Building Person-Centred Long-Term Care in Greece: From Service Availability to Individual Need

For an older person in Greece, the most important long-term care question is rarely which programme they fit into. It is whether the combination of support available can help them continue living safely, independently and meaningfully in the circumstances that matter to them. Yet services organised around separate programmes, administrative responsibilities and uneven local capacity can make the system easier to describe institutionally than to navigate personally.

That distinction is becoming increasingly important as Greece develops a new model for person-centred long-term care. The reform direction is explicitly focused on improving access to quality services at home and in the community, while work on needs assessment, eligibility, provider quality and governance addresses some of the mechanisms through which person-centredness has to become operational. Within the wider Greece Ageing, Long-Term Care & Community Support Knowledge Hub, this marks a shift from asking primarily what services exist towards asking whether support responds coherently to the individual.

That is a demanding transition. Greece already has established community programmes including Help at Home, KAPI and KIFI, alongside residential provision, healthcare, private and non-profit services and extensive family care. Person-centred reform does not simply require adding another programme. It requires assessment, funding, workforce, information and accountability arrangements that can organise these resources around changing needs rather than expecting people and families to assemble their own care system.

Person-centred care changes the organising question

Person-centred long-term care is sometimes reduced to courteous practice or individual preferences within an existing service. Those elements matter, but the policy concept is considerably broader. A system cannot be genuinely person-centred if someone is treated respectfully by an individual worker while the wider pathway remains fragmented, inaccessible or unrelated to their needs.

The organising question changes from “Which available service can this person receive?” to “What combination of support is appropriate to this person’s needs, abilities, preferences, environment and informal network?” That does not mean every preference can be funded or every service made available everywhere. It means the starting point for decisions should be an understanding of the person rather than the boundaries of an existing programme.

This requires attention to more than dependency. An assessment of whether someone can wash, dress, prepare food or move safely is important, but it does not fully describe how they live. Cognitive ability, communication, housing, social connection, family circumstances, financial pressures, transport and access to healthcare can all determine whether a care arrangement is sustainable.

For Greece, this is particularly relevant because formal and informal support are closely interconnected. A person may appear to require relatively little formal care only because a daughter visits twice every day, a spouse manages medication and a neighbour buys groceries. If those contributions are invisible within assessment, the system may underestimate both the person’s underlying need and the fragility of the arrangement.

The principles behind tailoring support to the individual are therefore relevant beyond individual care plans. They apply to the architecture through which Greece assesses need, connects services and decides what appropriate long-term support looks like.

Needs assessment is one of the foundations of reform

A coherent needs-assessment model is central to Greece’s reform work because assessment determines what the system sees. If different programmes use separate criteria and processes, the same individual can be understood differently depending on which service door they enter.

Assessment has several functions. It identifies the nature and intensity of need, informs eligibility and service decisions, supports care planning and provides evidence about population demand. These purposes overlap, but they should not be confused. A person may have substantial need even where a particular publicly funded service is unavailable or where eligibility rules do not provide access to it.

This distinction between assessed need and service entitlement is important. If assessment records only what can currently be provided, unmet need disappears from the evidence base. Policymakers then see utilisation rather than the full demand that future provision may need to address.

A person-centred assessment should also recognise strengths. An older person who can prepare meals, manage money and maintain community relationships with limited assistance should not be described only through deficits. Understanding what the person can do helps determine where targeted support could preserve independence rather than replacing abilities unnecessarily.

Assessment also needs proportionality. A relatively independent person seeking preventive support should not require the same process as someone with advanced dementia, substantial mobility limitations and an exhausted family carer. The system needs enough consistency to support fairness without creating administrative intensity disproportionate to the decision being made.

For organisations examining similar questions, the Positive Risk-Taking Planner offers a practical framework for considering how choice, safety and proportionate support can be balanced. It is not a Greek assessment instrument, but its underlying principle is relevant: risk should inform person-centred decisions without automatically overriding autonomy.

Scenario: the same physical need can produce very different care requirements

Two women aged 82 have comparable difficulty with mobility and personal care. The first lives in an accessible apartment in Thessaloniki. Her son lives nearby, she has regular contact with friends and local shops are within easy reach. She wants limited assistance in the morning and intends to continue managing most of her daily life independently.

