WHO Launches Toolkit to Improve Long-Term Care in Europe

The World Health Organization (WHO)’s Regional Office for Europe has introduced a new toolkit to help policymakers identify gaps in their long-term care systems and design policies to address them. 

“This toolkit is a game changer,” Natasha Azzopardi-Muscat, director of country health policies and systems at WHO/Europe, said at the launch event in Brussels. “It offers countries a pathway to building long-term care systems that truly serve people by prioritizing their care needs, preferences, and expectations.”

An overview of the kit with links to its components was posted online on November 12.

Engaging Stakeholders

The toolkit’s implementation guide consists of four main parts: Adaption and planning the long-term care approach, evidence gathering, stakeholder engagement, and interpreting and developing the knowledge base. 

“No one activity you do is going to include everyone, but you need to diversify so you get all these perspectives in the mix,” Stefania Ilinca, PhD, technical officer for long-term care at the WHO Regional Office for Europe, told Medscape Medical News. She said that one way the toolkit is designed to build trust is by engaging with stakeholders at all levels: From academia and public policy to family caregivers and care users. 

“We give some tips about how you might want to approach interviews, how you might want to think about these groups or individual engagement,” she said. “We propose a structure and an agenda for this larger event of the policy dialog. These [proposals] are not prescriptive, but we hope we can give guidance.”

Ilinca emphasized that improving the evidence base and ensuring sufficient capacity to analyze data are crucial for designing better policies. 

Reducing Strain

The toolkit emphasized the need to reduce strain on the health system, including shifting from a reactive to a prevention-oriented approach. For example, it recommends supporting and investing in age-friendly environments to address social isolation and promote healthy activities and diets.

Access to assistive technologies (such as sensor systems, lifts, and medical beds) is also recommended to improve functioning and independence and thus promote patients’ health and well-being while reducing long-term care needs.

Even the implementation of relatively simple technologies (such as better storage and reminder systems for taking medications alongside easy-to-use apps for health records and documentation) could significantly help patients and healthcare professionals alike, said an assistant doctor based in Hannover, Germany. 

The application of the long-term care toolkit in Ireland, Lithuania, and Greece, where the toolkit was piloted, is proof of its versatility, said Ilinca. “We are confident that whether countries are only starting to strengthen their care systems or whether they are considering reorienting or accelerating reform and transformation in long-term care, the State of Long-Term Care approach can be beneficial. We plan to show this by expanding the assessment within the European Union and, hopefully, beyond it, to the 53 states of the European region within the next few years.”

Challenges Remain

Findings from the pilot programs revealed two salient areas in need of improvement to help ensure the toolkit’s successful application: Care workforce shortages and data infrastructure. Ilinca emphasized that both areas apply not just to the pilot countries but also to most countries in Europe.

“We need to seriously reflect on this because, the vision we have for the care systems of the future is incompatible with the amount of resources that we are likely to have, particularly on the human resource side,” she said.

Estimates suggest that the numbers of EU citizens requiring long-term care will increase from 19.5 million in 2016 to 23.6 million in 2030 and to 30.5 million in 2050. Experts fear that medical personnel numbers that are already under tremendous strain will be unable to meet rising demand.

Commenting on the toolkit, Marius-Ionuț Ungureanu, MD, PhD, associate professor and chair of public health at Babeș-Bolyai University in Cluj-Napoca, Romania, noted that a lack of personnel increases the risk for burnout and high turnover, limiting the system’s ability to respond to demand. This, in turn, would hinder the toolkit in fostering responsive and inclusive care.

“Moreover, a shortage in skilled personnel can constrain service delivery and data-collection efforts, which are crucial for the evidence-based approach that is central to the toolkit’s framework,” he said.

Factors such as working conditions and recognition and protection of informal care workers may further influence countries’ abilities to implement the toolkit, he added. 

Ilinca agreed. She noted that the toolkit can do little, if anything, to improve long-term care systems should shortages in medical personnel remain unaddressed and that the toolkit should warn policy makers about the importance of resolving personnel shortages. 

“Policymakers don’t influence affordability or equity or coverage. They can, however, influence the resources they put in the system,” she said. 

Azzopardi-Muscat, Ilinca, and Ungureanu reported no relevant financial relationships. 

Annie Lennon is a medical journalist. Her writing appears on Medscape Medical News, Medical News Today, and Psych Central, among other outlets.