LTCcovid Country Profiles

Responses to 4.01. Reforms to address Long-Term Care governance

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 is compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project are moderating the entries and editing as needed.

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. 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.



Some reforms in LTC governance have been implemented in EU Member States (source: EU report 2021).

International reports and sources

Some information on recent reforms related to governance in LTC sector can be found in EU report 2021.

An EU report notes that Finland has launched programme for health and social services centres for the future, which will be implemented in 2020-2022 and where patients will have access to various services in one place (e.g. primary healthcare, local social work, and homecare services). Moreover, the responsibility for organising health and social will be transferred from the municipalities to 22 regional authorities to provide better access to LTC. Finland also took steps in 2018 to improve the sharing of individual social welfare information in the national archive with care institutions at county level, to improve care management.

Last updated: November 24th, 2021

A fifth pillar of social security is being created around long-term care insurance. Social care policy (termed policy of ‘independence’) will be steered between the Caisse nationale de solidarite pour l’autonomie (CNSA, which becomes a true insurance fund), and local authorities (the decentralised level). There are plans over  2020-2022 to improve and modernise local regional authorities for the disabled (Maison Departementale des Personnes Handicapees) and local regional authorities for independence (Maison Departementale de l’Autonomie), which help people who draw on care access care and support by providing services such as information, care assessments and planning, follow-up, and medication. The centres are made up of multi-disciplinary teams including doctors, nurses, occupational therapists, care workers, and inclusion specialists.

Last updated: December 21st, 2021   Contributors: Camille Oung  |  Alis Sopadzhiyan  |  

There is evidence of the need to formally develop a National Care System that provides support to those in need of care and their families, and that includes LTCFs. In view of the challenges due to the lack of information and competencies in infection prevention and control at LTCFs, a group of experts, in collaboration with different public institutions, joined efforts with the purpose to update the guidelines in order to allow LTCFs face the pandemic and to contribute to the generation of a National Care System.


Mena-Madrazo, J. A., Sosa-Tinoco, E., Flores-Castro, M., López-Ortega, M., & Gutiérrez-Robledo, L. M. (2021). COVID-19 and long-term care facilities in Mexico: a debt that cannot be postponed. COVID-19 e instituciones de cuidados a largo plazo en México: una deuda impostergable. Gaceta medica de Mexico157(1), 94–96.

Last updated: November 30th, 2021   Contributors: William Byrd  |  

Contributors to the LTCcovid Living International Report, so far:

this list is regularly updated to reflect contributions to the report, if you’d like to contribute please email

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.