Long-term care financing becomes visible most clearly when a family's circumstances change. An older person may have broad access to medical treatment through Türkiye's health system yet still require daily help with washing, mobility, supervision, meals or household tasks. One family may qualify for public home-care assistance, another may purchase support privately, and a third may provide almost all care themselves without a formal service entering the home.
That distinction sits at the heart of financing reform. Türkiye has achieved broad health coverage through General Health Insurance, but health insurance is not the same as a comprehensive long-term care financing system. Within the wider Türkiye Ageing, Long-Term Care & Community Support Knowledge Hub, financing therefore needs to be understood as the mechanism that determines not only who pays, but who can access support, what families are expected to provide, which services become financially viable and how risk is shared across society.
The present model combines central government expenditure, health financing, social assistance, municipal resources, household payments and unpaid care. That mixed structure supports many people, but it does not yet amount to one standardized national long-term care entitlement. Türkiye's Twelfth Development Plan identifies elderly-care insurance as a policy objective, while work on a long-term care insurance model was still being described as ongoing in 2026. The financing debate is therefore not theoretical: it concerns how Türkiye might move from fragmented support towards a clearer and more sustainable sharing of long-term care risk.
Health coverage and long-term care financing solve different problems
Türkiye's General Health Insurance system provides broad access to health services through the Social Security Institution, known as SGK. Social insurance contributions and public financing support a comprehensive health benefits package, with the state covering or subsidising participation for several groups. This creates an important foundation for an ageing population because older people frequently require primary care, hospital treatment, medication, rehabilitation and specialist services.
However, long-term care addresses a different category of need. A person may no longer require hospital treatment but still need daily support to live safely. Help with dressing, eating, toileting, mobility, supervision or community participation does not automatically become a health-insurance responsibility simply because the underlying need arises from illness, disability or ageing.
The distinction matters because financing determines institutional behaviour. If clinical treatment is covered but practical support is limited, pressure can migrate towards hospitals, households or privately purchased care. Conversely, if home and community support is sufficiently funded, people may be able to remain independent for longer and use high-cost institutional or hospital care only when it is genuinely appropriate.
This interaction explains why funding and payment models cannot be designed separately from care pathways. Financing should support the setting and level of care that best matches need rather than making one part of the system attractive simply because its funding route is clearer.
Türkiye currently finances long-term care through several channels
There is no single financial stream that covers all long-term care in Türkiye. Instead, different forms of support are financed through different institutional arrangements.
Central government funding supports social services, income-related assistance and publicly provided or supported residential care. The Ministry of Family and Social Services plays a major role in disability and older-person services. Health services, including home health care and rehabilitation, are financed through the health system. Municipalities may fund local social, home-support or community initiatives from their own budgets or through specific programmes. Private providers may charge individuals or families directly, while households themselves provide a very large amount of care without a formal payment being made to a service provider.
This produces a financing architecture containing several distinct forms of contribution:
- public health financing for medical and rehabilitative services;
- central social-service and social-assistance expenditure;
- means-tested household-related support such as Evde Bakım Yardımı;
- municipal expenditure on locally organised support;
- direct household payments for private care, equipment or services; and
- unpaid family care, whose economic cost is rarely visible in formal budgets.
The central challenge is that these funding mechanisms are not automatically coordinated around the person's full needs. A household may therefore be financially protected against one form of expenditure while remaining exposed to another.
Evde Bakım Yardımı demonstrates both the value and limits of targeted support
Türkiye's Evde Bakım Yardımı, or Home Care Assistance, is one of the most significant public mechanisms supporting care within families. It is administered through the Ministry of Family and Social Services and is intended to support people with substantial care needs to remain within their family and social environment.
Eligibility is not universal. The scheme combines an assessment of the person's dependency with a household income test. Current rules require per-person household income below a specified threshold linked to the net minimum wage, alongside evidence that the person cannot continue daily life without significant assistance.
In July 2026, the Ministry reported that around 516,000 people were benefiting from Home Care Assistance. It also announced an increase in the monthly payment to TRY 15,775 following adjustment of the relevant public-sector coefficient, with the increased payment taking effect from the following payment cycle.
