Alexander Chaverri-Carvajal (Centre d’Estudis Demogràfics, Universitat Autònoma de Barcelona, Spain)

Please note that this is an updated Country profile, the previous one was published in 2023 and is available here.

Costa Rica’s LTC system will turn five years old on March 4, 2026. It was established through Executive Decree in 2021 and subsequently formalized by national law in 2022[1]. It represents the first national LTC system in a middle-income country2. The system inherits a pre-existing landscape of government-subsidized services that are underdeveloped, fragmented, and primarily limited to day centres and a small number of residential facilities, operated by social welfare institutions. Private provision of LTC services is limited, resulting in most services being informally provided by women within families. Community-based care for older people, which forms the core of the system in Costa Rica, is decentralized in terms of service delivery. The law establishes that the system is managed nationally and that the Ministry of Human Development and Social Inclusion (MHDSI) can coordinate and transfer resources to Local Governments.

The governance framework of the system is based on Executive Decree 42878-MP-MDHIS, the National Care Policy 2021-2031 titled “Towards the progressive implementation of a Care and Dependency Support System”3 and Law No. 10192, which establishes the “Creation of the National System of Care and Support for Adults and Older Adults in Situations of Dependency (SINCA)”4.

The system brings together different institutions that must adjust their programs to include care for dependent persons. The target population are adults assessed as being dependent. The SINCA is run under the umbrella of the MHDSI.

SINCA is managed by the National Care Secretariat, based in the Ministry of Human Development and Social Inclusion. Its primary function is to organize and coordinate measures and resources of the different institutions that make up the SINCA for inter-institutional coordination in the system to fulfill its functions. The Ministry of Labor and the National Apprenticeship Institute are part of the system. Their inclusion, in conjunction with the National Women’s Institute, is intended to generate a mechanism to facilitate women’s (re-)entry into the labor market both as trained caregivers and if they had to leave their jobs to care for a dependent person at home because they had no other alternative. SINCA has two levels of organization. At the national level, brings together the management of the institutions that make up the system. This is where high-level decisions are taken. At the regional level, the Regional Intersectoral Councils of the social area coordinates everything related to coverage and adequacy of benefits. Before the enactment of SINCA, care programs were restricted only to poor or vulnerable people. The new policy will progressively advance towards universality of care. The services offered by SINCA are also available to people who are not poor, but they have to contribute through co-payments. The size of co-payments was to be published in November 2023 as mandated by law; however, as of April 2026, this has not been done.

Within the National Care System, the institutions are organized in 4 sections:

» Coordination. The Ministry of Human Development and Social Inclusion and the National Care Secretariat are in charge.

» Inter-institutional Committee. This has four subgroups: a) Service Provision; b) Quality and Employability; c) Resource Management and d) Data Intelligence. This section comprises institutions with a steering role on disability, seniors, public health, the formation of capabilities, and labour intermediation.

» Regional coordination. Six regional intersectoral councils are distributed throughout the national territory.

» Evaluation. This is carried out in the inter-ministerial council of the social area chaired by the President. It is technically accompanied by the Ministry of Human Development and Social Inclusion and the Ministry of Planning and Economic Policy.

The inception of the system was marked by the fiscal tightness faced by the country, which implies a shortage of public funding.

All services are financed through general taxes and co-payments. The main source is public funding through government revenues. Additionally, as of 2025, income-based co-payments will be implemented. The amounts have not yet been determined. Currently, total public LTC spending for people aged 18 and over is estimated at 0.1% of GDP. SINCA is scheduled to invest up to 0.52% of GDP in the fifth year of implementation.

In a comparative context with other OECD member countries that allocate an average of 1.5% of GDP5, Costa Rica began the implementation of SINCA in 2021 by investing approximately 0.1% of its GDP in social LTC6 7, almost four years later, its budget stands at 0,12%, and the system covers only 5% of dependent older adults8. Key challenges for implementation include coordination and the identification of new sources of funding.

Long-Term Care is regulated in two ways. First, the quality of workers’ training is the responsibility of the National Institute of Learning, which has a curriculum that certifies and develops job competencies. Second, regarding the quality of services provided in day centers and long-term care residences, the Ministry of Health conducts inspections to ensure that services are delivered in accordance with its operating and licensing standards. The quality ratings of providers are not publicly disclosed.

