For an older person or disabled adult who needs continuing support in Türkiye, the system is experienced through needs rather than institutions. The person may require treatment from the health system, assistance at home, rehabilitation, income support, help from a municipality and substantial care from relatives at the same time. Yet those forms of support have developed through different administrative, legal and financial arrangements.
The central challenge explored across the Türkiye Aging, Long-Term Care and Community Support Knowledge Hub is therefore larger than expanding any single service. Türkiye needs to determine how its existing health, social-service, social-assistance, municipal, residential, community and family-care arrangements can operate as a more coherent long-term care system as population ageing accelerates.
This does not necessarily require creating one organisation responsible for everything. Integration can instead mean establishing a clearer national framework within which responsibilities, entitlements, assessment, financing, service pathways, information and accountability connect. The distinction matters. Institutional consolidation without operational integration can simply move fragmentation inside a larger structure, while well-designed coordination can connect organisations that appropriately retain different responsibilities.
Türkiye already has important foundations: universal health insurance, national social-service infrastructure, home health services, home-care financial assistance, residential provision, municipal initiatives, community programmes and strong family involvement. The strategic task is to turn those components into a continuum in which people can move between levels of support without repeatedly reconstructing their needs, finances and circumstances for different parts of the state.
Integration begins by defining what the long-term care system is responsible for
Long-term care extends beyond medical treatment. It concerns the continuing assistance required when illness, disability, frailty, cognitive impairment or reduced functional ability makes everyday life difficult without support. That may include personal care, rehabilitation, supervision, practical assistance, assistive technology, social participation and support for family caregivers alongside health care.
This breadth explains why long-term care cannot be organised successfully by the health system alone. Nor can it be treated entirely as social assistance.
Türkiye’s present arrangements reflect different policy traditions. The Ministry of Health is responsible for health services, including home health care. The Ministry of Family and Social Services has responsibilities for older people, disabled people, social services, care models and relevant financial support. Social Assistance and Solidarity Foundations administer forms of assistance. Municipalities provide varying combinations of home, social, transport, practical and community services. Public and private organisations operate residential provision. Families provide much of the day-to-day care that holds these arrangements together.
WHO’s assessment of long-term care in Türkiye identified fragmentation across service provision, governance and financing, together with the absence of standardised needs-assessment procedures and clearly defined long-term care pathways. Its later evidence brief similarly emphasised that health, social care, housing and transportation can all affect long-term support and that no single component is sufficient by itself.
An integrated system therefore needs an explicit conception of long-term care that reaches across institutional boundaries. Without that, each organisation can fulfil its own mandate while the person still experiences discontinuity.
The objective is not to make every organisation perform the same functions. It is to make their different functions intelligible as parts of one long-term care pathway.
National stewardship needs to connect responsibilities that legitimately remain separate
Integration requires someone to govern the whole even where multiple institutions continue to govern their own parts.
Türkiye’s central government has the strongest capacity to establish that system-wide direction. National stewardship can define the objectives of long-term care, clarify institutional responsibilities, establish common principles for assessment and access, determine financing arrangements, set expectations for quality and create the information architecture needed to understand performance.
The Ministry of Family and Social Services has a particularly important role in older-person and disability policy. Its 2026 organisational arrangements give the General Directorate of Services for Persons with Disabilities and the Elderly responsibilities that include identifying needs, developing service models, supporting policies of central and local public institutions, contributing to national policy and strategy and coordinating relevant work.
The Ministry of Health remains essential because functional decline, chronic disease, dementia, rehabilitation, medication and palliative needs frequently interact with social support. Municipalities matter because ageing occurs in neighbourhoods and homes rather than national administrative structures. Social-security and financing institutions become increasingly important if Türkiye develops a dedicated long-term care insurance or assurance mechanism.
System leadership therefore has to answer questions that cannot be resolved by any one provider:
- what constitutes long-term care and who is eligible for publicly supported provision;
- how need and functional ability are assessed consistently;
- which responsibilities sit with health, social services, municipalities, families and other actors;
- how funding follows different levels and types of need;
- which national quality expectations apply across settings; and
- how information about access, outcomes, unmet need and system performance reaches national decision-makers.
This is the difference between coordination as goodwill and integration as infrastructure.