The scale of the programme demonstrates that public policy already recognises care delivered at home as deserving financial support. But its design also illustrates the difference between social assistance and universal risk pooling.
A means-tested programme protects eligible lower-income households. It does not automatically address households above the threshold who may still face very high care costs, nor does a cash payment itself guarantee access to trained formal care, respite, rehabilitation or specialist support.
The financing question is therefore not whether the scheme is valuable. It is how targeted assistance fits within a broader continuum that also needs to support people who do not qualify for means-tested assistance but cannot reasonably absorb substantial long-term care costs without financial strain.
Operational scenario: a household just above the eligibility threshold
Consider a retired couple living in Bursa. The husband develops substantial mobility limitations following neurological illness and needs help with personal care throughout the day. His wife provides most support. Their combined pension income places the household above the relevant threshold for means-tested home-care assistance, but they do not have enough disposable income to purchase several hours of professional care every day.
The financing problem is not that the household has no income. It is that long-term care costs can be large, recurring and unpredictable in duration.
The wife may reduce other household spending, rely increasingly on relatives or provide care beyond what is physically sustainable. If her own health deteriorates, the family may move rapidly from an apparently manageable arrangement to a need for much more intensive formal support.
A financing system focused only on poverty can therefore leave a middle-income protection gap. These households may be too well resourced to qualify for targeted assistance but insufficiently resourced to self-finance prolonged dependency.
This is one reason long-term care financing differs from conventional social assistance. The risk is not confined to people who begin with low incomes. A lengthy period of dependency can create financial vulnerability for households that were previously economically secure.
Unpaid family care is one of Türkiye's largest hidden financing mechanisms
Money does not have to change hands for a service to have an economic cost. Much of Türkiye's long-term support is financed through family time.
A daughter who reduces paid working hours to support her mother is contributing economically to long-term care. So is a spouse providing night-time supervision, an adult son travelling regularly between cities to coordinate appointments, or a relative who leaves employment because formal care is unaffordable or unavailable.
These costs are difficult to see in public expenditure statistics because they appear elsewhere: lower household income, reduced pension contributions, lost productivity, caregiver ill-health or constrained employment choices.
This is why family carers and care burden need to form part of financing analysis rather than being treated only as a social issue.
WHO's work on long-term care financing internationally has emphasised the substantial economic value of informal caregiving and the risk that poorly developed formal systems shift expenditure from the public budget onto families. Türkiye's own long-term care assessments have similarly highlighted the central role played by families and the increasing pressure created as women's employment and household structures change.
Recognising that contribution does not mean every hour of family care must be converted into a public payment. It means financing decisions should account for caregiver capacity, income effects and sustainability rather than assuming that unpaid support is unlimited.
Household spending can conceal unmet need
Out-of-pocket spending is often treated as a straightforward indicator of private demand. In long-term care, it can mean several different things.
Some households deliberately choose private residential or home-care options because they prefer particular services or amenities. Others purchase support because public provision is unavailable, difficult to navigate or does not cover the type or intensity of assistance required. Still others purchase only as much care as they can afford rather than as much as the person needs.
The last category is especially important. Low recorded spending does not necessarily demonstrate low need. It may indicate that households substitute unpaid care for services, delay seeking assistance or simply go without.
A stronger affordability framework therefore considers both expenditure and unmet need. It asks whether households face catastrophic or impoverishing expenditure, but also whether people receive inadequate support because they cannot pay.
This connects directly to budget impact and affordability. Financial protection should not be assessed only from the perspective of government expenditure. It should also examine what costs are transferred to individuals, what care is forgone and what later system costs may arise as a consequence.
Residential care illustrates how funding design shapes service choice
Residential care remains an important component of Türkiye's long-term care system. Public facilities, private institutions and other providers support older people who cannot remain at home safely or who require a level of continuous assistance that families cannot provide.
