During a recent webinar moderated by Adelina Comas Herrera, director of the Global Observatory of Long-Term Care (GOLTC) and Finn Turner-Berry, the workforce and research lead at the National Care Forum, a UK-based organization representing not-for-profit long-term care providers, a diverse variety of insights and action plans focused on long-term care in Japan, India, Slovenia, Spain, Denmark and Chile were shared with participants.

GOLTC, part of the International Long-Term Care Policy Network, has as its goal to identify key shared challenges worldwide and showcase how different countries and localities are addressing those challenges, sharing research evidence and facilitating collaborations.

According to Comas, one of the main sources of sharing information is through 30 interest groups, some of which are in collaboration with other groups, including the Global Ageing Network (GAN). “Those interest groups also host webinars and share relevant publications and resources,” she said. “We’re gradually building a database of experts by country, topics and  methods, research projects and videos of webinars.”

The 26 September webinar addressed the ways that these six countries, specifically, are focusing on long-term care and the initiatives they are launching, along with their strategies to build on the work. The following are some highlights from the webinar.

Long-term Care in Japan 

Riru Ping, associate professor at the Hitotsubashi Institute for Advanced Study within Hitotsubashi University in Tokyo, Japan, spoke about Japan’s long-term insurance system, characterized by a mandatory social long-term care insurance, introduced in 2000.

“It replaced a previous means-tested social assistance program, and now it provides universal entitlement to in-kind benefits covering adults between 40 and 64 who have specific age-related conditions,” said Ping. “To qualify for benefits, individuals need to pass a very comprehensive needs assessment.”

Japan’s care system relies on the community, providing help with personal care, nursing care, rehabilitation, medical management support and residential care. According to Ping, the country’s insurance system is reviewed every three years, spearheaded by the Ministry of Health, Labor and Welfare.

The Ministry also has access to evidence-informed elements in this process such as provider surveys and administrative data, while technical groups evaluate previous revisions and report to the committees.

“Timing is very important; local governments needs to set their premiums and develop their business plans every three years,” she noted.

Reforms in Keralam, India

Biju Mathew, from HelpAge India in the state of Keralam, India, explained that Keralam is now building community-based long-term care.

The demographics are challenging, he noted. By 2036, approximately one in four adults will be older – right now, it’s about 17%. Mathew said 2026 is a very critical year for ageing in Keralam because the government has recently announced a specific department for seniors— the Department for Senior Citizens–which includes a dedicated budget.

“In Keralam, there will be one person-centered system [for the elderly] called CAIS: Keralam Center for Aging, Active Aging, Community Care and Silver Economy,” said Mathew. “The new chief minister [V.D. Satheesan, who took on the role in May 2026], in his first speech said how a society is judged will be how they take care of the elderly.”

Mathew explained Keralam’s long-term care architecture. The older person and the family carer at the home, and in the community, are the center, and for the supports, the key factor is state government plus local government — that is the panchayats — the municipalities, and the corporations, plus civil society.

HelpAge India is involved in everything from service delivery to system strengthening. In Keralam, there are four different projects in the four different districts; Thiruvananthapuram, Wayanad, which is a hill district, Idukki, another hill district, and Thrissur. (Corporate, state and local governments are supporting the various district projects.)

According to Mathew, who has been working with HelpAge India for the last 30 years, the real design question becomes how to connect family, community, local government, health and civil society into one pathway— a continuum of care.

Reform Challenges in Slovenia

Tjaša Potočnik, research assistant at the Centre for Welfare Studies within the Faculty of Social Sciences, University of Ljubljana, Slovenia, spoke about the challenges facing this EU country with a population of 2.1 million. In 2021, Slovenia adopted its first Long-Term Care Act, after almost 20 years of unsuccessful reform attempts; at that time, 20.7% of the population was 65 or older, today it’s around 22.5% and by 2050, it’s expected to rise to 30%, meaning one in three people will be over 65.

“Before the reform, the long-term care system was fragmented across multiple sectors—health, social, pension, disability and family legislation, also heavily oriented towards institutional care,” said Potočnik. “Implicit familism was a characteristic. Families, above all women, frequently filled the gap and compensated for underdeveloped and regionally unequal services.”

Although Slovenia is a small country, there are 212 municipalities. Each municipality is responsible for the organization of community care, so as Potočnik indicated, there is fragmentation.