Organizations considering comparable cross-system responsibilities can use the Governance Maturity Assessment to structure questions about ownership, decision rights and assurance. It is not a Türkiye-specific governance standard, but the underlying test is directly relevant: responsibility needs to remain visible when delivery crosses organisational boundaries.
A common approach to need could become the organising mechanism
One of the most consequential design choices concerns assessment. A fragmented system often begins by asking which programme a person qualifies for. An integrated system begins by understanding the person’s needs and then determining which combination of support should respond.
Türkiye has different eligibility and assessment arrangements for different services and benefits. Health services assess clinical need. Social assistance can involve income and household criteria. Disability-related benefits may depend upon formal health-board reports and specified eligibility rules. Residential services have their own requirements. Municipal provision varies locally.
These differences cannot simply be abolished because programmes have different legal purposes. But they can be connected through a common functional picture.
A shared core assessment could capture what the person can do independently, where assistance is required, cognitive and communication needs, the home environment, caregiver availability, safety, social participation and relevant health factors. Programme-specific eligibility decisions could then be added where required rather than forcing the person to begin again at each doorway.
The advantage is operational as well as humane. Consistent information can support referrals, reduce duplication, make changes in need more visible and provide better population-level evidence about demand.
It also creates a basis for proportionality. Someone needing occasional practical assistance should not have to enter an intensive care pathway. Someone with severe dependency should not be left navigating multiple low-level services because no part of the system sees the whole picture.
Scenario: one household, several public systems
An 82-year-old man in Bursa lives with his 77-year-old wife. He has diabetes, heart failure and increasing difficulty bathing and moving safely around the home. His wife prepares meals and supervises medication but has arthritis and is becoming exhausted.
Under fragmented arrangements, the couple may encounter several separate systems. Health services address the husband’s chronic conditions. Home health may become relevant for defined medical needs. The family investigates social assistance and care-related financial support. The municipality offers some practical services. If dependency increases substantially, residential provision may eventually be considered.
Each response can be legitimate while the household still lacks a coherent plan.
An integrated pathway would begin with a shared understanding of both the husband’s functional needs and his wife’s capacity to continue caring. Clinical treatment remains with health professionals. Social-service eligibility remains subject to the relevant rules. Municipal support retains its local character. But the couple knows who is coordinating the pathway, what has been referred, what remains outstanding and when needs will be reviewed.
If the wife becomes temporarily unable to provide care, that change is treated as a change in the household’s support capacity rather than as an unrelated family event. If the husband is admitted to hospital, discharge planning has access to the established support picture rather than assuming that “family care” remains unchanged.
The value of integration is therefore not that one institution takes over every task. It is that the household stops functioning as the principal mechanism connecting institutions.
Financing reform has to answer what Türkiye intends to guarantee
Integration cannot be separated from financing. A pathway can be well designed on paper yet remain fragmented if different services have incompatible eligibility rules, unstable budgets or significant household costs.
Türkiye’s General Health Insurance provides a national mechanism for financing health care, but long-term social care is not simply an extension of insured medical treatment. Existing long-term support is financed through a combination of central government expenditure, social assistance, municipal resources, household spending and unpaid family care.
This creates a fundamental policy question: which long-term care needs should generate an entitlement to publicly supported services, and how should that entitlement be financed?
The Twelfth Development Plan for 2024–2028 explicitly includes establishing elderly care insurance to finance elderly care services. In May 2026, the Ministry of Family and Social Services also described long-term care assurance and financing as subjects being considered within its Older Care Models Workshop. These developments indicate policy direction rather than a fully implemented nationwide long-term care insurance system.
That distinction is important. Designing an insurance or assurance mechanism requires decisions about contributions, taxation, eligibility, benefits, cost sharing, provider payment and the relationship with existing health and social-assistance systems.
Financing design also determines equity. If publicly supported care depends heavily upon household income, people with similar functional needs can experience very different access. If benefits are too narrow, households may still purchase substantial care privately. If entitlement is broad without a sustainable revenue base, coverage may become difficult to maintain as demand increases.
These are not simply fiscal questions. Funding and payment models shape where services develop, which providers enter the market, whether home support is viable and what families are expected to absorb.
Funding should follow need without medicalising everyday support
A future financing model will need to distinguish health care from assistance with everyday life while recognising that the two frequently interact.