Financing affects who can access those services and when. Publicly supported places can protect people with limited resources, while private provision depends much more directly on household purchasing power unless another public funding route applies.
The strategic financing question is whether public resources create a balanced continuum or inadvertently make one setting easier to access than another.
If residential care has a clear funding route but sustained home support does not, some people may enter institutions earlier than necessary. If policy strongly promotes ageing at home but provides insufficient formal assistance, the opposite problem occurs: families carry intensive care for too long because institutional provision is seen as the only fully developed alternative.
The objective should therefore be financial neutrality around appropriate care. Funding should not force people towards a setting simply because another form of support is poorly developed.
That principle strengthens home- and community-based services without treating residential care as inherently undesirable. Different needs require different settings; financing should allow those decisions to be based on need, preference and safety.
Operational scenario: care becomes more expensive because support arrived too late
An 82-year-old man in İzmir lives alone following his wife's death. He initially needs only help with shopping, bathing and some household tasks. His daughter lives nearby but works full time.
No consistent formal home-support package is arranged, so the daughter gradually absorbs more responsibility. The man becomes less active, experiences two falls and is admitted to hospital after the second. Following discharge, his functional ability is significantly reduced and the family concludes that residential care is now the safest option.
The final placement is more expensive than the light-touch support that might have stabilised him earlier, but the original funding decision was never framed in those terms. The system did not explicitly choose between preventive support and later intensive care; the higher-cost pathway emerged because the earlier option was not sufficiently available.
This illustrates why long-term care financing needs a time horizon. The cheapest intervention today is not always the least expensive pathway over several years.
Public authorities therefore need ways to examine avoided deterioration, caregiver sustainability and future service use rather than evaluating each programme only against its immediate annual budget.
Financing reform must address the provider side as well as household protection
A long-term care entitlement has little value if services are unavailable. Financing policy therefore affects provider capacity as directly as household affordability.
Home-care providers, residential services, rehabilitation teams and community organisations need predictable resources to recruit staff, supervise practice, invest in training and maintain quality. If payment levels do not reflect the real cost of safe delivery, shortages and workforce instability can persist even while nominal funding increases.
Türkiye's future financing model therefore needs to consider the economics of provision as well as who qualifies for assistance. Travel time in rural home care, night support, specialist dementia practice, staff training, supervision, equipment and quality systems all carry costs.
This is part of the broader challenge of provider finance, cost controls and sustainability. Payment arrangements need to encourage efficient delivery without pushing providers towards staffing or service models that undermine quality.
Organizations examining similar questions can use the Digital Twin Scenario Modeler to test how different assumptions about demand, workforce and capacity affect service stability. It is not a Türkiye-specific financing model, but it illustrates an important principle: expenditure forecasts need to be connected to the service capacity those resources are expected to purchase.
The workforce turns financial entitlement into actual care
Long-term care financing is often discussed through taxes, insurance contributions and household payments. Ultimately, however, much of the money purchases human time.
Expanding formal coverage without increasing workforce capacity can simply create queues, price inflation or unmet entitlement. Türkiye therefore needs to connect any future financing reform to workforce planning.
This includes more than increasing headcount. Home and community care require suitable employment models, scheduling, supervision and travel arrangements. Residential care requires appropriate skill mix and continuous staffing. Dementia, complex disability and high-dependency care require additional competence. Training costs and career development have to be built into provider economics rather than treated as optional extras.
Family caregivers are part of that workforce equation as well. If formal services replace some unpaid care, public expenditure may rise while labour-market participation improves elsewhere. If insufficient formal support forces relatives out of employment, care appears cheaper to the state while imposing wider economic costs.
The financing debate therefore needs to assess who supplies care as carefully as who pays for it.
Long-term care insurance is now part of Türkiye's reform agenda
Türkiye's Twelfth Development Plan for 2024–2028 marks an important shift by explicitly identifying elderly-care insurance as a policy measure. The Plan states an intention to establish insurance for financing elderly-care services and also refers to complementary long-term care coverage within the broader savings and pension agenda.