The initial Law establishes that SINCA is progressively universal. Therefore, access is not means-tested and there is no requirement based on nationality. However, before accessing SINCA services, applicants must undergo the Dependency and Support Intensity Assessment Scale (Baremo). This scale assesses the need for support in 68 tasks, organized into 13 activities of daily living, evaluating three dimensions: the individual’s level of performance in each task, the type of support required, and the frequency of the need. The Baremo, applied by public institutions or by social welfare organizations that receive public funds (with informed consent and under confidentiality agreements), determines the level of dependency according to the score obtained: no dependency (0 points), mild dependency (1–13.5 points), moderate dependency (more than 13.5 up to 40 points), and severe dependency (more than 40 up to 100 points). Based on these results, individuals scoring above 13.5 are placed on the SINCA waiting list, as the system prioritizes those with moderate and severe dependency. However, the current government regulated the law differently: Article 19 establishes that once a person is assessed and classified as dependent, an additional income-based filter must be applied, and SINCA «…will prioritize individuals in extreme poverty, poverty, and economic vulnerability»9. This implies that, contrary to what is established in the law—which defines SINCA as universal—the current administration’s regulation effectively reverses this principle and shifts the system’s focus toward serving only the poor.

The system aims to avoid institutionalization, emphasizing home and community-based services to enable people to remain in their communities for as long as possible. It comprises five services: home care, long-stay residences, home teleassistance, day centers, and cash transfers, as well as benefits for women caregivers.

Cash-for-care: paid by MHDSI. This payment is aimed at women who meet the following three characteristics: 1) they care for a person assessed as dependent and entitled to the home care service; 2) they have no poten­tial to enter the labor market according to the criteria developed by the Ministry of Labor and the Minis­try of Gender Equality; 3) they are in a situation of extreme poverty. The stipulated amount is $184 (USD) per month. As of 2025, around 3700 people are receiving it, with a public investment of approximately $3.5 million.

Respite care, these services will be developed by public institutions responsible for older people, people with disabilities, women, poverty, and health.

Home-based care is established as the principal service. It comprises a maximum of 80 hours per month and aims at covering 80% of the needs of those with significant dependency in 2021-2031. The remaining 20% will be progressively covered through the expansion of residential care. Home teleassistance aims to achieve full coverage (100%) of the needs of those with the highest degree of dependency (critical) and 70% of severe dependents’ needs. Daycare facilities are reserved for older adults with severe and critical dependency, and 10% of this population is expected to use them. In brief, the system is designed to cover the needs of 55.9% of the total dependent population by 2031.

Home care is provided by people who have completed the LTC assistant training of the National Learning Institute. They can register independently with the National Employment Program (PRONAE) of the Ministry of Labor and Social Security (MTSS) or through non-/for-profit agencies accredited by the Ministry of Health. To date, the government has not developed this service. The only action taken has been to create a website with the profiles of caregivers, so that those who need them can search, hire, and pay 100% of the cost without public funding. This has been described as a kind of “Uber for care”10.

Daycare centers: non-/for-profit agencies accredited by the Ministry of Health. Data from June 2025 indicate that a total of 1,614 older persons are receiving the service.

Approximately 1,618 older people are living in 125 care homes throughout the country. All the care homes are administered and managed by non-profit organizations, which receive public funding from the central government and occasionally from municipal governments. The Ministry of Health pre-authorizes the operation of all of them. With the establishment of the SINCA, the Ministry of Health was also assigned the responsibility of creating and verifying quality standards.

Of the 84 local governments, 50 are recognized as Age-Friendly Cities for older persons. However, concrete actions in the provision of long-term care services remain limited.

Home teleassistance or assistance line: This initiative will be executed by the Ministry of Science, Innovation, Technology, and Telecommunications (MICITT) in collaboration with the National Communications Fund (FONATEL). However, it has not yet been carried out. At present, only one municipality, using its own resources, provides the service: the Municipality of Heredia, which serves 320 older people with care needs11.