A person with Parkinson’s disease may need medical treatment, physiotherapy, assistance dressing, home adaptations, transport and caregiver respite. Funding all of those needs through a medical insurance model could encourage unnecessary medicalisation. Separating them completely can create gaps at precisely the points where integrated support is needed.
The stronger approach is functional alignment. Different funding streams can remain responsible for different interventions while assessment, planning and accountability show how they combine around the person.
Benefit design would also need to support a continuum. If residential care receives stable public financing while preventive home support depends on variable local provision, the financial architecture can unintentionally favour more intensive settings. Conversely, an excessive presumption that everyone should remain at home can shift unsustainable responsibility onto families.
Financing should therefore be sufficiently neutral to support the setting appropriate to the person’s needs and preferences, subject to safety and available resources.
For Türkiye, this means considering home support, day services, respite, rehabilitation, assistive technology and caregiver support alongside residential care when defining the future long-term care architecture. The objective should be neither institutionalisation nor deinstitutionalisation as an ideology. It should be a balanced continuum capable of responding as needs change.
Local delivery needs national consistency without eliminating local flexibility
Türkiye’s municipalities are important participants in community support, but their scale, resources and service offers vary. Metropolitan municipalities can develop substantial social programmes, while smaller municipalities may have fewer specialist resources. Rural geography creates further challenges.
Variation is not inherently a defect. Local authorities need freedom to respond to population density, transport, poverty, housing, community networks and local service capacity.
The problem arises when geography determines whether an essential long-term care need is recognised or supported at all.
An integrated national system therefore needs to distinguish between national guarantees and locally adaptable delivery. National arrangements could establish core eligibility, assessment, quality and outcome expectations. Municipalities and provincial structures could then determine how some community services are organised within that framework.
This is particularly important for rural and underserved communities. A model based on specialist centres may work in Istanbul, Ankara or İzmir but provide little practical access for dispersed populations. Mobile provision, shared teams, transport support and digital specialist input may be more appropriate elsewhere.
Equity should therefore be assessed through effective access rather than nominal availability. A service 80 kilometres away is not equivalent to an accessible local service merely because both appear on a national inventory.
Scenario: integration has to work differently in a rural province
An older woman lives with her son and daughter-in-law in a village in eastern Türkiye. She has moderate functional impairment following a stroke and needs help with personal care and mobility. The nearest hospital can address medical complications, but routine specialist access requires significant travel. The family provides almost all daily assistance.
A national long-term care framework establishes the core assessment and support principles, but reproducing a metropolitan service model would be impractical. The local pathway therefore combines primary health care, scheduled home health input where clinically appropriate, social-service assessment, family support and mobile outreach. Digital consultation is used selectively to extend specialist input, while face-to-face alternatives remain available.
The family has a defined contact when circumstances change. If the woman’s mobility deteriorates, the issue is not treated solely as a new medical episode. The effect on personal care, equipment, caregiver workload and home accessibility is reviewed together.
Provincial and national reporting distinguishes travel time, service reach and unmet demand from metropolitan indicators. Lower service volume is not automatically interpreted as lower need.
This matters because national integration cannot mean identical delivery everywhere. It means that the person’s entitlement to an intelligible pathway should not disappear because the operational mechanism required to deliver it is different.
The workforce becomes the practical test of system design
Integrated systems require workers capable of operating across interfaces without losing professional accountability. Türkiye therefore needs to consider not only how many care workers it will require, but the workforce architecture through which long-term support will be delivered.
Doctors, nurses, physiotherapists, social workers, psychologists, care personnel, municipal staff and other practitioners have different responsibilities. Families and unpaid caregivers contribute enormous additional capacity. New community models may create further roles.
The aim should not be to make everyone interchangeable. It should be to ensure that each role contributes at the appropriate level and understands how to connect with others.
This requires common competencies around recognising functional decline, communication, safeguarding, referral, person-centred planning and working with family caregivers, alongside role-specific professional competence.
Supervision and progression matter as well. If long-term care expands primarily through low-status, poorly supported roles, recruitment may increase temporarily without creating a stable workforce. Formalising care work should improve competence and continuity rather than merely transfer unpaid work into insecure employment.
