Victor Andrés Fica¹, Pablo Villalobos Dintrans ^2,3,4,5, Jorge Browne ^4,6

¹ Facultad de Administración y Economía, Universidad Diego Portales (UDP), Santiago, Chile.

² Escuela de Salud Pública, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile

³ Centro de Observación y Análisis de Datos en Salud (CADS), Universidad Mayor, Santiago, Chile

⁴ Millennium Institute for Care Research (MICARE), Santiago, Chile

⁵ Red Interuniversitaria de Envejecimiento Saludable de Latinoamérica y el Caribe (RIES-LAC)
Santiago, Región Metropolitana, Chile

⁶ Sección de Geriatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

El perfil de Chile también está disponible en español aquí.

Chile lacks a formal public long-term care (LTC) system. Care for older people, persons with disabilities, and other persons with functional dependency falls overwhelmingly on informal, family-based provision, with the burden borne predominantly by women (1). Recently, the country approved a law to create a National System of Care (2).

The first steps toward addressing care needs among older adults were taken in 2004 with the creation of the Subsystem Chile Solidarity (Subsistema Chile Solidario), subsequently renamed the Safety and Opportunities Subsystem (Subsistema Chile Seguridades y Oportunidades). Within this framework, the Comprehensive Support Programme for Adults (Programa Integral de Apoyo para Adultos) aimed to provide psychosocial support and care services to older people. However, the first attempt to consolidate and organize care-related initiatives came in 2015, with the creation of Chile Cares (Chile Cuida)—part of the broader Intersectoral Social Protection Subsystem (Sistema Intersectorial de Protección Social, SIPS)—whose objective was to coordinate public and private actions across sectors to address varying levels of functional dependency (1). The core program of this subsystem was the Local Support and Care Network (Red Local de Apoyos y Cuidados, RLAC), which distributed the tasks of assessment, referral, and case follow-up to municipal governments. The RLAC began with a pilot in 12 municipalities; by 2022 it operated in 89, and by 2025 it covered 215 of Chile’s 346 municipalities (3). Nevertheless, these initiatives were not designed as a long-term care system per se; they were designed and implemented in isolation and, while valuable, have not been able to meet the growing demand for long-term care services.

Chile recently took a further step toward the construction of a public formal LTC system. In 2024, the country approved the first National Support and Care Policy 2025–2030 (Política Nacional de Apoyos y Cuidados, PNAC), establishing the policy foundations for the proposed National Support and Care System (Sistema Nacional de Apoyos y Cuidados, SNAC)—described as the fourth pillar of social protection (1). A legislative bill to formally institutionalize the new national care plan has been submitted to the National Congress. In the meantime, Chile continues to address LTC needs through more than 50 fragmented programs distributed across five ministries, providing uncoordinated support without a systems architecture, a dedicated financing mechanism, or adequate coverage (1,4). The Care Law (Chile Cuida Law, Law 21.805) launched in February 2026 aims at creating the Chilean System of Care and could become an umbrella regulation for the LTC sector (2).

At the national level, responsibility for care policy is spread across multiple ministries, with no single body holding comprehensive legislative authority over long-term care. The Ministry of Social Development and Family (MDSF) is leading the process of developing the programmes needed to provide care through the Interministerial Presidential Advisory Council (Consejo Asesor Presidencial Interministerial, CAPI), a ten-ministry advisory council co-chaired by the MDSF and the Ministry of Women and Gender Equity. Within the MDSF, the Undersecretariat of Social Services serves as its technical secretariat. Other key institutional actors include: the Ministry of Health (which governs home health care, palliative care, and services for persons with chronic conditions); the National Disability Service (Servicio Nacional de la Discapacidad, SENADIS, which coordinates support services and assistive technology for persons with disabilities); and the National Service for Older People (Servicio Nacional del Adulto Mayor, SENAMA, which administers residential facilities and active ageing programs for older people).

