Need, unmet need, and shortage in the long-term care market

The revised version of the European Social Charter, which was opened for signature in 1996, has a specific clause (Article 13) which concerns social and medical care. This clause recognises that the countries must “ensure that any person who is without adequate resources and who is unable to secure such resources either by their own efforts or from other sources, in particular by benefits under a social security scheme, be granted adequate assistance and, in case of sickness, the care necessitated by his condition.” In Article 23, the rights of older people are especially mentioned, both the right to “lead independent lives in their familiar surroundings for as long as they wish and are able”, receiving “the health care and the services necessitated by their state”, as well as the right to “appropriate support” of the older persons living in institutions. As a consequence, the member states are responsible to ensure that older people are guaranteed access to adequate care. The Charter does not require that that care is provided by the state itself, but rather that the necessary measures be taken - “either directly or in co-operation with public2 or private organisations”. Furthermore, Principle 18 of the European Pillar of Social Rights stresses the right to affordable long-term care services of good quality, in particular home-care and community-based services. Although appropriate care is generally acknowledged to be essential, several studies have detected the existence of unmet long-term care (LTC) needs (Scheil-Adlung 2015, Muir 2017, Burchardt et al. 2018). Portugal, which is identified as relying mostly on family-based LTC (Tavora 2012, Lopes 2013, Illinca et al 2015), is a typical example of a country where formal LTC for older people is commonly considered to be insufficient (Costa et al. 2014, Barros and Simões 2007), with limited public funding. Therefore, can we say that there is a shortage of LTC in Portugal? If so, how much more formal care is needed? The objective of this study is to understand the extent of the unmet need for care, the need for more formal care, and the existence of a shortage in the long-term care market, in Portugal, whilst conveniently differentiating these concepts.