Aside from the home teleassistance initiative provided by the Municipality of Heredia, no further measures have been implemented within SINCA.

The National Learning Institute (INA) offers three distinct training programs for formal caregivers: a) dedicated to the care of older people, has graduated 723 individuals; b) focused on the training of personal assistants for people with disabilities, has certified 758 individuals; c) which is open to those who have completed the first two, is intended for individuals in situations of dependency and has graduated 116 individuals. Official data as of June 2025 indicates that there is a total of 1 597 formally trained caregivers in Costa Rica12.

Insurance for formal caregivers: The Costa Rican Social Security Fund (CCSS) will promote social security coverage for paid caregivers. At present, only health insurance is available, with no contributions toward labor rights and benefits.

Since 2013, the country has had the National Information and Unique Registry System (SINIRUBE), which provides updated information on the population using social services and establishes prioritization criteria to ensure equitable access to services. In the case of SINCA services, in 2024 the MHDSI incorporated the assessment scale (baremo) into SINIRUBE, this means that it is possible to find out the dependency level of assessed persons, and to screen them according to their level of poverty for prioritization.

From September 2024 to September 2025, the Local Government of Heredia carried out and funded an experimental evaluation of home teleassistance for dependent persons. This study aimed to evaluate the impact of the home teleassistance pilot on four key areas: (a) improving quality of life for dependent individuals, (b) reducing unnecessary hospital visits, (c) promoting correct medication use, and (d) caregiver outcomes, including burnout and workforce participation among family caregivers. A randomized controlled trial (RCT) was conducted with 634 dependent older adults and their family caregivers. Participants were randomly assigned to receive home teleassistance services or remain in a control group. A structured questionnaire assessed the four dimensions outlined in the objectives. Home teleassistance improved the quality of life of care recipients, reduced caregiver burnout, improved medication use, and decreased hospital visits. Additionally, the program showed limited impact in enabling labour participation among caregivers. The findings underscore the potential of teleassistance programs to enhance the SINCA system. As of April 2026, Heredia has 520 dependent older persons enrolled, and following the dissemination of the study’s results, eight other municipalities are providing similar services at more moderate scales.

The main difficulty of SINCA is that it was created without new funding. And it is still not in place. Since its launch during the pandemic, it has faced severe fiscal constraints, public employment cuts, and weak inter-institutional coordination, which delayed the implementation of the Baremo for nearly three years. As a result, home care services have not been developed, cash-for-care has been overused for poor households13, and local governments have had to assume responsibilities without central transfers, widening coverage gaps between urban and rural areas.

The biggest challenge for strengthening SINCA is to obtain new funding and integrate its social and health services, working together with the country’s strong Social and Health Security System (CCSS).

Since COVID, CCSS has provided over 25,000 telehealth medical appointments. Still, it remains separate from SINCA, and no coordinated social and health services have been integrated14.

A proposal for constitutional reform has been presented to incorporate in the Political Constitution the recognition of the right to care, establishing as an obligation of the State the creation of public care services, as well as the recognition of work dedicated to care as an essential source of social protection and the generation of goods and services for economic activity (…)15. The reform is on the legislature’s agenda and is set to be voted on in May 2026.

Chaverri-Carvajal, A. (2026) Long-Term Care System Profile: Costa Rica, 2026. Global Observatory of Long-Term Care, Care Policy & Evaluation Centre, London School of Economics and Political Science. https://goltc.org/system-profile/long-term-care-system-profile-costa-rica/ 

Chaverri-Carvajal, A., & Alvarenga Fournier, X. (2026). Cuidados de larga duración no remunerados en Costa Rica: ahorro estatal y deuda social. Gaceta sanitaria, 40 Suppl 2, 102579. Advance online publication. https://doi.org/10.1016/j.gaceta.2026.102579

Chaverri-Carvajal, A., & Matus López, M. (2026). Perfiles de personas adultas mayores dependientes y sus cuidadoras en Costa Rica. En A. S. Solano Acuña, S. Rodríguez Brenes y M. Hernández Ramírez (Eds.), Prácticas socioculturales y políticas de los cuidados (pp. 231-252). Instituto de Estudios Sociales en Población (IDESPO): Línea Editorial Género y Diversidad Cultural, Universidad Nacional, Costa Rica.