The distinction between intention and implementation is important. Türkiye had not, by 2026, moved to a fully operational universal long-term care insurance scheme. Government statements continued to describe modelling and implementation work as ongoing.
This means current support arrangements remain in force while the design of a possible future mechanism develops.
That design choice is consequential because the term "care insurance" can describe very different systems. Internationally, long-term care insurance may be financed through mandatory social contributions, taxation, earmarked premiums, personal contributions or combinations of these. Eligibility may be universal or income-related. Benefits may be delivered in cash, services or both. User contributions may vary according to income or level of dependency.
Türkiye therefore has more than one possible route. The question is not simply whether to establish insurance, but what risk the scheme should pool and how it would interact with existing health insurance, social assistance and municipal provision.
A financing model needs a clear definition of entitlement
Insurance cannot be designed coherently until the underlying entitlement is defined.
Who would qualify for publicly financed long-term care? Would eligibility depend principally on functional dependency, disability status, age, income or a combination? Would benefits cover home support, residential care, respite, rehabilitation and assistive technology? Would cash benefits continue alongside services? Would existing disability-related programmes be integrated or remain separate?
These questions are operational rather than purely legal. Different eligibility rules create different incentives and administrative burdens.
A system based primarily on income assesses financial vulnerability but may not capture intensity of need. A system based only on diagnosis can miss functional differences between people with the same condition. A dependency-based system requires reliable assessment and reassessment. A broad universal entitlement creates greater financial certainty but requires a sustainable revenue base and sufficient supply.
This is why financing connects directly with intake, eligibility and triage operating models. The rules that decide who receives support are themselves part of the financing architecture.
A credible system needs eligibility criteria that can be understood by the public, applied consistently and reviewed as people's circumstances change.
Operational scenario: one diagnosis, three different levels of need
Three older adults are living with Parkinson's disease. One remains largely independent and needs only periodic rehabilitation and medication management. The second requires daily help with dressing and food preparation. The third needs extensive assistance with mobility, personal care and supervision.
If long-term care funding were triggered simply by diagnosis, all three could appear financially equivalent despite very different requirements. If it were based only on income, a person with intensive dependency might receive less support simply because household income sits above a threshold.
A functional assessment can distinguish need more accurately, but it also creates governance requirements. Assessors need common criteria. Decisions need review routes. Changes in functional ability need reassessment. Funding needs to respond when a person's dependency increases or improves.
The scenario shows why a sustainable financing model requires more than a funding source. It requires an operational mechanism that converts individual need into a fair and proportionate benefit.
If that mechanism is inconsistent, geographic or administrative variation can undermine the legitimacy of the entire financing system.
Pooling risk can protect households from unpredictable costs
The strongest economic argument for long-term care insurance is risk pooling.
No individual knows with certainty whether they will need intensive support, how long it will last or what form it will take. Some people will require relatively little formal care. Others may experience years of substantial dependency.
Expecting each household to save independently for that uncertainty is difficult because the distribution of costs is highly uneven. Insurance spreads the financial risk across a larger population and over time.
That principle does not dictate one particular institutional model. Germany, Japan, the Netherlands and South Korea, for example, have developed long-term care arrangements within different welfare, insurance and administrative traditions. Türkiye would need a model aligned with its own social-security structures, labour market, family patterns and public finances.
The transferable lesson lies in separating the probability of needing care from the household's ability to absorb its full cost at the moment need occurs.
Risk pooling can therefore strengthen financial protection while still allowing co-payments or means-tested contributions where policy chooses. The design question is how much risk is socialised and how much remains with individuals.
Insurance alone will not solve fragmented financing
A new funding mechanism can fail if it is added on top of existing fragmentation without clarifying responsibilities.
Türkiye already has health financing, social assistance, disability-related support, municipal services and institutional provision. Introducing long-term care insurance would require decisions about how these components interact.
For example, if an older person receives rehabilitation through the health system and personal assistance through a future care insurance scheme, responsibility for coordination still needs to be clear. If a municipality provides supplementary home support, authorities need to know whether this replaces, complements or sits outside national entitlement.
