Residential Long-Term Care in Poland: Capacity, Quality and the Future Role of Institutional Services

An older person in Poland may reach a point where living at home is no longer safe, sustainable or preferred. The reasons can vary: advanced frailty, dementia, severe mobility loss, repeated hospital admissions, complex nursing needs or the breakdown of an informal care arrangement. At that point, families and professionals may begin considering residential long-term care. Yet “residential care” in Poland is not one uniform system. Different institutions exist under different legal, funding and administrative arrangements, and the distinction between social and healthcare provision matters greatly.

The wider Poland Ageing, Long-Term Care & Community Support Knowledge Hub examines a long-term care system divided across healthcare, social assistance, municipalities, families and private provision. Residential services sit within that same fragmented architecture. Some facilities primarily respond to social-care and everyday support needs, while others provide healthcare-funded long-term nursing and treatment for people with substantial medical dependency.

Population ageing ensures that institutional care will remain necessary even if Poland successfully expands home and community services. The strategic question is therefore not whether residential provision should disappear. It is what role it should play, for whom, at what level of need and with what standards of quality, dignity and accountability. A stronger system would use residential care neither as the default destination for people who could remain at home with support nor as a last-resort service entered only after family collapse. It would position institutional care as one part of a broader continuum, with clearer pathways, better workforce capability and greater emphasis on quality of life as well as basic safety.

Poland has several forms of residential long-term care

Understanding residential long-term care in Poland requires separating institutions that may appear similar to an international reader but serve different functions.

Domy pomocy społecznej, commonly abbreviated as DPS, are social-assistance homes. They provide residential support for people who cannot live independently and require round-the-clock care because of age, disability, chronic illness or other circumstances covered by the social-assistance framework. Different types of DPS serve different groups, and responsibility for placement, funding and operation sits within the social-assistance system rather than the health-financing system.

Healthcare long-term care institutions include zakłady opiekuńczo-lecznicze, or ZOL, and zakłady pielęgnacyjno-opiekuńcze, or ZPO. These facilities sit within the healthcare system and serve people requiring long-term nursing, treatment and medical care but not necessarily acute hospitalisation. Their funding, eligibility and professional requirements therefore differ from DPS provision.

Private and non-public residential facilities add another layer. Some operate within public funding arrangements, while others are purchased directly by individuals and families.

The distinctions are operationally important because a person’s needs may cross these boundaries. Someone may require extensive personal support and some nursing oversight but not meet the criteria for a healthcare long-term care facility. Another person may have high clinical dependency that cannot be safely managed within an ordinary social-assistance setting.

A well-functioning system therefore needs more than sufficient bed numbers. It needs clear matching between need and setting.

Residential care should be understood as part of a continuum

Institutional care is sometimes presented as the opposite of ageing in place. That framing is too simple.

For some people, a residential setting can increase independence compared with remaining in an inaccessible or isolated home. A person who is largely confined to one room may gain greater social contact, safer mobility and access to support after moving. For another person, admission may feel like an unnecessary loss of autonomy if suitable home care could have sustained their existing life.

The relevant question is therefore not whether residential care is inherently better or worse than care at home. It is whether the setting matches the person’s needs, preferences and level of risk.

Poland’s long-term care pathway should ideally allow movement across several levels of support. Low-intensity community services may help someone remain independent. More intensive home support may become appropriate as needs increase. Rehabilitation may temporarily reduce dependency after illness. Residential care may then become suitable where needs exceed what can reasonably be managed in the home or where the person prefers a supported communal environment.

This continuum requires honest recognition that some people need 24-hour support. Community-care policy becomes distorted if institutional services are treated as evidence of failure rather than one legitimate component of long-term care.

At the same time, institutional capacity should not become a substitute for developing home services. If residential placement occurs primarily because a gmina cannot organise adequate support at home, the person’s choice is constrained by service availability rather than need.

Demand will rise even if community care expands

Poland’s demographic transition will increase the number of people reaching ages at which severe frailty, dementia and multiple chronic conditions become more common. The oldest age groups are particularly relevant because residential long-term care demand is driven less by age alone than by combinations of dependency, cognitive impairment and the absence of sustainable informal support.

Expanding home care can delay some admissions, but it does not eliminate future residential demand.

Indeed, successful community care may change the profile of people entering institutions. If more individuals with moderate needs remain at home, residential services may increasingly support people with higher levels of complexity.

