes (2022) Pflegeheime und verfügbare Plätze in Pflegeheimen. Gliederungsmerkmale: Jahre, Region, Art der Einrichtungen/Plätze, Träger. Available at: Ad-hoc-Tabelle ( 31 January 2022)

Kochskämper, S. & Pimpertz, J. (2015) ‘Herausfoderungen an die Pflegeinfrastruktur‘ Institut der deutschen Wirtschaft Köln. Available at: IW-Trends_2015-03-04_Kochskaemper_Pimpertz.pdf ( (Accessed 5 February 2022).

Last updated: February 13th, 2022   Contributors: Klara Lorenz-Dant  |  Thomas Fischer  |  Kerstin Hämel  |  

There has been an important effort to upgrade care homes. Whereas in 2005 just half of people in care homes were in single rooms, and 29% had a private bathroom, by 2013 83% were in single rooms. The emphasis, since a new policy approved in 2008 is to build smaller units (for 6 to 10 people) with private rooms and and a common area for residents and staff. Minimum standards for the construction and running of care homes were issued in 2013.

(Source: Sigurveig H. Sigurdardottir, Omar H. Kristmundsson & Steinunn Hrafnsdottir (2016) Care of Older Adults in Iceland: Policy Objectives and Reality,Journal of Social Service Research,42:2, 233-245, DOI: 10.1080/01488376.2015.1137535)

Last updated: January 6th, 2022

As of 2017, amongst OECD countries, Israel had one of the lowest numbers of LTC beds available in its hospitals at 23.6 beds per 1000 people aged 65+ (the OECD average is 47.2 beds) (source: OECD). Notably, The proportion of people aged 65+ who receive LTC in institutions in Israel is the lowest among OECD countries (under 2%), while the number of recipients of care in the community is among the highest in these countries (source: Muir, 2017).

Last updated: January 6th, 2022

The actual number of nursing homes in Italy is unknown: different institutional sources indicate distinct values. In particular, the Interior Ministry estimated that there were 4,629 nursing homes for dependent older people in 2019 (data confirmed also by the National Committee for the guarantee of people deprived of their freedom – Garante Nazionale dei diritti delle persone private della libertà personale). The National Health Institute provides data on 3,417 nursing homes for people living with dementia. The Ministry of Health considers 3.475 residential centers, which include nursing homes, care homes, hospice and a blurry “other type”. Such inconsistency between numbers makes it difficult to build up a comprehensive picture of the service supply.

Also the number of service providers is uncertain, estimates talk about 1.927 companies. As concerns nursing homes’ features, the Observatory on nursing homes from one of Italy’s largest trade unions pointed out that:

  • 10,3% NHs count less that 20 beds;
  • 33,1% NHs have 21 to 50 beds;
  • 38,9% NHs have between 52 and 100 beds
  • only 17.7% of NHs dispose of over 100 beds.

The average nursing home counts 67,5 beds. Moreover, the large majority (70%) of NHs is managed by private providers – generally in accreditation regime -, 38,2% are for profit companies, 6% are public owned foundations, 15% are NGOs. 14% of NHs are directly managed by municipalities or Local Health Authorities. On average, each provider manages 2,07 nursing homes and 140 beds. Hence, the typical nursing home is quite small and managed by a private provider which received an accreditation from the public sector.

The distribution of nursing homes is diversified and heterogeneous throughout the national territory, with strong consequences for equity in access. The table below shows the take up rate of care home beds with respect to the number of people with functional dependency aged 75 and over in each region, representing the population most likely to consider nursing home care.  the most vulnerable and likely target for such service

The distribution of the rate follows the Italian geography: Southern regions have the lowest rates; regions from the Centre reach middle values and the Northern regions have the highest take-up values. For example in Trento, there are 25 beds for each person aged 75 with dependency, compared to 0.65 in Basilicata, signalling the almost total absence of care home services in some areas of the country.