This is fundamentally a system integration and multi-agency working problem.
Organizations examining similar cross-system responsibilities can use the Governance Maturity Assessment to structure questions about accountability, escalation and oversight. The tool is not a Turkish financing framework, but the governance principle is directly relevant: a new revenue stream cannot compensate for unclear decision rights.
The stronger reform would align financing with a defined care pathway rather than simply create another institution that pays for selected services.
Regional equity needs to be built into financing
Türkiye's long-term care market is not evenly distributed. Service availability, workforce supply, population density, transport and municipal capacity differ considerably between major metropolitan areas, smaller cities and rural regions.
A national entitlement that pays the same amount everywhere may therefore produce different real access depending on local service costs and provider availability.
This creates two related risks. The first is that residents in underserved areas cannot use benefits because there are too few services. The second is that funding follows existing provision, reinforcing areas that already have stronger infrastructure.
Financing formulas may therefore need to recognise geographic and population differences rather than assuming identical delivery conditions nationwide.
That does not necessarily require different rights in different places. In fact, the stronger model is the opposite: common entitlements combined with flexible funding arrangements capable of supporting different delivery models.
Rural home care may require additional travel funding. Remote professional support can extend specialist reach. Smaller provider networks may require different purchasing arrangements from large urban markets. Municipal partnerships may be especially important where private provision is limited.
Equity is therefore not achieved merely by setting the same nominal benefit. It depends on whether that benefit can actually secure appropriate support.
Payment design can influence quality as well as cost
How providers are paid affects how services operate.
Payment solely by volume can encourage activity without necessarily rewarding continuity or outcomes. Budgets that are too rigid can discourage responsiveness when needs change. Very low reimbursement may create incentives to minimise staffing or avoid people with complex needs.
Türkiye's eventual financing architecture therefore has an opportunity to connect payment with quality without importing highly complex models unnecessarily.
At minimum, authorities need to know what publicly financed care is purchasing: staffing, hours, accessibility, continuity and minimum quality expectations. Over time, outcome measures can provide a fuller picture of whether investment is preserving independence, supporting caregivers and preventing avoidable deterioration.
This is where outcomes, value and system sustainability become part of financing governance.
Organizations developing comparable performance frameworks can use the Quality Dashboard Builder to structure how capacity, quality, workforce and outcome indicators can be reviewed together. The practical lesson is that financial accountability should extend beyond whether money was spent to what that spending enabled.
Operational scenario: equal budgets produce unequal access
Imagine two provinces receiving resources based primarily on population size. One has a relatively dense network of providers and available care workers. The other contains widely dispersed rural communities, fewer formal providers and longer travel times between households.
On paper, per-person funding may look equal. In practice, the second province purchases less direct care because more provider time is consumed by travel and recruitment is more difficult.
If national oversight looks only at expenditure, both areas may appear adequately funded. If it looks at waiting time, unmet need, hours delivered and workforce vacancies, the difference becomes visible.
The policy response may then involve adjusted funding, mobile teams, workforce incentives or different contracting arrangements rather than simply asking the weaker area to achieve the same output with structurally different resources.
This is why equity-adjusted financing needs meaningful performance data. Without evidence of what money achieves, nominal equality can conceal substantial variation in real access.
Sustainability depends on prevention as well as revenue
No financing mechanism can make demographic ageing costless. As more people live to advanced ages, long-term care expenditure is likely to rise.
But sustainability is not simply a matter of collecting more revenue. It also depends on the level and timing of need.
Investment in prevention, rehabilitation, falls reduction, chronic-disease management, accessible housing and caregiver support can affect how quickly dependency develops and how intensive support becomes.
A person who regains mobility after illness may need fewer care hours. A caregiver receiving respite may be able to sustain home care for longer. An accessible home may prevent a move to more intensive provision. Timely dementia support may reduce crisis-driven service use.
The financial benefits are not guaranteed in every case, and prevention should not be oversold as a mechanism for eliminating long-term care costs. But ignoring functional outcomes makes financing unnecessarily reactive.