The second lives alone in a village. Her bathroom is difficult to use safely, public transport is limited and her daughter lives in Athens. She has stopped going out after two falls and increasingly depends on a neighbour for food shopping.

An assessment based predominantly on physical dependency might produce similar scores for both women. A person-centred assessment should identify that the practical consequences of those limitations are different. Housing, geography, informal support and isolation substantially alter the second woman’s situation.

The resulting care arrangements may therefore differ even where some underlying impairments are similar. The first woman may need targeted home assistance while maintaining considerable independence. The second may require a broader combination of home support, environmental adaptation, transport or community connection and closer review.

Fairness does not necessarily mean identical services for apparently similar impairments. It means applying consistent principles to the person’s actual circumstances. The governance challenge is to make that reasoning sufficiently transparent that variation reflects need rather than arbitrary differences between places or assessors.

Eligibility determines whether assessed need becomes practical support

Needs assessment cannot be separated from eligibility. Once need has been identified, a system must decide which needs create an entitlement or priority for publicly supported services, which services are available and what contribution is expected from individuals or families.

Greece’s reform work is therefore examining the implications of different eligibility criteria as part of the wider redesign. This matters because eligibility rules do more than control expenditure. They influence when people enter the formal care system and how responsibility is distributed between public provision, private purchasing and family care.

Very restrictive eligibility can concentrate resources on people with the greatest dependency, but it may also delay intervention until needs become severe. Broad eligibility can improve earlier access while creating greater funding and workforce requirements. Neither choice can be considered independently of available capacity.

The design also needs to avoid assuming that the presence of relatives automatically means care is available. A family member may live nearby but be unable to provide physical care. Another may already provide many hours of support while managing employment and children. Treating theoretical family availability as care capacity can reproduce hidden gender and economic inequalities.

Person-centred eligibility therefore requires clarity about the relationship between individual need, public responsibility and voluntary family contribution. The objective should not be to remove families from care, but to avoid making access dependent on unpaid support that has never been properly assessed for sustainability.

Choice only exists where viable alternatives exist

Person-centred systems place significant emphasis on choice, but formal choice and practical choice are not the same. An older person cannot meaningfully choose home-based care if sufficient support is unavailable in their municipality. Nor can a family choose structured day care if the nearest suitable KIFI is inaccessible because of distance or transport.

This makes service coverage part of person-centredness. Greece’s territorial disparities in long-term care affect the real options available to people. Municipal resources, workforce supply, geography and existing infrastructure can all influence whether an individual has access to home, community or residential alternatives.

The issue is particularly important across islands, rural communities and less densely populated areas. Uniform service design may be neither practical nor efficient across every location, but equivalent objectives still matter. A remote community may require mobile support, stronger home-based provision or technology-enabled professional input rather than the same physical infrastructure as Athens.

The relevant principle within choice, control and co-production is that people should influence decisions that shape their lives. But policy should avoid overstating choice where structural constraints sharply restrict the available options.

Good governance therefore measures not only whether people were offered a nominal choice but what realistic alternatives existed. Repeated evidence that preferred forms of care are unavailable should become planning intelligence rather than being recorded simply as individual cases.

Person-centred care requires a pathway rather than a collection of programmes

Greece’s established community infrastructure provides important building blocks. Help at Home can bring support into the household. KAPI can sustain active ageing and community participation. KIFI can provide structured daytime care for people with greater needs. Healthcare services, residential facilities, private providers, non-profit organisations and families contribute additional forms of support.

From the individual’s perspective, however, these distinctions matter less than whether the pieces connect. A person’s needs do not divide neatly according to administrative boundaries.

An older person may simultaneously need help with bathing, physiotherapy after hospital treatment, medication support, accessible transport and opportunities for social participation. If each component requires separate navigation, repeated information and unrelated decisions, coordination becomes an unpaid responsibility transferred to the person or family.

Person-centred reform therefore depends on effective support planning and review. A plan should explain how different contributions fit together, what the person is trying to maintain or achieve, who is responsible for each element and what should happen if circumstances change.

This does not require one organisation to deliver everything. It requires sufficient coordination that organisational plurality does not become personal fragmentation.

Scenario: hospital discharge exposes the difference between services and a pathway

A 79-year-old man living on an island is admitted to hospital after a hip fracture. Before admission, his wife provided most household support and he managed personal care independently. Following treatment, he can return home medically, but his mobility is reduced and his wife cannot safely assist with transfers.