Region Take up rate of nursing homes’ beds with respect to dependent over75 residents in the region (2016)
Molise 0,26%
Basilicata 0,65%
Sicily 0,69%
Puglia 2,57%
Calabria 2,78%
Abruzzo 2,73%
Campania 0,73%
Marche 5,89%
Valle d’Aosta 0,25%
Tuscany 6,28%
Umbria 5,12%
Friuli – Venezia Giulia 15,36%
Liguria 9,73%
Emilia – Romagna 9,61%
Veneto 17,88%
Trento 25,66%
Lazio 2,85%
Sardinia 1,03%
Bolzano/Bozen 24,21%
Piedmont 18,15%
Lombardy 18,97%

Berloto, S., Fosti, G., Longo, F., Notarnicola, E., Perobelli, E., Rotolo, A. (2019). La rete dei servizi di LTC e le connessioni con l’ospedale: quali soluzioni per la presa in carico degli anziani non autosufficienti? In Cergas (Eds.), Rapporto OASI 2019. Retrieved from: Cap5OASI_2019.pdf (

Fosti G, Notarnicola, E. and Perobelli, E. (2021), Le prospettive per il settore socio-sanitario oltre la pandemia. Rapporto Osservatorio Long Term Care 3. CERGAS, Università Bocconi. Retrieved from: il+welfare+e+la+long+term+care+in+europa+cover.pdf (

Garante Nazionale dei diritti delle persone private della libertà personale (2020). Atto di sindacato ispettivo n° 3-01482.

Istituto Superiore di Sanità (2020). Mappa dei servizi.

Ministero della Salute (2021). Annuario Statistico del SSN. Anno 2019.

Ministero dell’Interno (2019). Le statistiche ufficiali del Ministero dell’Interno. Strutture per anziani. Ed. 2019.

Last updated: February 4th, 2022   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

The majority of nursing care facilities are run by non-profit social welfare or medical institutions (for profit organisations are restricted from entering the care market for the individuals with high needs). The rest of the market operates with a mixed market of provision, ownership types and sizes. For-profit assisted living facilities tend to cater to the more independent and hence less vulnerable population. They cannot provide LTC services unless they are specially licensed by the respective prefectural governments to do so, even if they have a licence, such facilities have to contract external licensed LTC service providers if the residents need nursing care. Providers are paid according to a national fee schedule, so they compete on quality and convenience, not price.  All providers must be licenced by the prefectural government (Estevez-Abe et al. 2021; covid19_and_japanese_ltcfs.pdf (


Margarita Estévez-Abe and Hiroo Ide. (2021). “COVID-19 and Japan’s Long-Term Care System.”, International Long-Term Care Policy Network, CPEC-LSE, February 27, 2021. Retrieved from:


Last updated: February 10th, 2022

Care homes are distinguished by whether they have an WLZ (Wet langdurige zorg, LTC) accreditation. These mostly include nursing homes and residential care homes with a nursing department. Care homes without a WLZ accreditation do not provide nursing care or medical treatments, but are residential homes that provide small-scale elderly housing and apartments linked to nursing homes, in which additional care can be provided as needs increase. In addition, there are private care homes for more affluent residents who contribute more to the costs of housing and facilities (such as entertainment). There is also small-scale housing where people pool their WLZ cash (provided as a personal budget) and which are self-organised or provided by entrepreneurs. Nearly 114,000 people aged 65 and over live-in residential care and nursing homes (Bruquetas-Callejo and Böcker, 2021).


Bruquetas-Callejo, M., Böcker, A. (2021) Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future MC Covid 19 Working Paper 11/2021 

Last updated: February 1st, 2022

Providers of institutional care facilities are mostly private; the majority are individual-owned, small-size homes, and their numbers have rapidly increased, resulting in fierce competition (source: Services comprise residential care homes, long term care hospitals, and community services. There has historically been a reliance on institutional care, and in 2018 the Government announced a “Community Care” policy, to shift care to home and the community.

The recent outbreak revealed that care institutions are particularly vulnerable to COVID-19 for the following reasons: (a) the high population density of long-term care hospitals: the number of beds in one room is 5.12 on average in long-term care hospitals compared to 3.61 in general hospitals, (b) difficulties in requiring people with dementia or respiratory disease to observe needed hygiene and/or to wear masks; (c) the pre-existing health conditions of most residents in care institutions that make them more susceptible to infection (source:

Last updated: January 6th, 2022

Singapore relies heavily on community-based care, however older adults who cannot receive care appropriate for their needs at home are able to seek accommodation in a Long-Term Care Facilities (LTCFs). Singapore has over 16,000 LTCF places as of 2019 of which 40% are run by the government, 37% by non-profit organisations and 23% by the private sector (Irving and Bloom, 2020).