At the local level, municipalities deliver fragmented care services through a public program—the Local Network for Supports and Care (Red Local de Apoyos y Cuidados, RLAC)—and the Primary Health Centres. The new national care policy contemplates an intersectoral governance model with defined roles for national and local actors, but this architecture has not yet been formally established.

Public programs related to care are funded through general taxes, distributed across multiple ministerial budget lines.

The new national care policy commits to establishing a financing management model for the new national care plan. However, no dedicated revenue source has been defined—whether through social insurance contributions or earmarked taxation—leaving both the system’s financing and its long-term fiscal sustainability unresolved (5). This is relevant since accelerating population ageing and sustained declines in fertility will reduce the supply of informal family caregiving, placing mounting pressure on public long-term care systems both at the global level (6-8) and in Chile (4,9). The debate on whether Latin American countries like Chile should transition toward a formal social insurance model for long-term care is gaining prominence (4,10,11).

Chile does not have a comprehensive regulatory system for long-term care. Long-term care facilities (Establecimientos de Larga Estadía para Adultos Mayores, ELEAM) are subject to a specific health regulatory framework (12), which sets standards for installation, operation, staffing, and infrastructure for both public and private facilities. Oversight and enforcement are shared between SENAMA and the Regional Ministerial Health Secretariats (SEREMIs), which are responsible for authorization and annual inspections. A significant proportion of these long-term care facilities operate informally or without the corresponding accreditation—a situation made fully apparent during the COVID-19 pandemic (1). There is no public quality ratings for care providers.

Support services for people with disabilities are partially regulated by the National Disability Service under Law 20.422, which establishes rights to assistive technology and support services, and requires minimum standards from organizations receiving public funding. For home care and community services, there is no systematic accreditation, standards or quality monitoring system. The new national care policy identifies the absence of a comprehensive regulatory framework as a central structural gap and proposes establishing quality standards, monitoring mechanisms, and provider accreditation as components of the new national care plan governance architecture (5).

One of the primary challenges in identifying care needs is the absence of consensus on how to identify and classify functional dependency. In Chile, several validated instruments are used to assess functional capacity and the need for care and support. In terms of functional capacity, four main instruments are employed (13,14): i) the Functional Assessment of the Older People (Evaluación Funcional del Adulto Mayor, EFAM) (15), which forms part of the Preventive Medical Examination for Older Adults (Examen de Medicina Preventiva del Adulto Mayor, EMPAM) (16) used in primary health care and which also includes scales to identify cognitive impairment (17,18) and depression (19); ii) the Barthel Index (20), also incorporated within the EFAM; iii) the Katz Index (21), and; iv) the Lawton and Brody Scale (22). The latter two instruments have been predominantly employed in Chilean surveys that have sought to measure functional dependency, including the 2009 Study on Dependency in Older Persons (EDPM) (23), the National Survey on Disability and Dependency (ENDIDE) (24), and the Socioeconomic Characterization Survey (CASEN) (25). On the other hand, the Local Network for Supports and Care, the backbone of the future system, uses data from the health module of the National Household Registry (Registro Social de Hogares, RSH) (26), an information system used by the Ministry of Social Development and Family that aims to establish a socioeconomic characterisation of the population and support the selection processes of beneficiaries for subsidies, contributions and social programs (27). The country also piloted the ICOPE (Integrated Care for Older People), an instrument proposed by the World Health Organization to identify decline in intrinsic capacity in primary care (28,29).

Chile currently lacks a standardized national LTC needs assessment instrument. While surveys provide population-level estimates of disability and functional dependency, their utility is constrained by their reliance on self-reported data rather than functioning assessment as eligibility instruments. The Chile Cuida Law that creates the system, states that the benefits are intended for people with dependency but does not establish a concrete mechanism for identifying and selecting beneficiaries (2,5).