A service-led response asks separately whether home support is available, whether rehabilitation follow-up can be arranged and whether his wife can help. A person-centred response starts with the outcome: what needs to be in place for him to return home safely without creating an unsustainable burden on his wife?

That requires the hospital team, relevant community and municipal services and the family to understand the same practical situation. His mobility, home environment, equipment needs, rehabilitation plan and wife’s capacity all influence the decision. Where a required component cannot begin immediately, that gap needs explicit management rather than an assumption that the family will absorb it.

After discharge, review is equally important. His needs may reduce as rehabilitation progresses. Continuing the same level of assistance indefinitely could unnecessarily replace regained abilities; withdrawing support too quickly could create falls risk and increase the likelihood of readmission.

The case demonstrates why hospital discharge and step-down support for older people are not simply healthcare processes. The quality of discharge depends partly on whether community long-term care can respond flexibly enough to changing need.

Family carers need to be visible without becoming default providers

Any person-centred model for Greece has to address informal care directly. Families currently provide a substantial proportion of long-term support, with women carrying a disproportionate share of that responsibility. Their contribution is essential to understanding how the existing system functions, but reliance on families also creates significant risks if public services assume that unpaid care will always remain available.

A person-centred assessment should therefore ask two related but distinct questions: what support does the individual need, and what support is the family genuinely willing and able to provide?

Conflating the two can conceal unmet need. A daughter who provides 30 hours of care each week because no alternative exists should not automatically be interpreted as evidence that formal support is unnecessary.

Carers themselves may need information, training, respite, emotional support or financial protection. They may also have their own health conditions, employment and family responsibilities. Supporting the person receiving care while allowing the carer’s wellbeing to deteriorate is not a sustainable care model.

The relationship should also preserve the identity of the family connection. A spouse should be able to remain a spouse rather than becoming, by default, the entire care infrastructure. Adult children should be able to contribute to their parent’s life without necessarily having to withdraw from employment to make the arrangement viable.

This makes family and advocate involvement important, but involvement should be based on partnership and consent rather than substitution for formal provision.

Risk needs to be shared, understood and proportionate

Person-centred long-term care inevitably involves risk. Remaining at home may involve falls risk. Going outside independently may involve uncertainty. A person with cognitive impairment may make choices that relatives or professionals find uncomfortable. Eliminating all risk can require restrictions that undermine the very autonomy community-based care is intended to preserve.

The objective is not unrestricted risk-taking. It is proportionate decision-making that distinguishes between risks that can be reduced, risks that can be monitored and risks that would create an unacceptable likelihood of serious harm.

That requires evidence. Workers need to understand what has happened previously, the person’s abilities, environmental factors and what support could reduce the risk. The person’s own view should be part of the decision wherever they can express it.

Family concern matters but should not automatically override the person’s wishes. Equally, an abstract commitment to independence should not be used to justify inadequate support. Person-centredness is not a mechanism for transferring responsibility back to the individual.

The balance is particularly important as Greece expands home and community care. Supporting more people outside institutional settings means risk management increasingly takes place in ordinary homes and communities rather than controlled environments. Workforce training and supervision need to reflect that reality.

Quality assurance must move beyond structural compliance

Greece’s long-term care reform also raises the question of how quality should be defined and assured across different providers and settings. Formal requirements concerning premises, professional roles and operating permission remain important. They establish basic conditions and accountability.

Person-centred quality requires an additional question: what difference does the service make to the individual?

A provider can meet structural requirements while delivering routines that offer little choice. Conversely, a highly personalised service still needs safe practice, competent workers and effective oversight. The two dimensions should reinforce rather than compete with one another.

A balanced evidence framework might therefore examine a limited set of connected domains:

• whether assessed needs are translated into appropriate support;
• whether people participate meaningfully in planning and review;
• whether independence and capabilities are maintained where possible;
• whether safety incidents, complaints and deterioration lead to appropriate action;
• whether carers experience the arrangement as sustainable; and
• whether access and outcomes vary systematically between places or population groups.

These questions connect with wider quality standards and assurance frameworks. Greece will need mechanisms appropriate to its own legislation, administration and provider landscape rather than imported regulatory models.