Public and non-profit run long term care facilities in Singapore are particularly vulnerable to infectious diseases due to their infrastructure: most facilities resemble dormitory-style housing shared by  between roughly 6 and 12 residents living in close proximity, with communal facilities. There is more variation in the layout of private nursing homes: some have dormitory-style living conditions that have as many as 30 residents; others have single or double private rooms. Most public and non-profit LTCFs have substantial subsidies from the government (Goh et al., 2022).


Goh, H.S.; Tan, V.; Lee, C.-N.; Zhang, H.; Devi, M.K. (2022) Nursing Home’s Measures during the COVID-19 Pandemic: A Critical Reflection. Int. J. Environ. Res. Public Health, 19, 75.

Irving and Bloom (2020) COVID-19, Older Adults and Long-Term Care in the Asia Pacific. Report prepared for HelpAge International Asia Pacific.

Last updated: February 11th, 2022

According to the IMSERSO report Social services aimed at older people in Spain (December, 2020), care homes are considered as Residential Care Services. They offer accommodation and support to older people on a permanent or temporary basis. Residential Centres are classed as social facilities that offer accommodation and specialized care to elderly people who, due to their family, economic and social situation, as well as their personal autonomy limitations, cannot be cared for at home.

The weekly IMSERSO report on the impact of Covid-19 in residential centres, states that care homes can be classed in the following ways:

  • Residential centres for the elderly
  • Residential centres for people with disabilities
  • Other permanent accommodation for social services aimed at the above groups.

Autonomous Communities have responsibility for care homes, and this contributes to the care home sector being remarkably heterogeneous and complex. This is due to the differences in each autonomous community’s criteria about what constitutes a care home for older people or people who are eligible for public care (Abellán García et al., 2019).

In Spain, there are 5,529 centres (1,451 publicly owned, and 4,078 privately owned) with a total of 389,677 beds, of which a total of 246,303 (63.2%) have public funding. The remaining 143,734 (26.8%) are privately financed. In general terms, the coverage index for all centres is 4.19 (number of places/population>=65)*100). Of this, 2.65 corresponds to public centres, and 1.54 to privately financed centres.

The weekly IMSERSO Report noted that as of 3rd June 2022 there are a total of 353,823 people living in residential centres, with 85.8% living in residences for the elderly. The remaining 14.2% live in residential centres for people with disabilities, and other permanent social services accommodation. The report also noted that 71% of care home residents are women, and 79.3% are over 80 years old. The annual public price of a place in a residential centre is estimated at €18,839.62, of which the beneficiaries contribute around €8,020.13 (42.6% of the total price).

The Community of Madrid has the highest proportion of private care homes (86.8%), followed by Catalonia (85.1%) and the Basque Country (74.1%) (IMSERSO, 2020). The average number of beds in care homes in Spain is 70.2, representing a notable increase compared to 2009 when centres with fewer than fifty beds prevailed (Comas-d’Argemir et al., 2021).

In 2020 three in every four long term care facilities in Spain were privately run and the fees for many residents were publicly funded. Mas Romero et al (2020) noted that the fees received by the care homes have not increased for a long time, a result of austerity measures, resulting in many private facilities making cuts to maintain their profits, for example by operating with minimum staff. They also identify this as a factor that may have affected the ability of care homes to respond to the challenges of COVID-19.

Despite concerns about large care homes (IMSERSO, 2009), the macro-residence model has been implemented especially in the Community of Madrid, where 41.9% of the centres have more than one hundred beds (compared to 17% in Catalonia and 16% in the Basque Country) (Abellán García et al., 2021). There are seventeen care homes that exceed three hundred places, and the largest has no less than 604 places. That is the case in public and privately-owned centres (Comas-d’Argemir et al., 2021).


Abellán García, Antonio; Aceituno Nieto, María del Pilar y Ramiro Fariñas, Diego (2019): Estadísticas sobre residencias: distribución de centros y plazas residenciales por provincia. Datos de julio de 2019, Informes Envejecimiento en red nº 24, Enlace.

Abellán García, Antonio; Aceituno Nieto, María del Pilar; Fernández Morales, Isabel y Ramiro Fariñas, Diego (2020): Una estimación de la población que vive en residencias de mayores, Informes Envejecimiento en red, Enlace.