That has major implications for workforce, building design and quality.

Facilities originally organised around relatively stable residents may need stronger dementia competence, more nursing input, better palliative care, more sophisticated mobility support and closer links with healthcare. The average resident may require more assistance rather than less.

This means planning should consider both volume and acuity.

A stable number of residential places does not imply stable service demand if the people entering those places have much more complex needs. Staffing and funding models need to reflect the changing intensity of care.

Organisations exploring these relationships can use the Digital Twin Scenario Modeller to test how changes in demand, dependency and workforce capacity might affect service stability. It is not a Polish planning instrument, but the principle is important: bed numbers alone are an incomplete measure of future residential capacity.

Scenario: a residential placement follows family-care collapse

An 84-year-old man with advanced Parkinson’s disease lives with his wife in a small town. She provides most of his daily care, while a municipal service offers limited assistance. Over time he requires more help with transfers, continence, medication and night-time repositioning.

His wife repeatedly says she wants him to remain at home. She also becomes increasingly exhausted. When she is admitted to hospital after a fall, the arrangement collapses overnight.

The family suddenly needs round-the-clock support. Because a high-intensity home-care package cannot be organised immediately, residential placement becomes the practical option.

A narrow interpretation would treat the admission as evidence that the man’s needs have become too great for home care. A broader review identifies a more complex picture. His own needs had increased, but the decisive trigger was the loss of his wife’s unpaid labour.

The residential setting may still be appropriate, particularly if his wife can no longer resume the previous role. But the pathway demonstrates why institutional admission should be examined in context.

For the local system, repeated admissions following carer breakdown may indicate that community services are detecting unsustainable family arrangements too late. For the residential service, the man arrives with significant physical dependency and emotional distress associated with an unplanned move.

The quality of the admission therefore depends on both the care provided after arrival and whether the wider system could have created a more planned transition.

Funding structures shape who enters which setting

Residential long-term care in Poland is financed through different mechanisms depending on the type of institution.

In DPS provision, financing commonly combines the resident’s contribution, family contributions where statutory rules apply and funding from the referring gmina where required. The resident’s contribution is linked to income within the framework established by social-assistance legislation, while the municipality can bear a substantial share of the remaining cost.

This arrangement makes residential care a significant local fiscal issue. A relatively small number of high-cost placements can absorb substantial municipal expenditure, particularly in smaller gminas.

Healthcare long-term care follows a different route. The NFZ finances the healthcare component of eligible long-term care services, while rules relating to accommodation and other costs differ from the social-assistance framework.

For families, these distinctions can be confusing because the practical experience may look similar: a relative lives in a facility and receives continuous support. Administratively, however, the funding and eligibility routes are not interchangeable.

The divide can create incentives and tensions. A person’s needs may sit near the boundary between social and healthcare provision. If one system lacks capacity, another may experience pressure even when it is not the ideal fit.

Financial governance therefore needs to examine whether funding structures are supporting appropriate placement rather than merely shifting costs between institutions.

Capacity means more than an available bed

A residential place is only useful if it can safely support the person who needs it.

Facilities differ in staffing, physical environment, specialist competence and clinical support. A nominal vacancy may be unsuitable for someone with advanced dementia, complex behaviour, high nursing dependency or specialised mobility needs.

Capacity planning should therefore distinguish between physical places and usable clinical or care capacity.

Several factors determine whether a bed is genuinely available:

• the type of institution and the population it is authorised or designed to support;
• workforce numbers and skill mix;
• availability of nursing and medical input where required;
• environmental suitability for mobility, dementia or sensory needs;
• ability to manage behavioural or safeguarding risks; and
• the financial and administrative route through which the placement can be accessed.

This matters particularly as resident complexity rises.

A facility may technically have an empty room while being unable to accept another resident safely because staffing is already stretched. Conversely, a service with strong workforce capacity may be constrained by building design or lack of appropriate specialist provision.

Governance should therefore avoid equating occupancy data with effective capacity.

Quality in residential care should extend beyond basic safety

Residential long-term care has legitimate safety responsibilities. Medication, falls, infection prevention, nutrition, pressure-area care, safeguarding and staffing all require robust controls.

But quality cannot be defined solely through the absence of harm.

