Although 88% of countries surveyed have included long-term care in national legislation, policies or plans, only 15 of PAHO’s 35 Member States report having a formal, publicly funded system.
Washington, D.C., 28 October 2026 (PAHO) – As the population of the Americas ages, the need for long-term care is growing, but fragmented services and insufficient public financing are leaving families to shoulder much of the responsibility and cost, according to a joint policy brief by the Pan American Health Organization (PAHO) and the Inter-American Development Bank (IDB).
By 2050, an estimated 306 million people in the Americas—more than one in four residents—will be aged 60 or older. As the population ages, countries will need to expand services that help people maintain their autonomy, functional ability and quality of life, while supporting those who provide care.
The publication comes ahead of the International Day of Care and Support on 29 October and highlights the need to strengthen long-term care systems to ensure that people who require ongoing assistance can access coordinated, quality services without facing financial hardship.
“Investing in long-term care is not simply an expenditure. It is an investment in healthier people, stronger families, and more resilient societies. It can help close gaps in access to health services, support caregivers, advance universal health coverage, and strengthen the health workforce,” said Mary Lou Valdez, PAHO Deputy Director.
Progress in policies, gaps in services
Countries across the Americas have made progress in recognizing long-term care as a public policy priority. According to the 2025 midterm review of the United Nations Decade of Healthy Ageing, 88% of countries responding to the survey reported including long-term care in national legislation, policies or plans, compared with 61% of countries responding in 2020.
However, only 15 of PAHO's 35 Member States reported having a formal, publicly funded long-term care system, while just seven of 27 countries responding to a separate question reported legal recognition of informal caregivers and an entitlement to support.
The joint PAHO–IDB policy brief, Governance and Financing of Long-Term Care, identifies fragmented services and inadequate financing as major obstacles to meeting care needs. Health and social protection services frequently operate independently, without coordinated assessments or care plans. As a result, people may receive assistance from different providers without the continuity of care they need.
Strengthening capacity to deliver long-term care requires bringing health and social services together, with clear responsibilities, coordinated assessments and care plans, quality standards and sustainable financing, so people receive the support they need regardless of who provides it.
Families often fill these gaps, either by providing unpaid care or paying directly for services. The brief estimates that the economic value of informal long-term care can represent between 0.8% and 4.9% of annual gross domestic product (GDP). Strengthening formal care services and support for family and other unpaid caregivers is therefore an important part of building more sustainable long-term care systems.
Uruguay: An example of coordinated care
Uruguay offers an example of how countries are addressing these challenges. Established in 2015, its National Integrated Care System brings together ministries, local governments and civil society under a shared governance structure, with responsibilities for coordinating policies, services and financing.
The system uses standardized assessments to determine care needs and eligibility for support. Public financing and co-payments are linked to income, while service providers must meet quality standards and care workers are subject to training and certification requirements.
PAHO supports countries in strengthening long-term care policies and integrating services into health systems. Its Regional Policy on Long-Term Care 2025–2034 promotes approaches to improve coordination, financing and quality of care, including through primary health care and community-based services, with a focus on maintaining people's functional ability and supporting caregivers.
These challenges will also be discussed during a PAHO–IDB high-level dialogue on 29 October, bringing together policymakers and experts to explore how countries can strengthen governance and financing to make long-term care more accessible, equitable and sustainable.
