Different systems, same challenges: a comparative analysis of long-term care resilience in Norway, Finland, the Netherlands, Romania, Spain, Italy and Australia

Background: Welfare states face multiple challenges in the sustainable organization of their long-term care (LTC) systems due to aging populations and structural workforce shortages. In this context, the need emerges to facilitate cross-country exchange of policy responses to strengthen LTC resilience.
Objectives: In this paper, we provide comparative insight into the LTC systems of Norway, Finland, the Netherlands, Romania, Spain, Italy, and Australia. We identify key challenges in organizing LTC in these systems and compare strategies implemented to enhance LTC resilience.
Methods: Our qualitative cross-country analysis is based on the Consolidated Framework for Implementation Research and adapted for LTC contexts. Data was derived from OECD databases and complemented with country specific publicly available data sources.
Results: We show that participating countries face similar workforce challenges and adopt comparable strategies such as aging-in-place policies, technological innovation, service integration, and task shifting. Subtle yet crucial differences can however be observed in the broader systemic conditions in place to support LTC employment, and in the trade-offs being made between care quality and accessibility. The differences highlight the crucial role of LTC organizations and particularly middle managers in translating workforce strategies into situated interventions that strengthen both organizational resilience and individual well-being.
Conclusions: To enhance LTC resilience in both the short and long term, translational challenges include strengthening the connections to informal carers; stabilizing ehealth technologies to support ageing-in-place; and balancing individual workers’ ambitions and needs with organizational goals to keep healthcare accessible, responsive and of good quality.