The Quality Dashboard Builder can help organisations exploring comparable questions structure information around outcomes, risks and quality trends. It does not establish Greek standards; its practical relevance lies in demonstrating how multiple indicators can be brought together without reducing quality to one activity measure.

Scenario: a care plan is technically complete but no longer person-centred

An 86-year-old woman receives regular home support after a period of declining mobility. Her original plan assumes that workers will prepare meals, complete several household tasks and help her dress. Six months later, her strength has improved and she wants to resume preparing simple lunches herself.

Continuing to do everything for her would be operationally straightforward. It would also risk increasing dependency by replacing abilities she has regained.

At review, the support arrangement changes. Workers remain available where physical assistance is necessary but encourage her to complete tasks she can safely manage. Her preference to prepare food becomes part of the plan rather than an informal exception to it. The approach includes proportionate consideration of fatigue and falls risk without interpreting those risks as reasons to prevent activity altogether.

The change appears small, but it demonstrates an important distinction. Person-centred care is not simply personalising the manner in which fixed tasks are delivered. It includes questioning whether those tasks remain appropriate.

For service governance, repeated examples of regained independence should also influence quality evidence. A home-care system measured only by visits delivered may reward continued activity. A system interested in outcomes can recognise when appropriate support enables some assistance to reduce.

This is where outcomes-focused and goal-led support becomes important: the purpose of care is not necessarily to maximise service volume, but to provide the right support at the right intensity.

The workforce has to exercise judgement, not merely complete tasks

A more person-centred system changes workforce requirements. Standardised procedures remain necessary for safety and consistency, but individualised care also requires workers who can observe, communicate and exercise appropriate judgement.

A home-care worker may notice that someone who usually prepares breakfast has stopped eating. A KIFI nurse may observe increasing confusion. A social worker may identify that a family arrangement previously considered stable is deteriorating because the main carer has become unwell.

These observations matter only if workers know what to do with them. Person-centred practice therefore depends on supervision, escalation routes and multidisciplinary communication as much as interpersonal skill.

Training should also help workers distinguish assistance from unnecessary substitution. Supporting independence can take longer than completing a task for someone. If workload and scheduling reward speed alone, organisational incentives can undermine person-centred intentions.

This connects workforce policy with funding. Service models need enough capacity for meaningful interaction, assessment and review. Workforce shortages can push organisations towards task-focused delivery because immediate practical needs take priority over broader outcomes.

As Greece develops its formal long-term care workforce, workforce planning therefore needs to consider skill mix, geographic distribution, supervision and role design as well as the total number of workers.

The Predictive Workforce Risk Module provides a way for organisations to structure comparable analysis of workforce instability and service continuity. The relevance to Greece is analytical rather than regulatory: person-centred continuity becomes difficult when vacancies and turnover repeatedly disrupt relationships.

Funding design can either support or constrain personalisation

Funding mechanisms influence how easily services can adapt around the person. Where resources are tied tightly to specific programmes, hours or institutional categories, flexibility may be difficult even when a different combination of support would better meet the individual’s needs.

Greece faces a broader financing challenge because public expenditure on long-term care has historically been low relative to many other European and OECD systems, while families carry substantial responsibility. Expanding formal access therefore has fiscal implications as well as organisational ones.

Person-centred reform cannot avoid those constraints. It can, however, improve how scarce resources are targeted. Consistent assessment can identify where needs are greatest. Earlier support may prevent some avoidable deterioration. Better coordination can reduce duplication. Regular review can identify when care intensity should increase or decrease.

Funding also needs to recognise the full cost of delivery in different places. Providing home care across a sparsely populated area may require more travel time than providing the same number of visits in a dense city. If resource allocation ignores geography, nominally equal provision can produce unequal capacity.

The strategic question is therefore not simply how much Greece spends on long-term care. It is how financing, eligibility and service design interact to determine who receives support, what form that support takes and whether local services can deliver it sustainably.

Digital systems can help build continuity around the person

Person-centred long-term care creates significant information requirements. Assessments need to remain current. Different professionals need access to relevant information. Changes in need should be visible. People and families should not have to repeat the same information unnecessarily whenever they encounter a new service.

Digitalisation can support these objectives, particularly if systems become more interoperable. A shared view of relevant needs, plans and responsibilities can make transitions between hospital, home support, community services and other care settings more coherent.

