Across 31 OECD countries, an average of 12% of people aged 65 and over received LTC, either at home or in LTC facilities, in 2023 (Figure 10.12). In four OECD countries (Lithuania, Israel, Switzerland and Germany) more than one in five of the population aged 65 and over received LTC services. Cultural norms around the degree to which families look after older people may also affect the use of formal services (see section on “Informal carers”). On average, the share of LTC beneficiaries aged 65 and over slightly increased by 1 p.p. from 11% in 2013. It increased by more than 8 p.p. in Lithuania, Germany, Israel and Spain, while a drop of 2% or more was observed in the Netherlands, New Zealand, Denmark and Hungary.
Many people in need of LTC wish to remain in their homes for as long as possible. In response to these preferences, many OECD countries have developed services to support home‑based care for older adults. Between 2013 and 2023, the proportion of LTC recipients who received care at home across 23 OECD countries increased slightly, from 66% to 70% (Figure 10.13). Increases were particularly large in Germany, Korea, Spain and Switzerland.
Changes in needs assessment and eligibility criteria contribute to some of the changes in the share of LTC beneficiaries since the 2010s (Llena-Nozal, Araki and Killmeier, 2025[1]). In 2017, Germany expanded the definition of LTC needs to expand support for people with cognitive impairments, which improved the accessibility of LTC insurance benefits. Spain has added an additional care level since 2015, to expand support to people with moderate dependency to have access to public benefits. On the other hand, a 2015 reform in the Netherlands transferred some responsibilities for LTC provision to local authorities, contributing to a substantial decrease in residential care recipients. In New Zealand, the provision of home care was effectively rationed, as home care providers limited the supply of services to manage operational costs and absorb wage increases under the Pay Equity Settlement, which mandated legal pay rises for care workers to address longstanding gender-based pay disparities.
Even where people live with limitations in ADL and IADL, they may not always receive sufficient formal LTC support. Among people aged 65 and over across 22 European countries, 47% of individuals living at home with at least one ADL/IADL limitation – and two in five (38%) people living with three or more ADL/IADL limitations – reported that they either did not receive sufficient informal LTC help, or did not receive formal LTC support (Figure 10.14).