The absence of a formal public LTC system means that publicly financed services are fragmented. The system is heavily oriented towards in-kind benefits delivered through programs directed primarily at households as assessed by the National Household Registry (RSH). More than 50 programs have been identified as part of the core care provision landscape across the Ministries of Social Development, Health, Education, and Women and Gender Equity, along with 16 associated programs (1). These programs are not coordinated under a common governance, generating duplication for some populations and service gaps for others, particularly for older people with mild and moderate dependency, who do not qualify for targeted interventions (1).

A Register of Carers was established in 2022, granting official recognition to informal carers and linking them to benefits such as preferential access to health services and allowances. The Local Support and Care Network provides some support and training for carers as part of its home-based interventions. Law 21.645 (2024) recognized specific labour rights for workers with unpaid caring responsibilities, including flexible working arrangements (30). For example, the 40-hour workweek reform incorporated provisions for flexible scheduling for registered primary carers, establishing that employers must offer the option of working remotely or from home to people that carry out care tasks. A monthly cash benefit of CLP$33,000 (~US$37) is available for carers of people with severe disabilities in poverty, but coverage is very limited. In broad terms, efforts have been directed towards incentivizing informal care—a practice that the international literature warns may generate adverse effects on the labour market participation of carers themselves (6,8). This concern is particularly salient in Chile, where the National Employment Survey conducted by the National Statistics Institute indicates that 33.9% of women report that their primary reason for not participating in the labour market is engagement in unpaid domestic and family care work (31). Caregiving tasks are also the main reason for not working among caregivers (32).

The Local Network for Supports and Cares the main program delivering home and community-based LTC services. Its territorial coverage has expanded from 22 municipalities in 2018 to 215 (out of 345) in 2025 (3). Despite this increase of territorial coverage, population coverage is still an issue, as intra-municipal reach remains unmonitored (26). Social workers from the Local Network for Supports and Care conduct assessments, coordinate referrals to available programs, and provide follow-up for households with dependent people. Home health care services are delivered by family health centres (Centros de Salud Familiar, CESFAM) as part of primary health care, although their scope and allocated hours are limited. Day care centres for older adults and persons with disabilities are managed primarily by municipalities, with significant geographic variation in availability. Teleassistance has been piloted for older adults in situations of social isolation.

There are few options for sheltered housing for older people and persons with disabilities. By 2016, the National Disability Service was managing 208 supported homes (Hogares y residencias protegidas)— a program aiming at helping people with psychiatric disabilities who do not have a social support network, nor the skills to live independently, and who have difficulties accessing social services and participating in their community environment—, proving food and for approximately 1,800 people (33). In 2024, the number of beneficiaries was estimated in 1,925 people (34). The Ministry of Housing and Urban Development of Chile (MINVU) has incorporated accessibility standards into public housing programs and urban planning norms, but these are not systematically integrated with care support services. The new national care policy acknowledges the need to develop housing with integrated care support as part of the new national care plan service continuum, however no significant programs have been implemented in this area.

Residential long-term care for older adults is provided through residential homes (Establecimientos de Larga Estadía para Adultos Mayores, ELEAM), which include nursing care homes, residences, and similar facilities. The total number of formally registered long-term care facilities is around 880, with capacity for 23,706 residents (35,36). The sector is predominantly private, with both for-profit (between 80%) and non-profit providers (20%) (36).

The National Service for Older People coordinates 22 publicly funded care homes, which are run by foundations and local authorities, and co-funds places in private and non-profit homes for older people living in poverty who are unable to pay for care themselves (35). Establishments range from small family-style homes to larger homes, many using converted residential buildings. There are registration and accreditation requirements, but the new national care policy identifies the development of quality standards and the design of a system for monitoring and supervising the provision of care as an ongoing challenge (3).

Chile has developed several initiatives to promote age- and disability-friendly environments. The country has actively participated in programs such as Friendly Cities to Older People, encouraged by the World Health Organization and the Pan American Health Organization, with more than 200 cities and communities participating in the initiative (37,38). The National Service for Older People has developed Safe Community Spaces and community programs to promote active ageing and social participation among older adults. At the urban level, The Ministry of Housing and Urban Development of Chile has incorporated accessibility standards into public housing design, and some municipal public spaces have been adapted under accessible cities agendas. Nevertheless, there is no comprehensive national strategy for age- or disability-friendly environments.

