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17 September 2025 | Policy Analysis
Development of the long-term care system
5.8. Long term care
Croatia’s long-term care system is underdeveloped, with little or no coordination between the social welfare, health and war veterans’ systems; between national, county and municipal/city levels; or between public and private (not-for-profit and for-profit) providers. Spending on long-term care only made up 3.0% of health expenditure in Croatia in 2018, far below the EU27 average of 16.1% (Eurostat, 2021). Formal long-term care is underdeveloped and mostly provided in institutional settings.
The benefits available to cover long-term care needs are fragmented, not available to all user groups, and often insufficient to meet basic needs. The burden of long-term care falls disproportionately on family members and a growing informal care sector as part of the grey economy, with considerable scope for exploitation (see also section 5.9). Flexibility in employment to allow for care leave is uneven and varies from one user group to another (Stubbs & Zrinščak, 2018).
The long-term care system in Croatia is composed of a combination of long-term care benefits that are in-cash and in-kind. Older people with long-term care needs can use a mix of different benefits and services. Two are in-cash benefits (assistance and care allowance and personal disability allowance), while five benefits are in-kind services consisting of help at home (home assistance allowance and organized housing) or in residential settings, such as nursing homes, family homes and adult foster families. Counties are responsible for the operating costs of homes for older people and people with disabilities (Oliveira Hashiguchi & Llena-Nozal, 2020).
In 2018 close to 4% of older people over 65 years received the assistance and care allowance and 0.7% received the disability allowance (Ministry of Demography, Family, Youth and Social Policy, 2019a, 2019b). Less than 1% received formal in-kind home assistance, as eligibility depends primarily on the support of family and friends.
Residential care is provided in nursing homes, family homes and adult foster families. Residential care is called “accommodation” in Croatia. Accommodation combines lodging with help with ADL and IADL, and can be provided by the state, counties or by private organizations such as NGOs or religious communities. In addition, family homes and foster care families provide accommodation in private households for older people, combined with ADL and IADL. Family homes and foster homes are both considered as non-institutional care in Croatia. About 3% of older Croatians received a form of public residential care in 2018 (Ministry of Demography, Family, Youth and Social Policy, 2019a, 2019b).
In 2017 a Social Welfare Strategy for Older People for 2017–2020 was adopted. In 2018 a project funded by the European Social Fund started, providing help with daily activities to 12 000 older people, especially in rural areas and on the islands. The project aims to provide care to older people, as well as employment to long-term unemployed women. The duration of projects across counties is defined by deadlines (mostly until 2021), so new ways of financing should be found.
The health care needs of older people are served through the health system, including palliative care and home care at primary care level. Chronic care beds are in wards for long-term treatment, palliative care, chronic mental disease, physical medicine and rehabilitation in special hospitals and resorts, chronic child diseases and chronic pulmonary diseases. The number of hospital discharges (including hospital rehabilitation) for patients aged 65 years and older in 2018 was 246 884, accounting for 37% of all hospital discharges (Croatian Institute of Public Health, 2019).
The development of the long-term care (LTC) system in Croatia is a key priority within the European Union’s Multiannual Financial Framework 2021–2027. Over the past four years, Croatia has adopted a series of strategic documents in both the health and social care sectors aimed at guiding the creation of models that connect the health and social care systems. These efforts focus on improving coordination and integration between both systems in the field of long-term care.
The National Health Development Plan 2021–2027 emphasizes integration between the health and social care systems to promote coordination, accessibility, efficiency, sustainability and affordability of services. These services range from home and community care to all levels of healthcare, including health promotion and disease prevention for vulnerable groups. Amendments to the Health Care Act have empowered health centres to create specialized units for LTC and care of complex patients, and have formalized cooperation with social care institutions. This fosters integrated service delivery accompanied by new nursing advisory units addressing the management of chronic conditions. New legislation on the National Health Care Network increased the number of health teams, significantly expanding access to home nursing, palliative care (with hospital palliative beds increased by 120%), physical therapy, speech therapy, psychological services, mobile clinics and pharmacies. These developments support continuous, multidisciplinary LTC services throughout the country.
In May 2025, Croatia adopted the Operational Plan for the Development of Integrated Long-Term Care 2025–2030, agreed by the Ministry of Health and the Ministry of Labour, Pension System, Family and Social Policy. This plan, aligned with the European Commission’s 2022 LTC Strategy, seeks to ensure accessible, high-quality LTC across Croatia. It aims to address the challenges of an aging population and to secure the economic sustainability of public spending on LTC by establishing a coordinated, integrated LTC system, improving access and quality for all users, and including both professional and informal caregivers.
To enhance coordination and integration of health and social care in LTC, an Intersectoral Working Group was established, comprising representatives from both ministries and related stakeholders. Their task is to complement national plans for health and social services for 2021–2027 and to identify models linking health and social care at home and in the community, ensuring 24/7 coverage. The group promotes horizontal coordination among healthcare institutions (general hospitals, health centres) and social care institutions (homes for older people and people with disabilities) to optimize resource use and ensure holistic patient management. It also supports horizontal and vertical integration across all care levels and among stakeholders involved in complex medical and social care processes through functional regional networks connected to clinical units and specialized hospitals.
Additional policy frameworks reinforce the development of LTC in Croatia. The Strategic Framework for Mental Health until 2030 aims to reduce mental disorders and improve care availability nationwide through coordinated action plans. Similarly, the National Cancer Strategy to 2030 focuses on comprehensive cancer prevention, treatment, research and rehabilitation, emphasizing multidisciplinary care as the new standard of care.
On the social care side, the government adopted three major national plans spanning 2021–2027: the National Plan for the Development of Social Services, the National Plan for Ensuring Equal Opportunities for People with Disabilities, and the National Plan to Combat Poverty and Social Exclusion. These plans collectively emphasize deinstitutionalization, expansion of community-based services, improving quality and accessibility, and preventive measures against exclusion, with tailored actions for vulnerable groups. They support the development of new social services such as respite care, caregiver support and peer assistance, and promote employment of new social care professionals.
The Social Care Act governs the provision and entitlements related to social services, introducing a new organizational structure with the establishment of the Croatian Social and Employment Institute and Family Centres to standardize procedures and strengthen professional capacity. The Inclusive Allowance Act introduces a new financial support model for people with disabilities, simplifying and unifying previous allowances based on individual needs assessed by competent authorities. The Personal Assistance Act (2023) institutionalizes personal assistance as a social service, enhancing independence and community inclusion for people with disabilities, helping to prevent institutionalization.
Together, these health and social sector frameworks and reforms underpin Croatia’s ongoing commitment to building a coordinated, accessible, and high-quality LTC system that addresses demographic challenges, supports vulnerable populations and ensures sustainable public spending.