The Future of Long-Term Care in Lithuania: Demography, Workforce, Technology and System Reform

An older Lithuanian entering their eighties in the 2040s will encounter a very different demographic environment from the one in which today's long-term-care system developed. There will be proportionately more older people, fewer working-age adults available to finance and deliver support, and greater pressure on families whose own employment and caring responsibilities may already be substantial. The strategic question is therefore no longer simply how Lithuania should expand long-term care. It is how the country can build a system capable of supporting more people without assuming that workforce, family capacity or public finance can expand indefinitely.

This final article in the Lithuania Ageing, Long-Term Care & Community Support Knowledge Hub brings together the pressures examined across the wider series. Lithuania is already reforming long-term care, expanding home and community support, developing more integrated health and social services, strengthening disability rights and investing in digital infrastructure. Yet the comprehensive integrated long-term-care model remains a developing reform rather than a completed national system.

The future will consequently be shaped by implementation as much as policy design. Lithuania needs to decide how responsibilities and funding should connect, where scarce workers create greatest value, how municipalities can maintain local flexibility without entrenching inequality, what technology should enable, how families can be supported without becoming the default substitute for formal services, and how prevention can delay avoidable dependency. These are interconnected decisions. A sustainable future will depend on treating long-term care as national social infrastructure rather than a collection of services activated only after independence has already been lost.

Demography changes the operating assumptions of long-term care

Lithuania's demographic direction is unusually important to long-term-care planning. The population was approximately 2.9 million in 2024, while projections indicate a substantial decline over the decades ahead. The working-age population is projected to contract particularly sharply, potentially falling by around 30% between the early 2020s and 2050. At the same time, the proportion of people aged 65 and over is expected to rise significantly.

The implications go well beyond a larger number of potential care recipients. Population ageing changes the relationship between demand, workforce and public revenue. Fewer working-age people may be available to work in health and long-term care, provide unpaid family support and contribute through taxation or social insurance, while more people require pensions, healthcare and assistance with everyday living.

These pressures will not occur evenly. Some older people will remain independent well into later life. Others will experience multimorbidity, frailty, cognitive impairment or disability that creates sustained support needs. Lithuania's strategic challenge is therefore not to equate ageing with dependency, but to prepare for a larger population in which the absolute and relative demand for support is likely to increase.

This distinction changes planning. A demographic projection cannot simply be converted into a forecast of residential-care beds. Future demand needs to be considered across prevention, primary healthcare, rehabilitation, home support, nursing, day services, personal assistance, technical aids, family support, community services and residential care.

Organisations examining comparable demographic uncertainty can use scenario modelling to test these relationships. The Digital Twin Scenario Modeller offers a practical framework for exploring how changes in demand, workforce and service capacity can interact. It is not a Lithuanian forecasting instrument, but the principle is relevant: future capacity should be modelled as a connected system rather than through isolated service projections.

The future model will need to start before long-term care

The most sustainable long-term-care service is sometimes the service that does not yet need to be provided.

This does not mean assuming that dependency is preventable in every case. Age-related disease, disability and progressive conditions will continue to create legitimate long-term-care needs. It means recognising that the timing, severity and consequences of functional decline can often be influenced.

Lithuania continues to experience significant preventable health risks and inequalities. Healthy ageing therefore needs to become part of long-term-care strategy rather than remaining primarily a public-health concern. Physical activity, cardiovascular risk management, nutrition, vaccination, falls prevention, medication review, mental wellbeing, social connection, accessible environments and timely rehabilitation can all affect whether a health event becomes a permanent loss of independence.

The boundary between prevention and care is particularly important for older people living with several conditions. A first fall may be treated as an isolated event, yet it can indicate declining strength, medication problems, poor vision or an unsuitable home. Bereavement can lead to isolation, poor nutrition and reduced mobility. A short hospital admission can produce deconditioning that makes everyday tasks harder after discharge.

A future system should become better at recognising these transitions before they produce substantially greater dependency. This links long-term-care sustainability with health inequalities, prevention and early intervention. The objective is not merely to reduce expenditure. It is to extend the period in which people retain function, relationships, choice and control.

Scenario: the difference between responding to a fall and responding to a trajectory

A 76-year-old man living in Kaunas has hypertension and arthritis but remains independent. During winter he falls outside his apartment building. He is not seriously injured and does not require prolonged hospital treatment.