Comas-d’Argemir, Dolors; Legarreta, Matxalen y García Sainz, Cristina (2021), Residencias, las grandes olvidadas, en en Comas-d’Argemir, Dolors y Bofill-Poch, Sílvia (eds.) (2021): El cuidado importa. Impacto de género en las cuidadoras/es de mayores y dependientes en tiempos de la Covid-19, Fondo Supera COVID-19 Santander-CSIC-CRUE Universidades Españolas.

IMSERSO (2009): Servicios sociales para personas mayores en España. Enero 2009, Boletín sobre Envejecimiento. Perfiles y Tendencias, 43. Enlace.

IMSERSO (2020): Servicios sociales dirigidos a personas mayores en España (Datos a 31/12/2019), Ministerio de Derechos Sociales y Agenda 2020, Enlace.

Mas Romero M, Avendaño Céspedes A, Tabernero Sahuquillo MT, Cortés Zamora EB, Gómez Ballesteros C, et al. (2020) COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn. PLOS ONE 15(10): e0241030.

Last updated: November 21st, 2022   Contributors: Carlos Chirinos  |  Adelina Comas-Herrera  |  Sara Ulla Díez  |  

In Catalonia, according to data from 2016, people living in an assisted living facilities, compared to the entire population over the age of 64, have greater dependence and clinical complexity and are on average 10 years older than those who do not live there (85.7 years vs. 75.7 years). The average age of patients admitted to a nursing home increases every year, with women being admitted on average almost 3 years older than men. However, people in assisted living facilities have more associated pathology, with dementia being up to 10 times higher than for people over the age of 64 in the general population (CAMFIC & AIFICC, 2016).

Catalan Long-Term Care facilities can have public, private or subsidized places. The facilities that are part of the Catalan Social Services System (public and private ownership), that is, that have been authorized by the DTASF or the DS (in the case of drug addiction therapeutic communities) are intended for 4 large groups of people and various residential resources are identified for:

  1. Older people:
    1. Assisted residence for the older people on a temporary or permanent basis.
    2. Sheltered housing for the older people on a temporary or permanent basis.
    3. Temporary or permanent home for the older people
  2. People with disabilities:
    1. Residences and Homes Residences for people with intellectual disabilities.
    2. Residences and Homes Residences for people with physical disabilities.
  3. People with mental illness and / or addictions:
    1. Residences for people with mental illness.
    2. Homes Residences for people with mental illness.
    3. Therapeutic communities and reintegration flats for the care of people with drug addictions.
    4. Residences for Children and Adolescents with Autism Spectrum Disorder.
  4. Child under custody:
    1. Educational Residential Centers.
    2. Residential Center for Intensive Education Action.
    3. Reception Centers.
    4. First Aid and Emergency Services.

According to 2019 data published by the Consejo Superior de Investigaciones Científicas (CSIC) in Catalonia, there were a total of 62,015 places for the older people in facilities, 12,601 (20.3%) publicly owned and 49,414 privately owned (79.7 %). (CAMFIC &AIFICC, 2016).


CAMFIC & AIFICC (2016) Model d’atencio sanitaria a les residencies de Catalunya.

Last updated: March 10th, 2022   Contributors: Cèlia Estruch  |  

The proportion of the older population living in care homes has been declining over time, from 20% of the population aged 80 and over in 2000 to 12% in 2019, and residents have become frailer, with 70% of them having dementia. On average, people live in care homes for 22 months and 20% die in the six months since moving in (Szebehely, 2020).

A study of use of care in the last 2 years of life among people who died in 2015 and were aged 67 and over found that, on average, women lived in care homes for 7.2 months before death and men for 6.2 months (Meinow et al., 2020).

The majority of the municipal long-term care (LTC) institutions in Sweden are not dissimilar to private housing arrangements. Roughly three-quarters of LTC residents in institutional care have apartments with 1 or 1.5 bedrooms, a kitchenette, and a WC/ shower. Many also have balconies. The residents can make the apartment as home-like as possible as they provide all the furnishings. These apartments are usually located along a corridor that has a dining room and TV room attached to it, and there is often also a garden or similar outdoor space (Johansson and Schön, 2020).


Johansson L. and Schön, P. (2020), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Sweden’, MC COVID-19 working paper 14/2021.

