This case study explores a social innovation project in Poland, funded by the European Social Fund (ESF), which aimed to address long-term care gaps for chronically ill individuals in rural areas. In response to demographic ageing, rural depopulation, and low family support networks, the initiative developed a comprehensive home care model. It expanded hospice care criteria and integrated trained caregivers into multidisciplinary Home Care Teams. Implemented by 21 organisations across 13 regions, the project enhanced patients’ quality of life, reduced hospital admissions, and alleviated the burden on informal caregivers. A key innovation demonstrated by the project was the cost-effective delegation of tasks through brief caregiver training and role clarification, leading to a 30% reduction in staffing costs without compromising the quality of care. ESF support was instrumental in fostering cross-sectoral collaboration, establishing coordination mechanisms, and addressing fragmentation within rural health and social services.
Long-term care in rural areas in Poland
Abstract
In Poland, the concept of social innovation has gained increasing prominence in both public policy and civil society discussions. The country experienced a push for social innovation and impact-driven entrepreneurship, supported by legal frameworks such as the Social Employment Act (2003) and the Act on Social Co-operatives (2006), which enabled community enterprises and inclusion initiatives (European Foundation for the Improvement of Living and Working Conditions, 2013[1]). These developments recognised that bottom-up solutions could complement market-driven action in tackling unemployment and social exclusion. The term “social innovation” is used to describe novel approaches to social needs, extending its scope beyond technology to include reforms in public services, corporate social responsibility initiatives, and the adaptation of international best practices within the Polish context (Klimczuk, 2015[2]). Recently, Poland has been active in setting up a structured system of social innovation incubators to support individuals and small entities with promising ideas for addressing social challenges in different regions (European Commission, 2024[3]).
The ESF was implemented through a multi-level structure with Managing Authorities at both national and regional levels (OECD, 2023[4]). At national level, the Ministry of Funds and Regional Policy is responsible for the Operational Programme Knowledge Education Development (OP KED), which supports national and cross-regional initiatives in education, employment, social inclusion as well as social innovation. At regional level, the Marshal’s Offices manage the Regional Operational Programmes in each of Poland's 16 voivodeships (regions), in line with local needs and priorities (The Federal Government, 2025[5]). For the programming period 2014-20, Poland received EUR 15.2 billion in ESF funding – including both EU and national co-financing – representing 13.7% of the European Structural and Investment Funds allocated to the country. The ESF intervention areas, in order of the amounts allocated, were (1) sustainable & quality employment, (2) educational & vocational training, (3) social inclusion, and (4) technical assistance (European Commission, 2025[6]).
ESF+ is managed at the national level by two Managing Authorities: the Ministry of Development Funds and Regional Policy, and the Ministry of Family, Labour and Social Policy. The former oversees the European Funds for Social Development through ten Intermediary Bodies, while the latter oversees the European Funds for Food Aid through one Intermediary Body. At the regional level, ESF+ is managed by the 16 administrative regions (voivodeships), each of which has its own Managing Authority and programme (see Figure 1).
Source: Authors’ own elaboration based on information provided by Poland.
The long-term care in rural areas project focused on accessible, tailored care services for chronically ill individuals in rural Poland (European Commission, 2024[7]). The demographic trend of an ageing population, combined with depopulation and weakened family structures in rural areas led to significant care gaps. Many elderly individuals live alone without nearby relatives or support. Additionally, the availability of services in rural areas is generally lower than in urban regions, which further contributes to the situation.
By introducing a comprehensive home care model, the project expanded hospice care criteria. Initially developed in 2018 as a micro-innovation by the Prophet Elijah Hospice Foundation and tested under the Operational Programme Knowledge, Education, Development (PO WER, Measure 4.1), the model extended access to care for patients who did not qualify for hospice services (Republic of Poland, n.d.[8]). It integrated trained caregivers into multidisciplinary Home Care Teams, including doctors, nurses, psychologists, and physiotherapists, to deliver comprehensive care directly in patients’ homes.