Chaverri-Carvajal, A. (2025). Evaluating Care Innovations: A RCT of Home Teleassistance for Older Adults in Need of Care in Costa Rica. Innovation in Aging, 9(Suppl 2), igaf122.2688. https://doi.org/10.1093/geroni/igaf122.2688

Chaverri Carvajal, A. (2025). Mapeo del sistema de cuidados para la población adulta mayor y alternativas para aumentar la cobertura y la sostenibilidad financiera. Ponencia preparada para el Informe Estado de la Nación 2025. San José: PEN-Conare y Fundación Yamuni. Available at: https://repositorio.conare.ac.cr/items/9d831230-ac01-44cb-ae37-62e456039013

Chaverri-Carvajal, A, Arguedas Navarro, K. (2024). Gobierno local de Heredia: Protocolo de evaluación experimental de impacto del primer piloto de teleasistencia domiciliaria en Mesoamérica. Actas de Coordinación Sociosanitaria, (35), pp 124-161.  https://doi.org/10.48225/ACS_35_5

Chaverri-Carvajal, A. y Matus-López, M. (2023). Cuidar a las cuidadoras, ¿Lo entendió Costa Rica en la pandemia?. Actas de Coordinación Sociosanitaria, (33), pp 74-91. https://doi.org/10.48225/ACS_33_74

Chaverri-Carvajal, A, Matus-López, M. (2023). Impact Evaluation of Cash-For-Care in Latin America’s New Long-Term Care Policies: A Randomized Controlled Trial Pilot Study in Costa Rica. Journal of applied gerontology: the official journal of the Southern Gerontological Society, 7334648231188284. Advance online publication. https://doi.org/10.1177/07334648231188284

Chaverri-Carvajal A, Matus-López M. Cuidados de larga duración en Costa Rica: enseñanzas para América Latina desde la evidencia internacional. Revista Panamericana de Salud Pública. 2021; 45: e146. https://doi.org/10.26633/RPSP.2021.146

Chaverri Carvajal A. Costa Rica y los cuidados de larga duración: las costuras revientan en tiempos de Covid-19. Sur Academia: Revista Académica-Investigativa De La Facultad Jurídica, Social Y Administrativa. 2020; 7(14): 44–55. https://doi.org/10.54753/suracademia.v7i14.761

Chaverri-Carvajal A, Matus-López M. The long-term care system in Costa Rica. SFB 16 Globale Entwicklungsdynamiken von Sozialpolitik 2021;1342. https://doi.org/10.26092/elib/935

Jara Maleš P, Matus-López M, Chaverri-Carvajal A. Tendencias y desafíos para conformar un sistema de cuidados de larga duración en Costa Rica; Nota Técnica IDB-TN 1878; Inter-American Development Bank: Washington, DC, USA. 2019. http://dx.doi.org/10.18235/0002214

Jara Maleš P, Chaverri-Carvajal A. Servicios de apoyo al cuidado en domicilio: Avances y desafíos para la atención de la dependencia en Costa Rica. Nota Técnica IDB-TN 2031; Inter-American Development Bank: Washington, DC, USA. 2020. http://dx.doi.org/10.18235/0002767

Matus-López M, Chaverri-Carvajal A. ¿Cuántos adultos mayores necesitarán atención a la dependencia en América Latina? Actas de Coordinación Sociosanitaria. 2022; 31(1), 74-94. Recuperado a partir de https://www.fundacioncaser.org/actividades/actas-de-coordinacion-sociosanitaria/actas-de-coordinacion-sociosanitaria-n-31

Matus-Lopez M, Chaverri-Carvajal A. Population with Long-Term Care Needs in Six Latin American Countries: Estimation of Older Adults Who Need Help Performing ADLs. International Journal of Environmental Research Public Health. 2021; 18(15):7935. https://doi.org/10.3390/ijerph18157935

Matus-López M, Chaverri-Carvajal A. Progress Toward Long-Term Care Protection in Latin America: A National Long-Term Care System in Costa Rica. Journal of the American Medical Directors Association. 2022; 23(2):266-271. https://doi.org/10.1016/j.jamda.2021.06.021