Türkiye’s demographic transition also makes workforce planning inseparable from productivity. Technology, better scheduling and role redesign can reduce avoidable administrative work, but they cannot eliminate the relational labour involved in helping someone eat, wash, communicate, mobilise or feel safe.
A sustainable system therefore needs workforce data and capacity planning connected to projected care demand rather than staffing decisions made separately within each institution.
Families need to be recognised as partners without becoming the default financing mechanism
Any integrated long-term care system in Türkiye will continue to involve families. Family relationships can provide continuity, trust, cultural familiarity and forms of support that formal services cannot reproduce.
But family care has also compensated for gaps between formal systems. Treating that contribution as infinitely expandable would weaken rather than strengthen integration.
A mature system needs to recognise caregiver capacity explicitly. Assessment should consider what relatives are willing and realistically able to provide, not simply whether a family member exists. Employment, health, distance, other caring responsibilities and the quality of relationships all affect sustainability.
Support may include information, training, respite, day provision, psychological support, practical assistance and financial measures. Importantly, formal support should be capable of increasing before caregiver breakdown rather than only after it.
This has a gender dimension. Women have historically undertaken a disproportionate share of unpaid care, and demographic ageing can increase that burden at the same time as labour-force participation and family structures change. A care system financed implicitly through women’s unpaid time is not financially costless; its costs are transferred into employment, income, health and family life.
Integrating family caregiver burden into system planning therefore improves both equity and reliability. Families remain part of the care ecosystem, but they are no longer expected to function as its invisible coordination and contingency workforce.
Information integration should make continuity visible
Türkiye has substantial digital health infrastructure, but integrated long-term care requires information that extends beyond clinical records.
A hospital may know a person’s diagnoses and treatment. A social-service team may know about household circumstances and care needs. A municipality may know which practical services it provides. A family may know that the person has stopped eating properly or can no longer be left alone.
No single dataset automatically produces an integrated picture.
The objective should not be unrestricted sharing of every piece of information. Privacy, consent, lawful processing and role-based access remain essential. The objective is to ensure that the information required for safe continuity can move appropriately between authorised participants.
At an operational level, this means knowing whether a referral was received, whether an assessment occurred, what support was agreed, who is responsible for the next action and when circumstances require review. At a strategic level, information should reveal demand, waiting, unmet need, geographic variation, service capacity and outcomes.
This connects integration with health and social care interoperability without assuming that technical interoperability alone solves organisational problems. Systems can exchange data perfectly while responsibility remains unclear.
Organizations examining similar digital foundations can use the Digital Transformation, AI and Cybersecurity Readiness Assessment to structure questions about systems, information governance and organisational readiness. It is not an official Turkish framework; its relevance lies in testing whether technology supports a defined operating model rather than attempting to substitute for one.
Quality assurance has to follow people across settings
Türkiye’s long-term care quality arrangements have developed through different regulatory and administrative mechanisms. Residential services have formal requirements governing establishment, operation, staffing and care. Health services have their own clinical and institutional governance. Municipal and community support varies in form and intensity.
The May 2026 regulation governing public nursing homes and nursing home elderly care and rehabilitation centres illustrates continuing development of the formal residential framework. But a future integrated system needs quality assurance that extends beyond individual settings.
A person may receive good hospital care, good home health care and good social support yet still experience a poor outcome because information is lost between them. Quality therefore needs to include pathway performance.
Useful system-level questions include whether people receive support at the appropriate intensity, whether hospital discharge connects with community arrangements, whether changes in need trigger reassessment, whether caregivers receive timely support and whether preventable deterioration is identified.
This does not replace service-specific inspection or professional regulation. It adds a second layer: accountability for what happens between services.
The Quality Dashboard Builder can help organisations exploring comparable systems structure measures across access, quality, workforce and outcomes. It does not define Türkiye’s national indicators, but it illustrates the broader principle that assurance information should allow leaders to see patterns rather than depend upon isolated reports from individual services.
Scenario: the measure of integration appears after hospital discharge
A 79-year-old woman in İzmir is admitted to hospital with pneumonia. She was previously living alone with support from her son several evenings each week, but during admission her mobility declines and she becomes less confident transferring independently.
A clinically successful discharge would mean that acute treatment is complete and she no longer needs a hospital bed. A successful long-term care transition requires more.