The project improved the quality of life of patients and their families while optimising healthcare delivery. The initiative was scaled up, involving 21 implementing entities across 13 voivodeships to provide care to 278 individuals with an average age of 77 (European Commission, 2024[7]). Patients received personalised support plans that were regularly adapted based on their evolving needs over 8 to 12 months. The intervention resulted in fewer hospitalisations and an improvement in patients’ sense of safety and well-being. It also alleviated the burden on family caregivers by offering them respite support and guidance on care techniques.
Incorporating trained caregivers into Home Care Teams enabled tasks to be redistributed and reduce reliance on expensive medical care. Following brief training by physiotherapists, caregivers conducted basic medical tasks, monitored patient health, and provided companionship and practical help. This led to a reduction in staffing costs of approximately 30% while maintaining care quality. The model was further developed in the “To Give What Is Really Needed” project, which was funded by the Employment and Social Innovation (EaSI) Programme. This generated best practices and data for future replication.
The project faced challenges due to fragmented rural services and unclear caregiver roles (Republic of Poland, n.d.[8]). Access to healthcare and social services is limited and fragmented in rural areas, primarily due to poor transport infrastructure and a shortage of staff. Establishing an integrated care model required collaboration among various stakeholders many of whom had little prior experience in cross-sectoral coordination. Moreover, the roles and competencies of caregivers were not clearly defined or recognised within existing care frameworks. This resulted in resistance from some professionals regarding the delegation of tasks traditionally performed by medical staff.
To overcome systemic fragmentation, the project encouraged the establishment of local networks to foster collaboration between family doctors, nurses, municipal social workers, and home care teams. The newly introduced role of “Coordinator of Care for Dependent Persons” helped to streamline this collaboration. To address workforce-related barriers, the project clearly defined the caregivers’ functions, provided training, and demonstrated the operational cost-effectiveness of their inclusion.
Through this project, the ESF funding supported the development and expansion of an innovative integrated approach to long-term care in rural areas and helped foster cross-sector collaboration (European Commission, 2024[7]). ESF funding of EUR 852 392 enabled this innovation to be piloted and subsequently implemented across 21 entities operating in 13 voivodeships.
References
[6] European Commission (2025), “Cohesion Open Data Platform - Poland”, https://cohesiondata.ec.europa.eu/countries/PL/14-20.
[7] European Commission (2024), “Long term care in rural areas”, European Social Fund Plus, https://european-social-fund-plus.ec.europa.eu/en/social-innovation-match/case-study/long-term-care-rural-areas (accessed on 21 May 2025).
[3] European Commission (2024), “Social Innovation Incubators”, https://european-social-fund-plus.ec.europa.eu/en/social-innovation-match/case-study/social-innovation-incubators.
[1] European Foundation for the Improvement of Living and Working Conditions (2013), “Social Innovation in Service Delivery: New Partners and Approaches”, https://www.eurofound.europa.eu/system/files/2015-01/ef1354en.pdf.
[2] Klimczuk, A. (2015), “Social Innovation Europe: Country Summary: Poland. Social Innovation in Poland”, Social Innovation Exchange, European Commission’s DG Enterprise and Industry. Brussels, 2015..
[4] OECD (2023), “Country Fact Sheet: Poland”, https://www.oecd.org/content/dam/oecd/en/topics/policy-sub-issues/social-economy-and-social-innovation/country-fact-sheets/country-fact-sheet-poland.pdf (accessed on 14 May 2025).
[8] Republic of Poland (n.d.), “Opieka Domowa: Na Terenach Wiejskich”, https://opieka.owop.org.pl/wp-content/uploads/2023/12/E-BOOK.pdf (accessed on 21 May 2025).
[5] The Federal Government (2025), “Ministerstwo Funduszy i Polityki Regionalnej, Department for ESF Management, Poland”, https://www.esf.de/portal/EN/Funding-period-2014-2020/TLN-Mobility/Partners/Poland/content.html.
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