In a reactive system, the episode ends when the immediate injury is excluded. His daughter begins doing more shopping because he has become anxious about going outside. He moves less, loses strength and falls again six months later. By then he needs more substantial support.

A preventive pathway treats the first fall differently. Primary care considers medication and relevant clinical risks. His mobility and function are reviewed, and he is connected with appropriate rehabilitation or physical-activity support. Environmental risks are considered rather than assuming that the problem lies solely with the individual. His confidence in leaving home becomes an outcome worth protecting.

The important intervention is not one new Lithuanian service. It is the connection between existing capabilities.

If similar cases repeatedly progress from minor falls to hospitalisation and social-care need, municipal and health decision-makers should be able to see that pattern. Future long-term-care planning then begins to influence prevention investment upstream.

This is particularly important because medicines, falls and frailty cannot be managed effectively as isolated issues when their combined effect determines independence.

Integration must move from projects to an operating model

Lithuania's historical division between health-related and social long-term care has been one of the defining structural issues examined throughout this series. Responsibilities have involved the Ministry of Health, the Ministry of Social Security and Labour, the National Health Insurance Fund, municipalities and different health and social-service organisations.

Recent reform has moved towards greater integration, including development of integrated assistance and a broader integrated long-term-care model. The direction is significant, but the long-term test will be whether integration becomes ordinary practice rather than a layer of projects operating alongside established systems.

A person with substantial needs does not experience their life as separate health and social-care domains. Diabetes, mobility, personal care, medication, nutrition, housing, loneliness and family-carer strain may all interact. Administrative boundaries remain necessary because professional responsibilities and funding rules differ, but the person should not carry the burden of reconciling those boundaries.

The future model therefore needs clarity in several places: assessment, referral, information exchange, responsibility for coordination, funding and review when needs change. Integration becomes meaningful when these functions connect reliably.

It does not necessarily require every service to be placed inside one organisation. A municipality can retain social-service responsibilities while health organisations retain clinical responsibilities. What matters is whether their combined pathway works.

This makes interoperability and system integration a governance issue as much as a digital one. The future should be judged by how effectively boundaries are crossed, not by how often the word integration appears in policy.

Home and community care will need considerably more operating capacity

Lithuania's policy direction towards greater support at home is consistent with both individual preference and wider European long-term-care reform. The country has expanded home help, day social care, integrated assistance and other community options, while disability reform and deinstitutionalisation have reinforced expectations of participation and community living.

The future challenge is scale.

Moving the centre of gravity away from institutional care does not remove care demand. It distributes that demand across thousands of homes and communities. Workers spend time travelling. Housing conditions become relevant. Family availability affects the pathway. Equipment must be installed and maintained. Clinical deterioration can occur away from an institutional workforce.

Community capacity therefore needs to be designed rather than assumed.

For municipalities, this means understanding not simply how many people receive a service but whether there is enough intensity and flexibility to prevent avoidable breakdown. Short visits may meet some needs while being inadequate for others. Day support can protect independence but only if transport and access are workable. Respite matters only if families can obtain it before exhaustion becomes a crisis.

Future community systems will also need stronger escalation routes. Supporting someone at home is sustainable when increasing needs trigger a timely review and additional assistance. It becomes fragile when the service model depends on relatives absorbing every increase between formal assessments.

The goal should therefore be neither institutional care nor home care as an ideology. It should be the least restrictive, most sustainable setting capable of meeting the person's needs and preferences safely.

The workforce constraint will shape almost every future choice

Demographic ageing creates a particularly difficult workforce equation for Lithuania. The country already has fewer long-term-care workers relative to its older population than the OECD average, while nursing supply is also below the OECD average. Geographic distribution adds another layer: national workforce totals can conceal substantial local differences.

Future demand will consequently collide with a labour market in which the working-age population itself is shrinking.

Recruitment remains necessary, but recruitment alone cannot solve this problem. Lithuania will need to consider who performs which tasks, how roles connect, which activities genuinely require scarce professional expertise, what administrative burden can be removed and how workers can be retained.

This is a much broader agenda than filling vacancies. It includes:

• attracting and retaining nurses, social workers, individual care workers and other long-term-care staff;
• building credible training and career pathways;
• using multidisciplinary skill mixes without weakening professional accountability;
• improving geographic distribution and access to expertise;
• supporting worker wellbeing and continuity;
• considering the appropriate contribution of migration and returning Lithuanian workers; and
• using technology to reduce avoidable workload rather than simply reducing headcount.

