ON THE NEED FOR LONG-TERM CARE AND THE ROLE OF THE STATE IN PROVIDING IT
Abstract
As societies progress through the processes of industrialization and socioeconomic development, they undergo a demographic transition characterized by increased life expectancy, a growing proportion of elderly individuals within the overall population, and the survival of population subgroups that, in earlier times, often did not reach adulthood. Although the precise effects of prolonged life expectancy on overall health status and the prevalence of disability remain uncertain, and the influence of advancements in medical science and healthcare practices on the quality of life in old age is not easily quantifiable, it is nonetheless clear that increasing longevity inevitably leads to a rising number of individuals requiring some form of long-term care services.
This demand is further exacerbated by an increasing prevalence of chronic illnesses and disabilities not only among the elderly but also within younger age groups, as well as by significant transformations in family structures and caregiving models. The traditional model, based on geographically close family members providing unpaid and direct care, is gradually being replaced by models of care provision that rely on long-distance support and formal caregiving systems. These sociocultural and demographic shifts have significantly reduced the availability of informal caregivers, thereby increasing the pressure on formal care systems and the need for organized and institutional responses.
Despite the uncertainties regarding the complex interplay of demographic aging, shifts in familial roles, and changing health profiles of the population, there is little doubt that contemporary societies are facing a steadily growing need for the establishment, regulation, and maintenance of comprehensive long-term care systems for persons dependent on the help and support of others in their daily lives. In this context, the role of the state becomes crucial—not only in terms of defining public policy priorities and legal frameworks but also in terms of ensuring equitable access, financial sustainability, and the coordination of diverse service providers. This paper discusses the structural determinants of the growing need for long-term care and critically examines the responsibilities of the state in meeting this need, particularly in light of the increasing gap between the demand for care and the available resources—both human and institutional.
References
Butler, R. (1989). Productive Age. U Bengston V. L. Schaie, K. W. (Prir). The Course of Later Life. New York: Springer. 55-64.
World Health Organization. (2017). WHO Clinical Consortium on Healthy Ageing. Topic focus: frailty and intrinsic capacity. Report of consortium meeting 1–2 December 2016. Geneva: World Health Organization, Department of Ageing and Life Course.
Девеџић, М. Стојилковић, Ј. (2012). Ново поимање старости – проспективна старост. Становништво. Vol. 50. Бр. 1/2012. 45-68.
European Commission, Directorate-General for Economic and Financial Affairs. (2021). The 2021 Ageing Report - Economic and Budgetary Projections for the EU Member States (2019-2070). Institutional paper 148. Brussels.
European Commission, Directorate-General for Economic and Financial Affairs. (2012). Long-term care: Need, use and expenditure in the EU-27. Economic Papers 469. Brussels.
European Commission, Directorate-General for Economic and Financial Affairs and Economic Policy Committee, Ageing Working Group. (2016). Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability. Institutional paper 037. Luxembourg: Publications Office of the European Union,
European Commission, Directorate-General for Employment, Social Affairs and Inclusion Directorate A — Employment and Social Governance. (2018). Informal care in Europe, Exploring Formalisation, Availability and Quality. Luxembourg: Publications Office of the European Union.
European Commission, Directorate-General for Employment, Social Affairs and Inclusion Directorate C — Social Affairs. (2018). Challenges in long-term care in Europe - A study of national policies 2018. Brussels: European Commission.
European Commission, Joint Research Centre (JRC). (2023). Demographic microsimulation of long-term care needs in the European Union - Prototype for a microsimulation model projecting the demand for long-term care up to 2070. Luxembourg: Publications Office of the European Union.
European Commission, Social Protection Committee. (2021). Long-term care report. Trends, challenges and opportunities in an ageing society. Luxembourg: Publications Office of the European Union.
Zanjani, F. Hosier, A. (2016). Long-Term Care Populations: Persons With Mental Illness. U Rowles, G. Teaster, P. (Prir.). Long-Term Care in an Aging Society. New York: Springer. 331-360.
Carter, R. Golant, S. K. (1994). Helping yourself help others: A book for caregivers. New York, NY: Three Rivers Press.
Clark, R. Burkhauser, R. Moon, M. Quinn, J. Smeeding, T. (2007). The Economics of an Aging Society. Malden/ Oxford/Carlton: Blackwell Publishing.
Colombo, F. et al. (2011). Help Wanted? Providing and Paying for Long-Term Care, OECD Health Policy Studies. OECD Publishing.
Katz, S. Ford, A. Moskowitz, R. Jackson, B. Jaffe, M. (1963). Studies of illness in the aged. Journal of the American Medical Association. 185(12). 914–919.
Lawton, M. P. Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist. 9(3). 179–186.
Михајловић, Т. (2013). Демографско старење старог становништва србије. Зборник радова - Географски факултет Универзитета у Београду. Бр. 61. 73-102.
Nyce, S. Schieber, S. (2005). The Economic Implications of Aging Societies - The Costs of Living Happily Ever After. Cambridge University Press.
OECD. (2007). Trends in Severe Disability Among Elderly People: Assessing the evidence in 12 OECD countries and the future implications. OECD Health Working Papers No. 26.
OECD. (2022). OECD Employment Outlook 2022: Building Back More Inclusive Labour Markets. Paris: OECD Publishing.
Rowles, G. Teaster, P. (2016). The Context of Long-Term Care. U Rowles, G. Teaster, P. (Prir.). Long-Term Care in an Aging Society. New York: Springer. 3-32.
Радевић, С. (2017). Родно специфичне особености старења становништва Републике Србије. Докторска дисертација. Крагујевац: Факултет медицинских наука Универзитета у Крагујевцу.
Рашевић, М. (2006). Феномен старења становништва Србије. Демографијa. Бр. 3. 43-58.
Републички завод за статистику. (2024). Пројекције становништва Републике Србије 2022-2052.
Републички завод за статистику. (2024). Статистички годишњак Републике Србије.
Schulz, J. H. (2001). The Economics of Aging. Seventh Edition. London: Auburn House.
Сјенчић, М. Миленковић, М. Николић Попадић, С. (2024). Неформални неговатељи старијих у Србији – ка препознавању формалног статуса?. Становништво. Бр. 1. 1-17.
Fortinsky, R. H. Shugrue, N. A. (2016). Understanding Long-Term Care Policy. U Rowles, G. Teaster, P. (Prir.). Long-Term Care in an Aging Society. New York: Springer. 419- 442.
Fujisawa, R. Colombo, F. (2009). The long-term care workforce: overview and strategies to adapt supply to a growing demand. OECD Health Working Papers No. 44. Paris: OECD Publishing.
Hoffmann, F. Rodrigues, R. (2010). Informal Carers: Who Takes Care of Them?. Policy Brief. 4/2010. Vienna: European Centre.
Džakula, A. Banadinović, M. Lončarek,K. Vočanec: D. (2023). Informal care: the indispensable pillar of care for complex patients. Croatian Medical Journal. 64(6). 448-451.