A sustainable system therefore combines revenue strategy with demand management based on health, independence and early intervention.
Data will determine whether financing reform can be governed
Türkiye cannot manage long-term care financing effectively without stronger visibility of who receives support, what it costs, which households remain unsupported and what outcomes different forms of care achieve.
Fragmented data make it difficult to answer basic policy questions. How many people have substantial functional dependency but receive no formal assistance? How does household spending differ by income? Which regions rely most heavily on unpaid care? How do costs compare between home support, residential care and repeated hospital use?
Better data do not require every institution to surrender control of all information. They require sufficient common definitions and interoperable reporting to understand the financial pathway.
Funding authorities need to distinguish between activity and value. A rising number of beneficiaries may demonstrate improved coverage, increasing need or both. Lower expenditure may indicate efficiency, but it may also signal unmet demand.
Financing governance therefore needs to interpret numbers within the context of access, quality and outcomes.
A sustainable settlement will need to share responsibility explicitly
Every long-term care system ultimately answers the same difficult question: how should the cost of dependency be distributed between individuals, families and society?
Türkiye's current arrangements answer that question indirectly. Public health care covers medical needs. Social assistance protects some lower-income households. Public and municipal services provide important support. Families supply extensive unpaid care. Individuals who can afford to do so purchase additional services.
The weakness of an implicit settlement is that households may not know what protection they can expect until dependency occurs.
A more mature financing framework would make responsibilities clearer. Public protection could be defined around assessed need. Household contributions could be structured transparently where appropriate. Caregiver support could be recognised as part of the system rather than residual family responsibility. Provider payment could be connected to realistic delivery costs and quality.
That clarity is valuable even if Türkiye adopts a mixed model rather than a fully tax-funded or insurance-funded system.
What Türkiye can learn from international financing reform
International long-term care systems provide useful evidence, but none offers a model that Türkiye can simply reproduce.
Mandatory insurance systems can broaden risk pooling, yet they require administrative capacity and sustainable contribution bases. Tax-funded models can integrate care with broader public provision but compete directly with other government expenditure. Means-tested approaches can focus resources on people with lowest incomes but may expose middle-income households to substantial costs.
Most mature systems therefore contain mixtures of public financing, user contributions and family involvement.
The relevant international lesson is less about selecting one country's mechanism and more about a small number of design principles: risk should be pooled before dependency occurs; eligibility should reflect care need; financial protection should extend beyond extreme poverty; payment should purchase sufficient service capacity; and funding arrangements should reinforce rather than fragment care pathways.
Türkiye's institutional starting point is different from Germany, Japan or other countries with established care insurance. Its future model will need to work alongside SGK, the Ministry of Family and Social Services, municipalities, existing disability programmes and a strong tradition of family caregiving.
Adaptation is therefore more important than imitation.
Conclusion
Financing long-term care in Türkiye is not simply a question of increasing one public budget. The existing system already mobilises substantial resources through health insurance, central government programmes, Home Care Assistance, public and private residential services, municipal provision, household spending and the unpaid work of families. The central weakness is that these resources do not yet operate as one coherent mechanism for pooling and responding to long-term care risk.
Türkiye's developing interest in elderly-care and long-term care insurance creates an opportunity to make that settlement more explicit. A sustainable model will need to protect lower-income households without leaving middle-income families exposed to prolonged dependency costs. It will need to connect eligibility with functional need, financing with workforce capacity, national entitlements with regional delivery and provider payment with quality and outcomes.
Implementation will matter as much as the funding source. Insurance without available services would create entitlement without access. Cash assistance without respite or formal support can leave families carrying unsustainable responsibility. Higher expenditure without integrated pathways can reproduce fragmentation at greater cost.
The strongest financing reform would therefore do more than raise revenue. It would define how Türkiye shares the financial risk of dependency, create predictable support before families reach crisis, strengthen community and residential capacity, and make the relationship between public investment, household contribution and human outcomes visible. That is the foundation required if long-term care is to remain financially sustainable while becoming more equitable, coherent and responsive to an ageing population.