The sequence matters. Lithuania has already had to balance workforce qualification ambitions with implementation capacity, including extending deadlines for specified professional-development requirements for nurses and nursing assistants working in long-term care. The wider lesson is that regulation, education capacity and labour supply need to be planned together.

The future workforce strategy must therefore move beyond vacancy numbers towards long-term workforce planning. How many workers are required under different models of home care? Which municipalities face the greatest retirement risk? Where can technology remove duplication? Which specialist functions can be shared across geographic areas?

The Predictive Workforce Risk Module provides organisations with a structured way to examine turnover, vacancy and continuity risks. It does not predict Lithuania's national labour market, but its underlying principle is increasingly important: workforce pressure should become visible before service failure makes it obvious.

Scenario: a rural municipality cannot recruit its way out of the problem

A smaller Lithuanian municipality has an ageing population spread across villages and small settlements. Demand for home support is increasing, but recruiting additional nurses and social-care workers has become progressively harder. Travel consumes a substantial part of each working day.

The municipality initially treats the issue as a vacancy problem. Recruitment campaigns generate few sustainable appointments.

A different approach begins by mapping demand. Some people need regular hands-on care. Others require professional assessment followed by lower-intensity support. Several routine administrative tasks require workers to return to an office unnecessarily. Specialist input is needed intermittently rather than continuously.

The operating model changes. Routes are redesigned geographically. Appropriate digital access reduces avoidable travel for administration. Specialist professionals provide remote advice where clinically and professionally suitable while retaining in-person involvement when required. Community partners help address social isolation, but they are not expected to replace professional care.

The municipality also identifies which cases are most vulnerable if one worker leaves or becomes absent, strengthening workforce resilience and continuity rather than measuring staffing only through total headcount.

No technology creates additional nurses. The improvement comes from protecting scarce professional time while ensuring that tasks remain with workers who have the competence and authority to perform them.

This is likely to become a defining future challenge for Lithuania: productivity must improve without reducing care to a sequence of increasingly compressed transactions.

Family care cannot remain the invisible balancing mechanism

Lithuanian families have historically provided a substantial proportion of everyday support to older relatives. Family involvement will remain valuable, and many people will continue to prefer support from people they know.

But demographic change also weakens the assumption that relatives will always be available.

Families are smaller. Adult children may live in another municipality or another country. Women, who have often carried disproportionate caring responsibilities, participate in the labour market. Older spouses may themselves have health problems. A shrinking working-age population increases the economic importance of keeping carers in employment.

The future system therefore needs to distinguish family partnership from family substitution.

Assessment should understand what relatives actually provide, whether they wish to continue and what would make the arrangement sustainable. Home services, respite, technical aids, accessible information and flexible support can preserve family relationships by preventing relatives from becoming overwhelmed care coordinators.

This also has fiscal implications. Unpaid care is not economically free. Reduced employment, lost earnings, poorer health and premature labour-market exit all carry costs even if they do not appear in a municipal care budget.

Lithuania's future long-term-care strategy should consequently make informal care visible in planning. If formal community capacity is insufficient, the system needs to know whether the gap is being absorbed by families rather than interpreting low formal-service use as low need.

Financing will need to become clearer, more sustainable and more integrated

Future long-term-care financing may be Lithuania's most difficult structural question.

The existing system combines health-insurance financing for health-related long-term care with social-service funding involving municipalities, state resources and personal contributions. This reflects the institutional division between health and social support, but it can also create complexity around responsibility and incentives.

As demand grows, Lithuania will need sufficient recurrent domestic financing to sustain services developed during periods of substantial European investment. EU funding can build infrastructure, support transformation and accelerate new models. It cannot remove the need for a durable national financing settlement.

The central question is therefore not simply whether spending increases. It is what the financing architecture incentivises.

If one part of the system saves money by shifting responsibility to another, integration becomes harder. If municipalities face rapidly different demand without adequate resources, geographic inequality can deepen. If household contributions become excessive, formal entitlement may not translate into practical affordability.