But a digital record is not automatically person-centred. Poor-quality information can simply make fragmented practice electronically visible. Systems also create questions about privacy, consent, cybersecurity and who is authorised to see sensitive information.

Technology needs to support relationships rather than replace them. Remote monitoring or telecare may help some people remain at home, particularly where geography makes frequent professional contact difficult. For others, technology may be intrusive, inaccessible or inappropriate. Choice and proportionality remain essential.

This is particularly important for people who are digitally excluded. Greece cannot make access to long-term care dependent on confidence with online systems. Digital channels should expand options without removing accessible human alternatives.

The broader themes of person-centred technology and digital enablement therefore apply directly: the measure of successful technology is not how much technology is deployed, but whether it improves autonomy, continuity, safety or access.

Organisations considering similar transformation can use the Digital Transformation Readiness Assessment to examine strategy, workforce capability, governance and resilience before expanding digital models. It is not specific to Greece, but it reinforces the need to treat digital transformation as organisational change rather than simply technology procurement.

Scenario: technology expands choice only when the person controls its role

A 77-year-old man with heart disease and reduced mobility lives alone in a mountainous community. His daughter lives several hours away. He wants to remain at home but worries about falling when alone, while his daughter believes he should move closer to her.

A technology-enabled arrangement is considered alongside home and health support. The discussion starts with his concerns and preferences rather than with the equipment available. He agrees to a falls alert and scheduled remote contact but does not want continuous monitoring inside his home.

The technology therefore addresses defined risks without creating surveillance disproportionate to those risks. His daughter understands how alerts will be handled and, crucially, who responds when she cannot. The equipment is tested, and the arrangement is reviewed after an initial period to determine whether it is useful and acceptable.

Technology does not make the underlying workforce requirement disappear. Someone still needs to respond to an alert, maintain the equipment and act when information suggests deterioration. Nor does remote contact replace the social and practical value of in-person support.

The scenario demonstrates that digital care becomes person-centred when technology is selected around an outcome and incorporated into a real support pathway. Installing equipment without response capacity, consent or review would produce technological activity rather than meaningful care.

Governance must make individual experience visible at system level

Person-centredness is often discussed at the interaction between one worker and one individual. Yet whether it can be sustained depends heavily on governance.

National government influences strategic direction, eligibility design, financing and the wider quality framework. Municipalities play significant roles in community provision. Regions hold responsibilities relevant to parts of service oversight. Public, private and non-profit providers control aspects of their own operational practice. Health services influence pathways whenever clinical and long-term support intersect.

No single actor therefore sees the whole experience automatically. Governance has to assemble evidence from across those boundaries.

That evidence should reveal more than activity. Leaders need to know whether assessments are timely, whether people can access the services identified as appropriate, whether geographic variation persists, whether care plans are reviewed and whether workforce limitations repeatedly restrict choice.

Complaints and individual experience are equally important. A pattern of families repeatedly reporting that they cannot navigate transitions may indicate a pathway problem even if each individual organisation can demonstrate compliance with its own responsibilities.

The principle behind learning, incidents and continuous improvement is relevant here. Governance becomes person-centred when information from individual experience changes how the system operates rather than remaining contained within individual cases.

Consistency and local flexibility have to coexist

A national person-centred model cannot mean identical service configurations across Greece. Population density, island geography, workforce supply and municipal infrastructure make that unrealistic.

But flexibility should not become a justification for inequity. The stronger model distinguishes between consistent principles and locally adaptable delivery.

Nationally, Greece can establish clearer expectations around assessment, eligibility, quality, information and outcomes. Locally, municipalities and providers can determine how those expectations are delivered within different geographic and community conditions.

This creates a governance requirement for comparative evidence. If one area achieves substantially better access or continuity than another, the difference should be understood. Sometimes geography will provide a legitimate explanation. Sometimes the cause may be workforce, funding, service design or administrative practice that can be changed.

Person-centred reform therefore needs enough standardisation to identify unjustified variation without imposing a rigid model incapable of responding to local circumstances.

A framework such as the Governance Maturity Assessment can help organisations structure questions about accountability, evidence and escalation. Greece’s actual governance arrangements must of course follow its own public administration and legal framework, but the analytical principle remains useful: responsibility needs to be clear enough for persistent variation to trigger action.