A resident may be physically safe while experiencing little autonomy, social connection or meaningful activity. Institutional routines can unintentionally prioritise efficiency over individual preference: everyone waking at similar times, meals served according to the facility rather than the person, limited privacy or activities organised around staffing rather than interest.

A stronger quality framework asks whether the resident continues to live a life rather than merely receive care.

This includes choice about daily routines, relationships with family and friends, access to community life where possible, privacy, cultural and religious preferences and the ability to make ordinary decisions.

For people with cognitive impairment, quality also depends on staff understanding the person’s communication, history and sources of distress.

The challenge is operational. Individualisation requires flexibility, and flexibility becomes harder when staffing is limited.

This is why workforce and person-centred care cannot be separated. Residents experience quality through the time, judgement and relationships of the people supporting them.

Dementia will increasingly shape residential service design

Dementia is likely to become one of the most significant drivers of residential long-term care need in Poland.

Many people with dementia remain at home for years, often supported heavily by families. Residential admission may occur when supervision needs become continuous, behaviour becomes difficult to manage at home, family carers become exhausted or other health conditions add complexity.

Facilities therefore need more than secure environments.

Good dementia care requires staff who understand communication, distress, life history, sensory needs and the effects of environmental design. Excessive noise, poor signage or frequent staff changes can increase confusion and anxiety.

Meaningful activity also matters. A person with dementia may be unable to participate in a formal group session but respond positively to familiar music, household activities, conversation or time outdoors.

The physical environment can either enable or restrict independence. Clear visual cues, safe walking routes, access to outdoor space and familiar domestic features can reduce unnecessary dependency.

This creates an important distinction between containing risk and supporting life.

As Poland’s residential population becomes older and more cognitively impaired, dementia service pathways will need to connect community, residential and healthcare support rather than treating residential admission as the end of the pathway.

Scenario: behavioural distress is treated as a staffing problem

An 86-year-old woman with dementia moves into a residential facility after her daughter can no longer provide continuous supervision. During the first weeks, she repeatedly tries to leave the building in the late afternoon and becomes distressed when staff redirect her.

The initial operational response is to increase observation because staff perceive the behaviour primarily as a safety risk.

A more person-centred review gathers information from her daughter and learns that the woman worked for many years in a school and used to leave home at a similar time each afternoon to collect grandchildren. The behaviour is therefore understood less as random wandering and more as an expression of routine and purpose.

Staff adjust the afternoon environment, introduce a familiar activity and support walking at the time she usually becomes restless. They also reduce unnecessary confrontation when she asks to leave.

The risk does not disappear completely. She still requires supervision because she could leave the site unsafely. But the frequency and intensity of distress reduces.

The governance lesson is important. If repeated behavioural incidents are recorded only as resident risk, the service may respond by increasing restriction. If information about triggers, patterns and outcomes is reviewed, the same incidents can generate learning about care quality.

Residential care becomes stronger when behaviour is treated as communication rather than simply a problem to control.

The workforce challenge is different from home care but equally serious

Residential services benefit from having multiple workers in one location, which reduces the travel inefficiency found in home care. But they face their own workforce pressures.

Twenty-four-hour provision requires staffing across nights, weekends and holidays. Residents may need assistance with intimate personal care, mobility, dementia-related distress and end-of-life support. The work can be physically and emotionally demanding.

Skill mix matters greatly.

Healthcare facilities require appropriate nursing and clinical expertise. DPS services need workers capable of supporting everyday life, social needs and increasingly complex dependency. The two sectors should not be collapsed into one workforce model simply because both provide residential support.

Retention is particularly important because residents often depend on familiar relationships. High turnover can affect trust, communication and the ability of staff to recognise subtle changes in a person’s condition.

Workforce shortages can also encourage task compression. Staff may complete essential personal care while meaningful activity, conversation or community access are repeatedly postponed. These omissions may not appear in traditional safety metrics but still affect quality of life.

Organisations examining similar pressures can use the Predictive Workforce Risk Module to structure analysis of vacancy, turnover, capability and continuity. The framework is generic rather than Polish, but the principle is directly relevant: staffing adequacy should be judged by whether the workforce can deliver the intended model of care, not simply whether minimum shifts are filled.

Institutional care needs stronger connections with healthcare

Residents of long-term care facilities often live with multiple chronic conditions. Some require frequent primary care, specialist review, medication monitoring, rehabilitation or palliative input.

