International organisations (OECD, Eurostat, World Health Organization) define long-term care for older people as the provision of non-medical care services over an extended period to people with reduced capacity for self-care, to help them perform fifteen (15) “basic activities of daily living” (ADL – Activities of Daily Living) and/or “instrumental activities of daily living” (iADL – Instrumental Activities of Daily Living).
The important role played by public programmes in financing long-term care is explained by the significant costs faced by older people who need it.
These costs vary from country to country, but are always high relative to older people’s average income. For example, the cost of caring for an older person with greater problems and needs is, on average, equivalent to their pension income. This cost quadruples (four times the average pension) when an older person requires continuous, primarily institutional care.
Despite differences between countries, long-term care policies have followed these common trends in recent years:
- A reduction in institutional care and a shift towards care at home.
- A move away from the public provision of care services in kind towards private or mixed (private and public) services that are subsidised partly or fully by the state (cash transfers).
- The provision of services that complement, rather than replace, informal/family care.
- Cost-sharing and synergies between families, the public sector and private insurance appear to be a one-way street for creating modern, integrated long-term care systems for older people.
The proportion of people aged 65+ in Greece who have some degree of difficulty looking after themselves stands at 28.14%. The detailed percentages by level of difficulty and age group are shown in Table 1.
The state should pay particular attention to levels 4 and 5: 4.11% and 3.32%, respectively, of people aged 65+ face the greatest difficulties in looking after themselves. Among those aged 80+, the corresponding figures are 9.5% and 6.5%.
Women are more likely than men to have difficulty looking after themselves (33% vs. 21%), partly because they have a significantly higher life expectancy (almost five years).
| Table 1. Percentage of people aged 65+ in Greece by level of difficulty with self-care |
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| Level of difficulty | 65–79 | 80+ | Total 65+ |
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Level 1: Help with social activities only
Getting out of the home, managing money. | 2.45% | 8.11% | 4.40% |
Level 2: Help with household management and/or taking medication
Shopping, housework, cooking, laundry and taking medication. Regardless of whether level 1 assistance is needed. | 5.68% | 22.04% | 11.31% |
Level 3: Low need for personal care
Help with exactly 1 ADL, regardless of whether level 1 or 2 assistance is needed. | 2.32% | 10.10% | 5.00% |
Level 4: Moderate need for personal care
Help with 2 or 3 ADLs, regardless of whether level 1 or 2 assistance is needed. | 1.27% | 9.52% | 4.11% |
Level 5: High need for personal care
Help with 4 or more ADLs, regardless of whether level 1 or 2 assistance is needed. | 0.80% | 6.48% | 3.32% |
| TOTAL – All categories | 12.52% | 56.25% | 28.14% |
| Source: SHARE-w9, authors’ analysis. |
The total number of people aged 65+ needing care is expected to rise from 677,000 in 2021 to around 900,000 by 2050, an increase of 33%. Of these, an estimated 238,000 will have moderate or severe difficulties looking after themselves, up from 179,000 today.
To meet these needs, however, they must first be measured in terms of numbers, hours of care required and value.
Total estimated annual care hours required nationwide are expected to increase from 411 million today to 548 million hours by 2050—an increase of almost 140 million hours over 25 years. Of these hours, 58% will be for people with moderate or high care needs. This means that 26% of people aged 65+ who need care will “consume” 58% of total care/assistance hours and 88% of personal care hours.
In terms of the number of carers required on a full-time basis (professional or informal), these hours equate to 250,000 carers by 2050, up from 187,000 today. Of these, 37% would provide personal care and the remaining 63% household management and companionship services.
The estimated economic value (market size) of long-term care services nationwide, in nominal terms, stands at €5.54bn today and is expected to reach €12.54bn by 2050.
Focusing on difficulty levels 4 and 5, where state involvement in providing assistance is more likely, the estimated economic value in nominal terms is €3.34bn today and is expected to reach €7.55bn by 2050.
For groups with high levels of difficulty, levels 4 and 5, the number of formal carers required has been calculated for the country as a whole and for all 13 regions. Table 2 shows that Greece needs 73,000 professional carers, while existing jobs number no more than 15,000.
The remaining positions are filled by informal care provided by a relative. The provision of professional care appears to have declined in recent years compared with previous years.
| Table 2: Estimated need for professional carers by region for difficulty levels 4 and 5 |
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| No. | Region | Personal care | Household and/or social activity assistance | Total need |
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| — | National total | 59,729 | 13,458 | 73,187 |
| 1 | Attica | 19,665 | 4,431 | 24,096 |
| 2 | North Aegean | 1,179 | 266 | 1,445 |
| 3 | South Aegean | 1,643 | 370 | 2,013 |
| 4 | Crete | 3,129 | 705 | 3,834 |
| 5 | Eastern Macedonia & Thrace | 3,494 | 787 | 4,281 |
| 6 | Central Macedonia | 10,522 | 2,371 | 12,893 |
| 7 | Western Macedonia | 1,621 | 365 | 1,986 |
| 8 | Epirus | 2,282 | 514 | 2,797 |
| 9 | Thessaly | 4,436 | 1,000 | 5,436 |
| 10 | Ionian Islands | 1,186 | 267 | 1,454 |
| 11 | Western Greece | 3,694 | 832 | 4,526 |
| 12 | Central Greece | 3,281 | 739 | 4,020 |
| 13 | Peloponnese | 3,596 | 810 | 4,407 |
In light of the above, and given the ageing population and the expected decline in the supply of informal care as a result of changes in family structure, social change, greater participation by women in the labour market and increased mobility among workers who live in areas away from their elderly parents, there is both a need and an opportunity to develop the care services sector, as well as to design comprehensive public policies and finance them.
The University of Piraeus has completed a full business plan for a new long-term care insurance system for older people and its implementation across the country’s 330 municipalities.
* Professor at the University of Piraeus