Many people receiving LTC wish to remain at home for as long as possible, and most countries have taken steps in recent years to support this preference and promote community and home‑based care. However, depending on individual circumstances, a move to LTC facilities may eventually be the most appropriate option. It is therefore important that countries retain an appropriate level of residential LTC capacity. The number of beds in LTC facilities and in LTC departments in hospitals offers a measure of the resources available for delivering LTC services to individuals outside their home.
Across 34 OECD countries, there were an average of 41 beds per 1 000 people aged 65 and over in 2023 (Figure 10.21). The vast majority of beds – 40 per 1 000 – were located in LTC facilities, while just 3 beds per 1 000 were located in hospitals. The proportion of LTC beds in hospitals exceeded 10% of all LTC beds in just four OECD countries: Greece (68%), Korea (52%), Czechia (20%) and Israel (16%). Among OECD countries reporting both facility-based and hospital-based LTC beds, the number of beds available per capita varied enormously, with a more than seven‑fold difference between the highest and lowest. Luxembourg, the country with the highest number of beds, reported almost 79 beds per 1 000 people aged 65 and over, compared to fewer than 3 beds per 1 000 in Greece.
Between 2013 and 2023, OECD countries reduced the number of LTC beds in facilities by an average of 5 beds per 1 000 people aged 65 and over. In some cases, the number of LTC beds per 1 000 people 65 and over may have fallen even as the absolute number of beds increased, as population ageing outpaced the growth in beds. However, the change in the number of beds in facilities varied significantly between OECD countries. Over the decade, nine countries reduced the ratio of LTC beds by about 10 or more. In contrast, in Italy and Japan the number of LTC beds increased by more than 2.5 per 1 000 people aged 65 and over between 2013 and 2023. These substantial changes were driven by policy changes over the period. In the Netherlands, declines were driven by major LTC reforms in 2015, aiming at de‑institutionalising care (Llena-Nozal, Araki and Killmeier, 2025[1]). Although the number of LTC beds in OECD accession/partner countries is below the OECD average, they have recorded the largest increases from 2013 to 2023 – notably Argentina and Croatia with increases of 17 and 12 beds per 1 000 people 65 and over, respectively.
Approximately two in three LTC beds were owned by private facilities across 21 OECD countries in 2023 (Figure 10.22). The share of privately owned LTC beds exceeded 90% of the total LTC beds in nine countries, including the Netherlands and New Zealand with only private beds. In contrast, LTC beds were predominantly owned by public facilities in Norway (92%) and Latvia (92%). Variation in LTC bed ownership across countries may be attributable to many institutional factors, including public policy and regulations. Countries with centralised health and social care systems (e.g. Norway, Latvia) are more likely to maintain LTC provision publicly than countries with more market-oriented systems, which outsource LTC provision to private entities while retaining regulatory oversight, as is the case in the Netherlands.
Developing and applying models of care that respect residents’ wishes and promote dignity and autonomy is a critical aspect of high-quality care. This includes ensuring that staff working in LTC facilities are appropriately trained, and that facilities receive the support they need to deliver high-quality care, reduce high turnover and facilitate the recruitment and retention of high-quality care workers (see section on “Long-term care workers”).