The National Disability Service provides assistive technology through the Technical Assistance Program, which subsidizes devices such as wheelchairs, hearing aids, orthopaedic equipment, and communication aids for people with disabilities based on socioeconomic need. The new national care policy emphasizes community integration and assistive technology as cross-cutting elements of the new national care plan, including the promotion of adapted housing. Access to assistive technologies remains limited, particularly in rural areas and lower-income populations.

Currently, there are no initiatives to promote digital technologies and/or artificial intelligence (AI) in the care sector.

Information on the LTC workforce in Chile is scarce and largely undocumented. Unpaid family carers—predominantly women (~70%)—remain the primary care providers, constituting by far the largest segment of the sector’s workforce; most caregivers (73%) are also older people (24,32).

Most care is provided by unpaid carers, living in the same house than people with LTC needs; only 8% of people providing care services are paid (32). Paid carers are mostly domestic workers, many of them without employment contracts, social security coverage, or formal training (defined as informal workers). Formal care occupations include nurses, nursing assistants (TENS, the most widespread formal care occupation), occupational therapists, social workers, kinesiologists, and psychologists, working across care homes, day care centres, community health teams, and home care services. Wages and working conditions in the care sector are generally lower than in the health sector, with high turnover and limited career pathways. Workers in private households are covered by the domestic workers statute (introduced in 2015), which provides minimum protection but does not recognize LTC-specific competencies or create career frameworks. One of the strategic objectives of the new national care policy explicitly commits to promoting decent work for paid caregivers, including training, certification, and formalisation. The National Disability Service and the National Training and Employment Service (Servicio Nacional de Capacitación y Empleo, SENCE) operate training and skills certification programs for carer workers, though these reach only a small share of the workforce.

Projections have shown that the country’s needs of human resources for care—including formal carers but also health professionals—will increase markedly in the coming years (39) and that the gap of formal carers exceeds 10,000 people in 2020 (40).

The country does not have an integrated LTC information system, aside from the system to monitor care homes (5). The most comprehensive national data source about LTC is the Socioeconomic Characterization Survey (CASEN) survey, which provides population-level estimates of disability and functional dependency (since 2015) but is not linked to care program records and is administered biannually. In 2022, the country also carried out a National Survey of Disability and Dependency (Encuesta Nacional de Discapacidad y Dependencia, ENDIDE) aimed at estimating the prevalence of dependency in Chile (24). The Local Support and Care Network collects socioeconomic vulnerability data used for program targeting but does not capture specific functional dependency information. The Ministry of Social Development and Family development tracks some performance indicators for individual programs.

The National Service for Older People and the National Disability Service maintain separate administrative records of their respective programs and facilities. Health data are collected through Ministry of Health information systems but are not integrated with social care data. The sixth strategic objective of the new national care policy explicitly commits to designing a unified care and support information management system to enable cross-program referrals, coverage and quality outcomes monitoring, and the new national care plan performance evaluation. This is identified as a foundational element for the effective functioning of the system, but it has not yet been developed and implemented.

Recent years have brought significant policy change. Chile Cuida, the national care system created under Law 21.805, scaled up the Local Support and Care Network, testing an integrated model of assessment, care navigation, and local referral. This represents the most significant attempt to date at a coordinated community care architecture, but it remains a program designed to address care needs across all age groups in the population, including childcare unrelated to LTC needs, rather than a long-term care structure per se.

The new national care plan bill legally recognises the right to care in three dimensions: receiving care, providing care, and self-care. The law establishes the need to create dedicated a governance architecture and set quality standards for providers and a data infrastructure.

The Register of Unpaid Carers has been established as a tool to identify, recognise, and reach informal carers. Teleassistance and remote monitoring services have been piloted for older adults and persons with disabilities in situations of social isolation.