Before she returns home, the pathway identifies whether she can manage personal care, meals and medication; whether rehabilitation is required; what her son can realistically provide; and whether existing community support remains sufficient. Information about her changed function reaches the relevant services rather than remaining solely in the hospital record.
For the first weeks at home, support is proportionate to the transition risk. Functional recovery is reviewed rather than assuming that the higher level of assistance will be permanent. If she regains independence, support can reduce. If she deteriorates, reassessment occurs without requiring the family to restart the navigation process from the beginning.
At governance level, repeated cases of delayed support after discharge are visible as a pathway problem. Leaders can determine whether the cause is insufficient community capacity, slow assessment, poor information transfer or unclear responsibility.
This is why hospital discharge and transitional care are powerful tests of integration. They expose whether separate parts of the system actually function as a continuum when responsibility changes.
Accountability needs to move from institutional activity to population outcomes
Fragmented systems naturally report vertically. Each institution describes the services it delivered, the money it spent and the people it reached. Those measures remain necessary, but they cannot answer whether the overall long-term care system is working.
System accountability requires a different set of questions.
Who needs long-term care? How many people receive appropriate support? Who cannot access it? How long do people wait? How much do households contribute financially and through unpaid care? Are people able to remain independent where possible? Does access vary substantially by geography or income? Are caregivers sustaining their role safely? Are transitions between health and social support reliable?
Türkiye’s evidence base has historically been stronger on people already known to services than on the total population with unmet long-term care need. WHO has highlighted limitations in performance data and knowledge about people who do not apply for or reach services.
A national long-term care framework could gradually close this gap by connecting administrative information with population-needs evidence. That would improve planning and make resource allocation more defensible.
Accountability should also operate at different levels. Providers need to understand their own quality. Municipalities and provincial structures need visibility of local access and capacity. Ministries need national and regional comparisons. Central government needs to understand fiscal sustainability and whether policy objectives are being achieved.
The strongest model is not one enormous dashboard. It is an information hierarchy in which each level receives the evidence necessary to make the decisions for which it is responsible.
Integrated governance needs a response when variation persists
Measurement matters only if it changes decisions.
If one locality repeatedly has weaker access to home support, national data should trigger investigation rather than simply document variation. If residential services experience persistent workforce instability, funding and workforce policy may need review. If hospital discharge problems repeatedly arise because social support is unavailable, the solution cannot sit entirely within hospital performance management.
This is where accountability connects with improvement.
A mature governance cycle moves from evidence to explanation, action and reassessment. Some variation will be justified by local circumstances. Other variation will reveal capacity gaps, inconsistent implementation or inequitable access.
National government does not need to manage every local corrective action directly. It does need mechanisms for determining when local variation becomes a national policy concern.
Likewise, local leaders need sufficient flexibility to solve problems rather than simply report them upward. Integration works best when accountability is accompanied by decision rights and resources.
This connects long-term care with wider cross-sector system leadership. No institution can improve a multi-agency pathway by optimising only its own performance.
Scenario: national data reveal a problem that local reporting had normalised
A national review finds that older people with similar levels of functional limitation experience substantially different access to home and community support across several provinces. Each local organisation can explain its own activity, and no single service appears to be performing poorly.
Closer analysis shows that the problem lies in the pathway. In some areas, people are identified early through strong municipal and primary-care links. Elsewhere, formal support is more likely to begin only after hospital admission, caregiver breakdown or severe deterioration.
The national response is not to require every province to deliver identical services. Instead, it establishes a common expectation for identifying and responding to functional need, while regional teams examine how that function can be delivered within their local infrastructure.
Funding is reviewed where lack of capacity is contributing to the difference. Local areas with stronger early-support arrangements share their operating models, but those models are adapted rather than imposed wholesale. Subsequent reporting examines whether the access gap narrows and whether earlier intervention affects demand for more intensive support.
The scenario demonstrates the value of data-led equity planning. Data do not determine the policy response by themselves. They make a previously hidden system difference visible enough for governance to act upon it.
A future long-term care assurance mechanism could become a catalyst for wider reform
The proposal to develop elderly care insurance or a broader long-term care assurance system is potentially significant because financing reform can force decisions that fragmented systems can otherwise postpone.
A defined financing mechanism requires clarity about who is covered, what needs are assessed, which benefits are included, which organisations can provide them, how providers are paid and what quality is expected.