Meinow B, Wastesson JW, Karehold I and Kelfve S (2020) Long-Term Care use during the last 2 year of life in Sweden: Implications for policy to address increased population aging. JAMDA 21:6, 799-805.

Szebehely M (2020) The impact of COVID-19 on long-term care in Sweden., Long-Term Care Policy Network, CPEC-LSE, 22 July 2020.

Last updated: March 6th, 2023

Residential nursing care and specialist care are less available than community care, but they are  growing as well. Most residential care services for dependent older persons are found in private nursing homes and private hospitals, although some residential homes and homes for poor older persons are financed by the government and charitable organizations. The Ministry of Social Development and Human Security manages public homes called “Social  Welfare Development Centers for Older Persons,” which aim to provide shelter, but also a degree of care for residents if they develop care support needs.  Services at residential care facilities range from basic to complex care, including accommodations, help with personal hygiene, assistance with ADL and moving about, care that requires nursing skills, rehabilitation, day care, respite care, and hospice care (source: Country Diagnostic Study on Long-Term Care in Thailand (

A survey of care home residents  living at two government long-term care centres during August 2020 to October 2020 found that most residents (82.5%) lived in shared rooms (government financed rooms) and the median length of stay was 5 years (Srifuengfung et al., 2021).


Srifuengfung, M., Thana-Udom, K., Ratta-Apha, W., Chulakadabba, S., Sanguanpanich, N., & Viravan, N. (2021). Impact of the COVID-19 pandemic on older adults living in long-term care centers in Thailand, and risk factors for post-traumatic stress, depression, and anxiety. Journal of Affective Disorders, 295, 353–365.

Last updated: January 14th, 2022

Number of care homes and beds

The Office for National Statistics estimated that, between 2019 and 2020, there were 462,460 care home beds in England. Of these, 84.7% (391,927) were occupied. 36.7% of residents were self-funders (paid for their care privately). The Care Quality Commission (CQC) reported that occupancy levels fell during the pandemic, reaching a low of 80% during the summer of 2020.

The Future Care Capital estimated that in 2019 there were 15,661 care homes. Their report found that the number of registered care home beds has declined over time and that, at the same time, there has been a shift towards larger care homes, with the average size of care homes increasing from 26.8 beds in 2014 to 29.2 in 2019. Similarly, Kings Fund report indicated that number of care home places declined between  2012 and 2020, care home places declined from from 11.3 to 9.6 and nursing home places from 5.2 to 4.7 for every 100 people over the age of 75. There report also noted that there was a lot of regional variation.

Sector of ownership and quality

In terms of market composition, the Future Care Capital report estimated that, in 2019, 83.4% of care homes were private for-profit, 2.8% were public and 13.6% were not-for-profit. In 2019, just under 17% of all care home beds were owned by the five largest groups of providers. Quality of care,  is highest among not-for-profit providers, with 16.4% inadequate or requiring improvement by the CQC, compared to 24.8% for private companies. Care homes with fewer than 30 beds tended to be rated better than larger care homes.

Last updated: March 2nd, 2022   Contributors: Adelina Comas-Herrera  |  

Community support services for people living with dementia

A survey of people living with midl-to-moderate dementia and their care partners in Britain found low rates of receipt of dementia support services, with people who were female, older, and with lower education level receiving fewer services (van Horik et al, 2022).


van Horik J.O., Collins R., Martyr A., Henderson C., Jones R.W., Knapp M., Quinn C., Thom J.M., Victor C., Clare L., on behalf of the IDEAL Programme Team (2022) Limited receipt of support services among people with mild-to-moderate dementia: Findings from the IDEAL cohort. International Journal of Geriatric Psychiatry. 37(2).


Last updated: March 21st, 2022   Contributors: Adelina Comas-Herrera  |  

The Center for Disease Control (CDC) studies LTCFs with regards to the following categories: adult day services centres, nursing homes, residential care communities, hospices and home-health agencies. State-by-state information on the number of each kind of LTCF, the number of people they serve, ownership (i.e. for-profit or governmental), certification, staffing, and services provided can be found in the CDC’s National Post-Acute and LTC Study (source:

Last updated: February 11th, 2022

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica BreuerJorge Browne Salas, Jenni Burton, William Byrd, Sara CharlesworthAdelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin HämelNina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’DonovanCamille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. SchmidtAgnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.