The quality of residential care therefore depends partly on access to healthcare outside the facility.

This is especially important in DPS settings because they are social-assistance institutions rather than healthcare facilities. Staff may recognise deterioration but need external healthcare services to assess or treat the person.

Poor integration can produce avoidable hospital transfers. An older person may be sent to emergency care because timely clinical support is unavailable in the residential setting. Conversely, residents can return from hospital with changed needs that the facility is not prepared to manage.

Clear escalation arrangements between residential services and healthcare are therefore essential.

Primary healthcare, out-of-hours services, emergency medical services and hospitals all have roles, but responsibility should be explicit enough that staff know whom to contact and when.

Hospital discharge also needs to account for the facility’s real capacity. A resident returning with significantly increased dependency may require equipment, revised staffing or additional clinical support.

Good integration reduces unnecessary movement between settings and protects continuity for residents who may find hospital transitions particularly disorientating.

Scenario: discharge back to a DPS creates a hidden capability gap

A resident of a DPS is admitted to hospital following pneumonia. Before admission he required assistance with personal care but could transfer with minimal help. After two weeks in hospital, he returns much weaker and now requires two people for transfers.

The discharge paperwork records his medical treatment and medications accurately. Operationally, however, the facility faces a different problem: its existing staffing pattern and equipment were designed around his previous level of need.

If the change is treated as an ordinary return from hospital, staff may improvise. That increases injury risk for both the resident and workers.

A stronger pathway identifies the functional change before discharge. The DPS reviews transfer requirements, equipment, staffing and rehabilitation needs. Where additional support is required, this is clarified before the resident returns.

The case is also reviewed later to determine whether his dependency improves as he recovers. Permanent staffing assumptions should not be based automatically on the highest level of temporary need.

The scenario demonstrates why transitions between healthcare and social-assistance residential care require more than exchanging documents. The receiving service needs enough information to understand what the person can now do, what they cannot do and what support must change.

Safeguarding in institutions requires attention to culture as well as incidents

Residential care creates particular safeguarding responsibilities because residents may depend heavily on the same organisation for accommodation, personal care, medication, food and access to the outside world.

Abuse can take obvious forms, but institutional risk can also emerge through poor culture: rough handling, infantilising language, unnecessary restriction, lack of privacy or routines that prioritise staff convenience over residents’ preferences.

These practices can become normalised without generating a single dramatic incident.

Safeguarding therefore depends on more than reacting to allegations. It requires supervision, complaints routes, family involvement where appropriate, resident voice and leadership willing to identify patterns.

People with dementia, communication difficulties or limited family contact can be especially vulnerable because they may find it harder to report concerns.

Staff also need safe ways to raise problems. A workforce under pressure may recognise poor practice but fear challenging colleagues or managers.

Strong safeguarding culture connects everyday dignity with formal protection.

Where serious concerns arise, safeguarding incident response and escalation need to be proportionate, timely and centred on the person affected. But governance should also ask what conditions allowed the problem to develop and whether similar risks exist elsewhere in the service.

Technology can strengthen residential care without making it impersonal

Residential settings can benefit from digital records, medication systems, remote consultation, monitoring technology and more efficient workforce scheduling.

These tools can reduce duplication and improve visibility of changing needs.

Sensor technology may help identify falls risk or night-time movement. Digital records can make trends easier to see. Remote clinical advice can reduce some unnecessary transport to healthcare settings.

Yet technology in residential environments raises important ethical questions.

Monitoring can become intrusive if residents are not meaningfully involved in decisions. Staff may rely excessively on alerts rather than observation. Digital systems can increase administrative burden if poorly designed or duplicated alongside paper processes.

Artificial intelligence may eventually support risk identification or workload planning, but it should not be treated as an established replacement for professional judgement.

The Digital Transformation Readiness Assessment can help organisations test whether governance, workforce skills, cyber resilience and implementation capability are developing alongside technology. The relevant principle for Polish residential care is simple: digital tools should increase the quality and responsiveness of human care rather than create distance between residents and workers.

Quality assurance needs to connect regulation with lived experience

Residential services operate within formal legal and administrative frameworks, but compliance alone cannot demonstrate quality.

Inspections, staffing records, incident data and documentation remain necessary. They provide evidence that basic requirements are being met. Yet they can miss aspects of everyday life that residents experience most directly.

