LTCcovid Country Profiles

Responses to 1.13. Equity and Long-Term Care

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.



Unmet care need in international context

Overall, there is a considerable difference in care demand across countries. For example, in Norway,  23,2% of the population 65+ report care needs; this figure is  45,6% in the UK and Spain, and over 50% in Italy, Hungary and Estonia. Potential factors that might contribute to these differences might be differences in life-expectancy or cultural differences in terms of perceptions of care need. In terms of unmet need (i.e. the gap between people who report needing care and those who report receiving it), there are substantial cross-national disparities. For example, one of the highest unmet need is reported in Estonia and Hungary (over 80% of people who report care need, do not receive any services), as well as in Spain, UK and Italy (over 60%), while Norway has a relatively small care gap (16%) (Grages and Pfau-Effinger, 2022).

Social groups particularly affected by (unmet) care needs

Overall, data indicate that the risk of needing care increases with age and with decreasing  income across different countries. Women also tend to be at a higher risk of needing care than men. Moreover, there is a likely increase in the risk of care needs if a person combines several of the attributes mentioned above (e.g. an older woman, on low income will have a higher risk of care need than a woman on higher income). Consequently, in countries with less generous care provision, women aged 65+ with a low  income have a particularly high risk of developing care needs, including unmet care needs (Grages and Pfau-Effinger, 2022).


Grages, C. and Pfau-Effinger, B. (2022) Gaps in the provision of long-term care across Europe. EUROSHIP Working Paper No. 14 

Denmark was as other countries little prepared for the pandemic but was favoured by the high degree of integration of the health and social care sector. The health sector was prioritized during the first wave of the pandemic, and therefore there were challenges early on with preventing infections and securing resources to protect nursing homes. Conversely, adequate measures in LTC facilities have been implemented later on. The implication for the users and staff concentrated on the nursing home sector while the effects for the home care sector was not documented in the first waves (Kjellberg et al, 2022; Rostgaard, 2020; Daly et al, 2022).


Daly, M. ; Leon, M.; Pfau-Effinger, B.; Ranci. C. & Rostgaard, T. (2022): COVID-19 and Policies for Care Homes in European Welfare States: Too little, too late?, Journal of European Social Policy, 32 (1), pp 48-59.

Kjellberg, P.K., Kjellberg, J.; Hirani, J.C., Mikkelsen, M.; Juel, K.; Christensen, J.; Lauritzen, H.H.; Thøstesen, A.; Topholm, E.H.E.; Martin, H.M.; Navne, L.E.; Johansen, M.B. & Bech, M.  (2022b) Baggrunden for covid-19-udbrud og -dødsfald på plejecentre og i hjemmeplejen i Danmark i perioden januar 2020 – april 2021. Tværgående analyse og besvarelse af opdraget. København: VIVE.

Rostgaard, T., Jacobsen, F., Kröger, T. & Petersen, (2022) ‘Revisiting the Nordic long-term care model for older people— still equal?’ in European Journal of Ageing. 19, 2, pp. 201-210.

Last updated: May 24th, 2023

Extensive reliance on private funding has given rise to inequality in LTC services received by Israel’s older people from different socioeconomic backgrounds (source: Taub Centre).

Last updated: February 11th, 2022

A national framework for eligibility and benefits based on need only, creates consistency. Co-payment operates on a sliding scale according to income. Monthly cap on co-payments protects against high costs (Curry et al. 2018).


Curry, N., Castle-Clarke, S. Hemmings, N. (2018). ‘What can England learn from the long-term care system in Japan?’ Nuffield Trust Research Report. Retrieved from:

Last updated: February 10th, 2022

There is an increasing disparity in health service access between socioeconomic groups, with people in rural areas have notably less access than those in urban areas. Older people are frequently limited by mobility issues and an inability to afford health care services; in particular, long-term care. Given that chronic illness is prevalent in around 40% of older people, support for long-term elderly care has become an issue in rural areas (Hoi et al., 2011). Private nursing homes, which are more available in urban areas, are still relatively expensive for most Vietnamese people and are therefore exclusionary.


Hoi, L. V., Thang, P., & Lindholm, L. (2011). Elderly care in daily living in rural Vietnam: Need and its socioeconomic determinants. BMC Geriatrics, 11.

Last updated: December 30th, 2021   Contributors: Daisy Pharoah  |  

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.