Developing a Climate-Tailored Integrated Long-Term Care Framework: Strengthening Policy and Practice Response

As countries confront rapid population ageing alongside escalating climate hazards, long-term care (LTC) systems are increasingly exposed to climate-related risks yet remain under-recognised within climate adaptation policy. This study aims to bridge the gap between climate and health adaptation frameworks and LTC system planning by developing a climate-tailored integrated LTC framework. A horizon scanning and theory-informed synthesis approach was employed, drawing on peer-reviewed and grey literature published between 2010 and 2025 to identify climate hazards affecting LTC users and systems. Evidence was organised by hazard type and analysed in relation to system-level disruption mechanisms and adaptation functions. Findings demonstrate that major climate hazards, including heatwaves, flooding, storms, droughts, wildfires, and air pollution, disproportionately affect LTC users, leading to increased morbidity, cognitive decline, and functional deterioration. At the same time, LTC systems are vulnerable to cascading infrastructure failures, workforce strain, supply chain disruptions, and service discontinuities. Despite these risks, the WHO Operational Framework for Climate-Resilient and Low-Carbon Health Systems does not explicitly address LTC, while the WHO Integrated LTC Framework does not incorporate climate-related risks. In response, this paper proposes a climate-tailored LTC framework that systematically embeds climate risk, adaptation, and mitigation within the four core LTC domains of needs, governance, service delivery, and system enablers. Equity, user participation, and decarbonisation are integrated as cross-cutting principles. The framework provides a policy-oriented architecture to strengthen climate-resilient LTC systems and align long-term care reform with broader climate and sustainable development strategies.