It can therefore become more than a revenue mechanism. Properly designed, it could help create the common architecture around which assessment, services, workforce and accountability align.
But insurance alone would not create integration.
If a new financing stream were added to existing structures without resolving responsibilities, it could create another layer of administration. If benefits were defined without sufficient workforce and provider capacity, formal entitlement could exceed practical access. If assessment focused narrowly on dependency, opportunities for prevention and restoration could be missed.
The design process therefore needs to connect financing with service development from the beginning.
Organizations modelling comparable system changes can use the Digital Twin Scenario Modeler to explore hypothetical interactions between demand, workforce, capacity and service stability. It is not a financial model for Türkiye’s proposed care insurance. The relevant principle is that major entitlement reform should be stress-tested against the delivery system expected to make that entitlement real.
Implementation should be staged without losing sight of the whole system
Building an integrated long-term care system is unlikely to be achieved through one reform date. Türkiye’s existing services support large numbers of people and cannot simply be replaced while a new architecture is designed.
A staged approach can strengthen integration progressively.
Early work could establish a national long-term care definition and governance framework, map responsibilities and develop a common functional assessment core. Financing reform could then be tested against clearly specified benefits and population needs. Local integration models could demonstrate how national expectations work in different geographic contexts. Information standards could be introduced around defined pathway functions rather than attempting immediate universal data integration.
Quality measures could similarly evolve from service activity toward outcomes and continuity. Workforce planning could connect national demographic projections with the skill mix required by the future service model.
The important principle is sequencing without fragmentation. Each reform should be designed as part of the same destination.
Türkiye already has examples of inter-ministerial and local cooperation, expanding community models and national policy attention to long-term care. The task is to convert individual initiatives into durable architecture.
International experience offers design principles, not a ready-made model
Countries have organised long-term care through very different combinations of taxation, social insurance, municipal responsibility, private payment and family support. Some operate dedicated long-term care insurance schemes. Others integrate care more closely with general social protection or local-government systems.
Türkiye cannot simply select one model and reproduce it.
Its health-insurance architecture, central government responsibilities, municipal diversity, family-care traditions, labour market and existing social-assistance arrangements create a distinctive starting point. Institutional models developed in Germany, Japan, the Netherlands or Nordic countries reflect different histories and revenue structures.
The transferable lessons lie at a deeper level.
Long-term care systems become easier to navigate when need is assessed consistently. Entitlements need sustainable financing. Home and community support require real infrastructure rather than policy preference alone. Family caregivers need support. Workforce capacity has to develop alongside benefit expansion. Quality assurance needs to follow pathways as well as institutions. National government needs sufficient information to understand whether access is equitable.
These principles can inform Türkiye without prescribing the institutional mechanism through which each is achieved.
Türkiye’s own experience may also become internationally relevant. It is confronting a transition faced by many countries where family-based care remains central while demographic, economic and social conditions make exclusive dependence upon that model increasingly difficult. How Türkiye combines national stewardship, family solidarity, municipal innovation and more formal long-term care financing could therefore offer lessons well beyond its borders.
Conclusion
Türkiye’s next long-term care challenge is not simply to provide more care. It is to make the different forms of care and support already developing across the country function as a recognisable system.
That requires national stewardship strong enough to define responsibilities while allowing health services, social services, municipalities, providers and community organisations to retain appropriate roles. It requires financing that reflects functional need without medicalising everyday support, a workforce capable of sustaining expanding provision and information that shows what happens to people across organisational boundaries. Families should remain valued partners, but not the invisible mechanism through which gaps in funding, navigation and continuity are absorbed.
The policy discussion around elderly care insurance and long-term care assurance creates an important opportunity. Its significance will depend on whether financing reform is connected to assessment, service capacity, quality, workforce and accountability rather than treated as a standalone payment mechanism.
Integration ultimately becomes visible in ordinary experiences: whether an older person understands where to seek help, whether a caregiver receives support before exhaustion, whether hospital discharge connects with life at home and whether geographic differences in access trigger meaningful action.
For Türkiye, the strongest direction is therefore neither complete centralisation nor continued reliance on loosely connected programmes. It is a nationally coherent, locally adaptable continuum in which funding, governance and accountability align around people’s changing needs. That is the architecture capable of turning demographic preparation into dependable long-term support.