A facility may have complete records while residents feel lonely. Care plans may be current while daily routines remain rigid. Activities may be scheduled while participation is low because they do not reflect residents’ interests.

Quality assurance therefore needs several forms of evidence.

Resident and family feedback can reveal whether people feel respected, whether staff respond when preferences change and whether complaints lead to improvement. Workforce data can show whether continuity is being undermined by turnover. Health indicators can identify repeated falls, weight loss or avoidable hospital transfers.

The Quality Dashboard Builder offers organisations a generic way to connect these different evidence streams. It does not define Polish inspection requirements, but the principle is useful: leadership needs a view of quality broad enough to include safety, workforce, experience and outcomes together.

Quality improves when information leads to action. Repeated complaints about night-time response, for example, should trigger examination of staffing and routines rather than being closed individually without thematic review.

Scenario: occupancy looks healthy while quality indicators deteriorate

A residential facility operates close to full occupancy and has no difficulty filling places. From a financial perspective, the service appears stable.

Over several months, however, other signals begin to change. Staff turnover increases. Relatives report that residents are seeing more unfamiliar workers. Falls rise slightly. Activities are cancelled more often because staff are redeployed to essential personal-care tasks.

No single indicator is dramatic enough to trigger immediate concern.

A stronger governance process brings the data together. Managers recognise that occupancy is masking declining operational resilience. Recruitment has kept minimum staffing levels broadly intact, but experienced workers are leaving faster than replacements can become confident in their roles.

The service responds by reviewing supervision, shift design and workload. New employees receive stronger mentoring, while activity provision is protected rather than continually sacrificed to personal-care pressure.

Resident and family feedback is monitored alongside staffing data to assess whether continuity improves.

The example demonstrates why residential capacity cannot be judged solely through filled beds. A service can be commercially or administratively full while becoming less capable of delivering high-quality care.

The meaningful capacity of a facility depends on the stability and competence of the workforce behind the occupancy figure.

Private purchasing can expand choice but also create inequality

Private residential care can provide additional options for families able to pay. It may offer faster access, different environments or specialist provision not easily available through publicly organised routes.

That flexibility can be valuable, particularly where public capacity is limited.

But private purchasing also introduces equity concerns. Families with greater financial resources can sometimes resolve waiting or geographic problems more easily than households dependent entirely on publicly funded arrangements.

The existence of private capacity should therefore not be interpreted automatically as evidence that the system has sufficient accessible capacity.

Quality oversight remains important regardless of payment source. A person purchasing care privately still requires protection, clear information and appropriate standards.

Families may also find it difficult to compare providers. Marketing materials can describe accommodation and activities but provide limited insight into workforce stability, safeguarding culture or clinical relationships.

Greater transparency around meaningful quality indicators could support more informed choice while avoiding simplistic league tables.

The wider policy challenge is to maintain a mixed provider landscape without allowing financial means to determine access to fundamentally necessary care.

Residential care should become more connected to community life

Institutional care does not have to mean social separation.

Many residents retain interests, relationships and roles beyond the facility. They may want to attend religious services, visit local shops, maintain friendships or participate in community activities.

Residential services can either support those connections or unintentionally narrow them.

Location matters. A facility isolated from transport and local amenities creates different opportunities from one embedded within a neighbourhood. Staffing also matters because community participation often requires worker time.

Families can support connection but should not be the only route through which residents access ordinary life.

Community organisations, schools, cultural groups and volunteers may contribute to social participation, provided these relationships respect residents’ preferences and privacy.

The goal is not constant activity. Some people value quiet, familiar routines and private time. Person-centred care means avoiding the opposite assumption that a busy activity schedule automatically represents quality.

The stronger model treats the residential setting as the person’s home within a wider community rather than a separate institution disconnected from ordinary life.

Residential design will need to respond to higher dependency

Physical environments influence both resident experience and workforce efficiency.

As residents become more frail and cognitively impaired, building design becomes increasingly important. Space for mobility equipment, accessible bathrooms, safe outdoor areas, good lighting and environments that reduce confusion can materially affect care.

Large institutional layouts can make navigation difficult and contribute to impersonal routines. Smaller household-style environments may support familiarity, although they require thoughtful staffing and are not automatically superior.

Future investment should therefore focus less on architectural fashion and more on how environments support independence, privacy, infection control, social contact and worker safety.