The assessment process, which begins at the Center for Social Work, places eligible applicants into one of five categories, then allowing them to select between monetary or non-monetary rights, which are long-term care in an institution, long-term care at home, day care in an institution, and family member caregiver, a right which is available to those in the fourth and in the fifth category. Eligible individuals can choose the care benefit or service that best meets their needs and go to the long-term care coordinator in their municipality. The Long-Term Care Coordinator creates a personal plan and links the needs to services.

Long-term care is currently financed in one of two ways: long-term care insurance and the state budget (up to 190 million euros per year are allocated to the Long-Term Care Fund).

Potočnik said there is a potential third pillar which would start in 2028.

“It’s included in the Long-Term Care Act that there will be potential co-payments, where 10 to 20% of the service price will be from users,” she said. “Since July 2025, we have had long-term care insurance where employees and employers contribute 1% from the gross wages, pensioners, 1% of the net pensions and self-employed people and farmers contribute 2% of the contribution base. The money goes into a dedicated fund, the Health Insurance Institute.”

Brand New Reforms in Spain

Spain is the most recent country to adopt a long-term care reform. Elia Gomez Castro, of Fundacion SEAS, addressed the country’s latest development: Congress had just given final approval to the reform a week prior to the webinar.

With the reform, she said, “choice, control, independent living, community inclusion and care” are all strengthened. It also gives stronger rights and support to family caregivers—services are redefined around rights, personalization and life plans.

Gomez Castro explained that the reform in Spain was the outcome of a process that unfolded from 2021 to 2026. The need was triggered by the health and care crisis caused by the COVID-19 pandemic. “The pandemic exposed the vulnerability of institutional care models and made action urgent,” she said. “Long-term care systems are difficult to reform. They involve several levels of government and many different actors.”

In January 2021, the Spanish government, the autonomous communities and the trade unions approved the Plan de Choque de Dependencia, which increased central government’s funding by 600 million euros per year and addressed key weaknesses in the system such as waiting lists, management, services and employment.

The system was also evaluated, said Gomez Castro. “Before changing the care model, the system needed a stronger capacity and better cooperation across levels of government.” She explained that the government also created the VIDAS platform, an ecosystem connecting projects, offering opportunities for shared learning and supporting knowledge transfer.

Denmark and Long-Term Care

Tine Rostgaard, professor of social sciences at Roskilde University, spoke about Denmark’s universal and tax-financed systems, composed of 98 municipalities, which assess the needs for care, organize care and are also the main providers of home care and nursing homes.

“Approximately 12% of people aged 67 and over receive home care, free of charge. Around 3% live in nursing homes,” said Rostgaard. However, due to demographic ageing, along with workforce shortages and more complex care needs, the system has increasingly come under pressure.

Rostgaard said that approximately one-third of the long-term care workforce in Denmark has no formal care qualification. “At the same time, since the 1990s, care has become quite rigidly organized around predefined tasks and time allocations, with limited flexibility for responding to changing everyday needs.”

Over the past decade, there’s been growing awareness that reform was necessary to meet the needs of the ageing population. In 2025, there was reform centered on the ways care is organized, governed and delivered. Rostgaard highlighted three changes: a move towards more holistic care where the older person is allocated a broader care pathway – with one provider; a move from predefined tasks to more flexible and person-centered care; and third, a move towards a more plural care system, with free choice in home-care between a public and private for-profit provider, extended to the whole care pathway.

Long-Term Care in Chile

Pablo Villalobos, head of the School of Public Health at Universidad Mayor in Chile, spoke on Chile’s long-term care reforms, which have taken place over the past several years. The population of Chile is about 20 million people right now, and poised to experience a rapidly ageing demographic in the next year.

“We have experienced an increase in the number of people with long-term care needs, but also the prevalence of the dependence in the population and the severity of the dependence, which is a problem,” said Villalobos. “In February 2026, the country published the National Care Law, Law 21805, that creates the National Care System.” He noted that two documents, launched in 2024, the National Policy of Care and the National Plan of Care, helped establish the groundwork for the law —but added that reforms will continue.

Five elements he said need to be considered include governance challenges, the promotion of intersectoral work, a discussion about beneficiaries, benefits and acquiring funding for maintaining and increasing current coverage of the system.

If you’re interested in accessing the full recording, please contact Shannon Davis at SDavis@GlobalAgeing.org.