Chile’s care system exhibits significant weaknesses in several performance dimensions. With respect to coverage, the National Survey on Disability and Dependency 2022 found that 40.3% of adults with functional dependency lack a permanent carer; 24.5% report receiving insufficient assistance; 4.9% report needing assistance they cannot access; and 44.2% of older adults report that household income does not cover their health expenditures (1). In 2018, the largest public care program reached approximately 14% of older people with dependency, and it was estimated that approximately 5% of those in need of care resided in publicly subsidised care homes (41).

With respect to equity, the prevalence of dependency in the lowest income quintile is more than double that of the highest quintile (26.7% versus 6.2% among adults aged 60 and older), and access to formal care services is heavily skewed toward higher-income and urban areas (1). Regarding effectiveness and quality, the high burden borne by family carers—with 32.4% of people with dependency having carers that experience severe overload, and 42.9% having carers with symptoms of anxiety or depression—indicates that the informal care system is under severe strain and raises serious questions about the quality of care provided (1). The fragmentation of more than 50 programs across five ministries without common referral mechanisms or monitoring further erodes system efficiency. Gender equity remains a fundamental structural challenge: women bear a disproportionate care burden with significant consequences for their labour market participation, economic autonomy, and well-being (32).

During the pandemic there was a significant withdrawal of women from the labour market in order to provide care. This was a setback after more than a decade of increasing female labour market participation rates in Chile (42-44). This exposed the role of informal care as a contributor to gender inequalities.

A broader policy lesson explicitly recognised in the new national care policy is that COVID-19 exposed the structural deficits and fragility of the existing care provision arrangements and reinforced the urgency of establishing an integrated information system with individualised data on care users, staff and facilities, as a minimum requirement for an effective LTC policy (1,41). At the start of the pandemic, the country lacked a comprehensive register of establishments, which prevented an official assessment of the impact of COVID-19 in terms of cases and deaths in this sector. A 2019 register identified at least 200 establishments operating without health authorization, concentrated in the Metropolitan, Valparaíso and Bío Bío regions, caring for approximately 2,000 people (42).

A key lesson identified is the need to institutionalise cross-sectoral coordination, strengthen information systems on care homes (1,42), and diversify provision towards home-based (‘ageing in place’) and community-based models that are more resilient to future health emergencies (42).

Chile recently took a further step toward the construction of a formal public LTC system. In 2024, the country’s first National Support and Care Policy 2025–2030 (PNAC) was approved by Supreme Decree, establishing the policy foundations for the proposed National Support and Care System (SNAC)—described as the fourth pillar of social protection (1). A legislative bill to formally institutionalise the SNAC has been submitted to the National Congress.

The academic and policy debate has also intensified around the financing architecture for a long-term care system, with a growing argument that Latin American countries should advance toward a formal social insurance model for long-term care to ensure fiscal sustainability, risk pooling, protection against adverse selection, and stronger incentives for labour formalization (11,45). Chile could potentially benefit the experience of countries such as Germany, Japan, China, and the Republic of Korea, all of which have addressed this challenge through social long-term care insurance.

Andrés Fica, F., Villalobos Dintrans, P.& Browne, J. (2026). Long-Term Care System Profile: Chile. Global Observatory of Long-Term Care, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.5281/zenodo.21933024

• Sistema Nacional de Apoyos y Cuidados – Chile Cuida https://chilecuida.cl/
• Law 21805 (Chile Cuida Law) https://www.bcn.cl/leychile/navegar?idNorma=1221443
• Encuesta de Discapacidad y Dependencia, 2022 https://observatorio.ministeriodesarrollosocial.gob.cl/endide-2022
• Encuesta CASEN https://observatorio.ministeriodesarrollosocial.gob.cl/encuesta-casen
• Registro Social de Hogares https://www.registrosocial.gob.cl/
• Fundación Nacional de la Vejez https://www.eleam.cl/

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