Climate resilience also matters. Heatwaves create particular risks for frail older residents. Buildings need adequate ventilation and temperature management, while emergency plans must account for power disruption and extreme weather.

Residential infrastructure has long life cycles. Facilities built or refurbished today may still be supporting residents decades from now.

Capital planning should therefore reflect the likely future profile of residents rather than current averages alone.

The future role of institutions should become more specialised and flexible

If community services expand successfully, residential long-term care is likely to change rather than disappear.

One plausible direction is greater specialisation. Facilities may increasingly support people with high dependency, advanced dementia, complex neurological conditions, palliative needs or combinations of medical and social support that cannot be sustained easily at home.

Another possibility is greater flexibility between permanent and temporary care. Short-term residential support can provide respite, post-hospital recovery or assessment without automatically becoming a permanent placement.

This could help bridge the current gap between home and long-term institutional admission.

Residential services may also become centres of expertise for surrounding communities. Staff with dementia, rehabilitation or palliative expertise could support outreach or training beyond the facility where funding and governance allow.

Such developments should not be assumed to happen automatically. They require workforce, financing and clear responsibility.

But they illustrate a broader point: the future of institutional care does not have to be defined only by the number of permanent beds. Its value may increasingly lie in providing flexible, specialist capacity within a wider long-term care system.

Governance should examine why people enter residential care

Admission data can provide important system intelligence.

If people enter residential care primarily because of severe dependency, the capacity question is different from a pattern in which admissions are frequently triggered by unavailable home support, inaccessible housing or family-care breakdown.

Local and national planning should therefore examine pathways into institutions, not simply occupancy.

Useful questions include whether admission followed hospital discharge, whether intensive home care was available, whether the person had dementia, whether the family arrangement had become unsustainable and whether the placement was planned or urgent.

This information can reveal where community investment might reduce avoidable institutionalisation and where residential capacity genuinely needs to grow.

It can also improve transitions. Planned admissions allow time for the person to visit, understand the setting and share preferences. Emergency admissions provide far less opportunity for preparation.

Governance becomes stronger when residential services are treated as part of the wider pathway rather than the point at which system analysis stops.

International learning lies in balance, not deinstitutionalisation alone

Many countries are trying to shift long-term care towards homes and communities. Poland shares that direction but starts from a system with comparatively limited formal provision and substantial reliance on families.

The international lesson is therefore not that residential care should simply be reduced.

Community expansion and institutional quality need to progress together.

If residential capacity is reduced before robust home support exists, responsibility moves to families. If institutional capacity expands without investment in community alternatives, people may enter residential care earlier than necessary.

The transferable principle lies in building a continuum where different settings serve different needs.

Residential care should be available when it offers the safest, most appropriate or preferred option. Home care should be strong enough that admission is not driven by avoidable service gaps. Rehabilitation should create opportunities to recover independence. Temporary care should help prevent emergency permanent placements.

Poland also illustrates how institutional boundaries can complicate planning. Social-assistance homes and healthcare long-term care facilities are not interchangeable, even though both provide residential support. Other countries with divided funding systems face similar challenges.

The most useful comparison is therefore not bed numbers between countries but how clearly each system matches need, setting and accountability.

Conclusion

Residential long-term care will remain an essential part of Poland’s ageing society. Even with stronger home care, prevention and family support, some people will require round-the-clock assistance, specialist nursing, dementia support or an environment that cannot reasonably be reproduced in their existing home. The question is not whether institutions have a future, but what that future should look like.

Poland’s residential system is already diverse. DPS homes operate within social assistance, while ZOL and ZPO facilities sit within healthcare and respond to different levels and types of need. Private provision adds further choice and complexity. Future planning therefore needs to distinguish physical beds from usable capacity, and occupancy from genuine quality.

The strongest direction is towards residential services that are more specialised, person-centred and connected to community and healthcare pathways. Workforce capability, dementia competence, safeguarding culture, environment, technology and resident voice will all become increasingly important as the complexity of residents rises.

Implementation also needs to connect institutional and community policy. Residential admission should not occur simply because families are exhausted or home support is unavailable, yet community-care ambitions should not deny the legitimate need for high-quality institutional provision. Poland’s long-term care system will be stronger when residential services are neither the default nor the last resort, but a respected, well-governed part of a coherent continuum of support.