Person-centred reform should change what success looks like

If Greece succeeds in expanding formal long-term care, service volumes will increase. More people may receive home support, attend community services or use other formal provision. Those measures will matter because current coverage remains an important policy issue.

But volume alone cannot demonstrate person-centredness.

A stronger evidence model would ask whether people receive support at an appropriate time, whether care reflects their circumstances and preferences, whether independence is maintained where possible and whether families experience arrangements as sustainable. It would also examine whether access and outcomes differ by geography, income, gender or other relevant factors.

Person-centred outcomes are sometimes harder to aggregate than activity measures, but they need not be vague. Measures can include continuity of workers, progress towards individual goals, avoidable disruption, reported autonomy, carer sustainability, timeliness of review and whether people remain in their preferred living arrangements where this is safe and feasible.

Not every outcome can be attributed solely to long-term care. Health, housing, income and family circumstances also influence people’s lives. Good evidence therefore requires proportionate interpretation rather than claims that one service caused every positive change.

The value of outcome information lies in the questions it creates. If people consistently report limited influence over care planning, governance can investigate why. If rural users experience poorer continuity, workforce and delivery models can be examined. Measurement becomes useful when it informs decisions.

The reform opportunity is larger than redesigning assessment

A stronger assessment framework is important, but person-centred reform will not be achieved through assessment forms alone. Assessment has to connect with services capable of responding to what it identifies.

If a person is assessed as needing home support but no workforce is available locally, the assessment records unmet need rather than resolving it. If a family carer’s situation is recognised but respite or day support is unavailable, recognition alone cannot make the arrangement sustainable.

This is why Greece’s reform needs to connect several components simultaneously: needs assessment, eligibility, formal service expansion, workforce, quality assurance, coordination with non-state providers, family-carer support and better information.

The relationship between them matters as much as the individual components. Expanding eligibility without workforce capacity can increase waiting. Expanding services without common quality expectations can increase provision without consistent assurance. Introducing digital systems without interoperable processes can digitise fragmentation.

Person-centred reform is therefore a system-design task. Its effectiveness will ultimately be judged in ordinary operational moments: whether someone receives help before a family arrangement collapses, whether a hospital discharge connects with community support, whether changing needs trigger review and whether an older person retains meaningful influence over how they live.

International learning lies in connecting entitlement, capacity and experience

Many countries are attempting to move long-term care towards home and community settings while populations age and workforce supply becomes more difficult. Greece shares those pressures but approaches them from its own institutional starting point, including relatively limited formal coverage and substantial reliance on informal care.

The Greek experience therefore highlights a broader lesson: person-centred policy cannot be evaluated solely through the language used in national strategy. Three dimensions need to align.

First, entitlement and assessment need to recognise the person’s actual circumstances. Second, sufficient service and workforce capacity must exist to provide realistic options. Third, quality and governance need to show whether those arrangements produce acceptable experiences and outcomes.

Weakness in any one dimension undermines the others. Generous entitlement has limited value without capacity. Extensive services can remain impersonal if assessment and review are weak. Good individual practice can be difficult to sustain where financing and workforce arrangements are unstable.

The model cannot be transferred directly between countries because legal responsibilities, funding structures and family expectations differ. The transferable principle is the alignment itself: person-centredness becomes credible when policy, resources and operational practice point towards the same individual outcomes.

Conclusion

Greece’s move towards person-centred long-term care represents more than a change in care philosophy. It creates a practical requirement to redesign how need is understood, how eligibility relates to support, how services connect and how quality is judged. The central challenge is to make the person rather than the existing programme the organising point while recognising real constraints in funding, workforce and geographic coverage.

That requires a system capable of seeing the whole care arrangement. Family contributions need to be recognised without being assumed. Choice needs to reflect viable alternatives rather than nominal options. Risk needs to be balanced with autonomy. Digital development should improve continuity without excluding people or replacing essential relationships. Municipal and provider experience needs to reach national decision-making so that persistent gaps influence future investment and reform.

The strongest forward direction is therefore not unlimited personalisation but structured flexibility: consistent assessment and quality principles combined with support capable of adapting to different people and places. Implementation will determine whether the reform changes everyday experience. When assessment, workforce, funding, information and accountability operate together, person-centredness can move from policy language into the practical decisions that determine whether an older person remains independent, whether a family arrangement remains sustainable and whether long-term care responds as needs change.