LTCcovid Country Profiles

Responses to 4.06. Reforms to improve support for unpaid carers

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.



Between 2017 and 2020, most European Union Member States have implemented numerous measures to improve the situation of informal carers. These include introducing or raising carer’s allowances, more favourable social protection conditions, work-life balance measures as well as training, psychological support and respite services. In 2019 the EU introduced a directive on work-life balance, aiming to improve access to family leave and flexible work arrangements for carers -Member States have three years to implement the directive (source: Several EU Member States (Austria, Belgium, Czech Republic, Estonia, Croatia, Portugal and Spain) introduced a carer’s leave in line with the work-life balance Directive. A carer’s allowance has also been introduced in Czech Republic, France, Poland, Portugal, Slovakia (source:

International reports and sources

EU report on LTC (2021) highlights recent reforms which aim to support unpaid carers in Member States.

In 2019, Austria introduced a legal entitlement to care leave, which applies in companies with more than five employees; where previously the employer had to agree to it which impacted the uptake (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

Last updated: November 23rd, 2021

An EU report noted that from 2019 the country has provided extended leave for workers to provide informal care under specific conditions (including provision of at least 50 hours care per month or 600 hours per year).

Last updated: November 23rd, 2021

In 2018 the Czech Republic, introduced a ‘long-term care-giver’s allowance’ for employed or self-employed carers who can be compensated for the loss of income from work due to taking care of a family member discharged from hospital and requiring at least 30 days of further care up to a maximum of 90 days (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

Last updated: November 23rd, 2021

In 2016 Finland increased the number of holidays for informal carers who enter into a care agreement with the municipality to at least two or three days off per month; informal carers have the right to coaching and training organised by the municipality (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

Last updated: November 23rd, 2021

In 2019 the country introduced an allowance for people entitled to carer’s leave to encourage carers to make use of the leave, which, at that point, had a low take up (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

Last updated: November 23rd, 2021

Replacement care

The care strengthening bills ensure that when unpaid carers are temporarily unable to provide care (e.g. holidays, illness) for people with care level 2 or higher, the long-term care insurance covers the costs of up to six weeks replacement (up to €1,612) care per calendar year. This can also support other household members/unpaid carers taking on the replacement care. This replacement care can also be taken up on an hourly basis. (erste pflegestarkungsgesetz). In addition, replacement care can be combined with 50per cent of the support for short-term care (Kurzzeitpflege) (Bundesministerium für Gesundheit, 2017b; Bundesministerium für Gesundheit,2021).

Retirement contribution & unemployment insurance

Following the care strengthening bills, unpaid carers in Germany providing community care for people at care level 2 or higher, providing 10 or more hours per of care and do not work more than 30 hours per week are entitled to retirement contributions through the long-term care insurance. In addition, protection through the unemployment insurance has been expanded for carers. This also remains when unpaid carers take holidays (Deutsche Rentenversicherung. 2022 ;Bundesministerium für Gesundheit, 2021).

Entitlement to qualified advice

The care strengthening bills also provided an entitlement to qualified advice from their care fund. This can help unpaid carers to organise and coordinate care arrangements (Bundesministerium für Gesundheit, 2017b).

Leave and reduced hours for working family carers

A bill to improve the compatibility of family, care and work enables employees to leave their job for up to six months to care for a close relative at home. In addition, employees can reduce their work hours for up to two year to up to 15 hours per week. To mitigate the loss of income, employees taking up this possibility can apply for an interest-free loan from a government agency (Bundesministerium für Gesundheit, 2017b).

In addition, working unpaid carers can take up to 10 days paid leave (paid by long-term care insurance – care support money) if they need to temporarily organise care for a close relative (Bundesministerium für Gesundheit, 2017b).

Improved access to rehabilitation

From 2019 unpaid carers receive improved access to rehabilitation. The changes include that unpaid carers can now access residential rehabilitation even if from a medical perspective ambulatory treatment would be sufficient. Unpaid carers are also entitled to have the person they care for looked after in the same residential setting where they receive medical rehabilitation (Bundesministerium für Gesundheit, 2018).


Bundesministerium für Gesundheit (2021) Verhinderungspflege (Urlaubs-/Krankheitsvertretung). Available at: (Accessed 1 February 2022).

Bundesministerium für Gesundheit (2018) Neuregelungen im Jahr 2019 in Gesundheit und Pflege. Available at: 1 February 2022)

Bundesministerium für Gesundheit (2017b) Die Pflegestärkungsgesetze – Das Wichtigste im Überblick. Available at: 1 February 2022)

Deutsche Rentenversicherung (2022) Pflege von Angehörigen lohnt sich auch für die Rente. Available at: (Accessed 1 February 2022)

Last updated: February 12th, 2022   Contributors: Klara Lorenz-Dant  |  Thomas Fischer  |  Kerstin Hämel  |  

In 2017 Ireland implemented a programme of training and support for family carers which is funded from unused funds in dormant accounts in credit institutions and unclaimed life assurance policies (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

Last updated: November 23rd, 2021

In 2019, a programme entitled ‘Respite care’ (Opieka wytchnieniowa) was started in Poland to provide help for informal carers (source: EU: Long-term care report).

Last updated: November 24th, 2021   Contributors: Joanna Marczak  |  Agnieszka Sowa-Kofta  |  

In 2019 Portugal introduced a major reform establishing a formal status for informal carers, with  the right for ‘principal carers’, who provide care on a permanent basis, to receive a carer’s allowance. This is conditional on: the carer being a family member and living in the same household as the care recipient; not receiving any remuneration (for instance from work, pension); and the household in which the principal carer lives having an income below a certain threshold. The law also introduced new rights for both principal and non-principal carers, including the right to: accumulate social security credits; receive training; receive information and psychological support; and respite periods. The new law also contains rules to facilitate the work-life balance of ‘non-principal informal carers’ (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

Last updated: November 23rd, 2021

In 2019 Slovakia introduced a social benefit for long-term carers for a sick relative. This benefit will be implemented as of 2021; it allows people to care for relatives who leave hospital in bad health or in need of palliative care for a maximum of 90 days. Slovakia repeatedly increased the amount of the ‘attendance service benefit’, which in 2018 reached the level of the minimum wage (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

Last updated: November 23rd, 2021

In 2019, Spain reinstated the payment of social protection credits by the state for informal carers who were recognised as care-givers in an individualised care plan (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (

This means that, people who can prove they are a non-professional caregiver and meet the conditions necessary to receive a cash benefit for caring for a family member, will be able to apply for social security credits without incurring any financial penalty. Instead, it will be the General State Administration that will pick up the cost of paying for the benefits.

As of January 2022, 67,249 special agreements have been signed by non-professional caregivers (of which 88.6% correspond to women, and the remaining 11.4% to men). The total cost of special agreements for the General State Administration since the signing of the Dependency Law, is €1,639,881,600.61. However, this measure was suspended between 2012 and April 2019.

Last updated: July 4th, 2022   Contributors: Sara Ulla Díez  |  

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.