Matus-Lopez M, Chaverri-Carvajal A, Jara Maleš P. O desafio de envelhecer na América Latina: cuidados prolongados na Costa Rica. Saúde E Sociedade. 2022; 31(1): e201078. https://doi.org/10.1590/S0104-12902022201078

[1] Chaverri-Carvajal A, Matus-López M. Cuidados de larga duración en Costa Rica: enseñanzas para América Latina desde la evidencia internacional. Revista Panamericana de Salud Pública. 2021; 45: e146. https://doi.org/10.26633/RPSP.2021.146

2 Matus-López M, Chaverri-Carvajal A. Progress Toward Long-Term Care Protection in Latin America: A National Long-Term Care System in Costa Rica. Journal of the American Medical Directors Association. 2022; 23(2):266-271. https://doi.org/10.1016/j.jamda.2021.06.021

3 Government of Costa Rica. Executive Decree 42878-MP-MDHIS, 3 March 2021. Ministry of Human Development and Social Inclusion of Costa Rica. http://www.pgrweb.go.cr/scij/Busqueda/Normativa/Normas/nrm_norma.aspx?param1=NRM&nValor1=1&nValor2=94029&nValor3=125029&strTipM=FN

4 Law No. 10192. “Creation of the National System of Care and Support for Dependent Adults and Older Adults (SINCA).” Available at: http://www.pgrweb.go.cr/scij/Busqueda/Normativa/Normas/nrm_texto_completo.aspx?param1=NRTC&nValor1=1&nValor2=97181&nValor3=130901&strTipM=TC

5 OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris. https://doi.org/10.1787/ae3016b9-en.

6 Ministerio de Desarrollo Humano e Inclusión Social. Política Nacional de Cuidados 2021-2031: Hacia la implementación progresiva de un Sistema de Apoyo a los Cuidados y Atención a la Dependencia en Costa Rica. San José: IMAS/MDHIS; 2021.

7 Matus-Lopez M, Chaverri-Carvajal A, Jara Maleš P. O desafio de envelhecer na América Latina: cuidados prolongados na Costa Rica. Saúde E Sociedade. 2022; 31(1): e201078. https://doi.org/10.1590/S0104-12902022201078

8 Chaverri Carvajal, A. 2025. Mapeo del sistema de cuidados para la población adulta mayor y alternativas para aumentar la cobertura y la sostenibilidad financiera. Ponencia preparada para el Informe Estado de la Nación 2025. San José: PEN-Conare y Fundación Yamuni.

9 Regulation of the Law for the Creation of the National Care and Support System for Dependent Adults and Older Persons (SINCA), Executive Decree No. 44242-MDHIS-MTSS-MP.

10  Find the caregiver that best suits your needs. https://cuidar.cr/

11 Chaverri-Carvajal, A, Arguedas Navarro, K. (2024). Gobierno local de Heredia: Protocolo de evaluación experimental de impacto del primer piloto de teleasistencia domiciliaria en Mesoamérica. Actas de Coordinación Sociosanitaria, (35), pp 124-161.  https://doi.org/10.48225/ACS_35_5

12 Instituto Nacional de Aprendizaje. (2025). Programas de Formación. Available at: https://www.ina.ac.cr/SitePages/nucleos/saludculturaartesanias.aspx

13 Chaverri-Carvajal, A. y Matus-López, M. (2023). Cuidar a las cuidadoras, ¿Lo entendió Costa Rica en la pandemia?. Actas de Coordinación Sociosanitaria, (33), pp 74-91. https://doi.org/10.48225/ACS_33_74

14 https://www.cendeisss.sa.cr/wp/wp-content/uploads/2020/11/LINEAMIENTOS-Modalidades-alternativas-a-la-atencion-presencial.pdf

15 Bill 23.448. “Addition of a second paragraph to Article 51 and Article 56 of the Political Constitution for the recognition of care as a constitutional right.” Legislative Assembly, Republic of Costa Rica. Available at: http://www.asamblea.go.cr/Centro_de_informacion/Consultas_SIL/SitePages/ConsultaProyectos.aspx

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