International analysis has previously raised options including clearer integrated funding routes and potentially broader mechanisms for long-term-care financing. Such options should not be confused with decisions already taken. Lithuania's future financing model remains a policy choice requiring consideration of equity, fiscal sustainability, risk pooling and the relationship between health and social care.

A stronger financing framework would make several things visible: what public protection covers, what individuals are expected to contribute, which level of government bears demand risk, how funding follows people with combined needs and how new community capacity will be sustained once temporary investment ends.

Technology should increase capability rather than become a workforce substitute

Lithuania enters this period with an important advantage: substantial experience in digital public services and national digital health infrastructure. The next stage is not simply to digitise more activity. It is to make technology useful across increasingly complex care pathways.

Future applications may include better information exchange, remote clinical input, assistive technology, medication support, telecare, scheduling, workforce deployment, predictive analytics and tools that help people manage aspects of their own health and support.

Artificial intelligence may eventually assist with forecasting, administrative workflow or identifying patterns that warrant professional review. Those applications should be treated as emerging capabilities rather than established Lithuanian long-term-care practice.

The governing principle should remain person-centred. Technology is valuable where it extends independence, removes repetitive administration, gives professionals better information or makes scarce expertise more accessible. It becomes problematic where efficiency is achieved through unwanted surveillance, inaccessible digital routes or withdrawal of human contact that the person still needs.

This is particularly important for older people who may have sensory impairment, cognitive difficulties, limited digital confidence or poor connectivity. A digital-first system should not become a digital-only system.

The wider person-centred technology principle therefore matters: begin with the person's desired outcome and the operating problem, then decide whether technology contributes.

Organisations planning comparable change can use the Digital Transformation Readiness Assessment to examine strategy, workforce adoption, interoperability and resilience together. Technology should strengthen a care system's capability; it cannot compensate indefinitely for weak pathways or unclear responsibility.

Scenario: technology notices deterioration, but people still need to act

An 82-year-old woman in Klaipėda lives alone with support from her daughter and periodic formal services. With her agreement, simple technology helps monitor aspects of her daily routine and provides medication prompts.

Over several weeks the pattern changes. She becomes less active and misses several usual routines. The technology does not diagnose her or automatically determine that she needs more care. It creates information that warrants human attention.

A defined response pathway means the change is reviewed rather than remaining an unexplained alert. Her daughter is contacted appropriately, relevant health concerns are assessed and her support needs are reconsidered. The cause turns out to include an emerging health problem and reduced confidence after a near fall.

The technology has value because an operating system exists around it.

Without clear responsibility, the same data could create hundreds of alerts that nobody reliably owns. Without consent and proportionality, monitoring could undermine privacy. Without alternative support, it could become justification for reducing visits rather than improving care.

The future Lithuanian opportunity is therefore not simply more sensors or more data. It is digitally enabled care in which information has a legitimate purpose, a responsible recipient and a route into timely action.

Municipal variation will become a strategic governance issue

Lithuania's municipalities give the country an important mechanism for adapting social services to local circumstances. That flexibility will remain valuable as demographic change develops differently across communities.

Yet future variation may become more pronounced. Rural areas can experience older population profiles, longer travel distances and smaller labour pools. Larger cities may sustain more diverse provider markets and specialist services but also face complex demand and affordability pressures.

The policy objective should not be to make every municipality operate identically. It should be to prevent geography from determining whether people can obtain reasonable support.

This requires stronger national visibility of local capacity, waiting, intensity, workforce, unmet need and outcomes. Municipalities should be able to explain legitimate differences while persistent disadvantage triggers analysis and support.

Inter-municipal collaboration may also become increasingly important where individual municipalities cannot sustainably maintain specialist capacity. Shared expertise, joint service arrangements or coordinated pathways can preserve local access without requiring every locality to duplicate every function.

Quality assurance must evolve from service compliance to system outcomes

As Lithuania changes where and how care is delivered, its quality architecture will need to change with it.

Traditional assurance can establish whether a service is licensed, staffed appropriately and operating against required standards. These controls remain essential. But an increasingly integrated and community-based system raises questions that no single provider inspection can answer.

Did the person receive support early enough? Did health and social services coordinate? Did a transition cause an avoidable gap? Is home care preserving independence or merely recording completed tasks? Are families becoming more or less sustainable? Are some municipalities producing systematically different outcomes?

These questions move quality assurance towards pathway and population-level evidence.

Future assurance should therefore combine service quality with outcomes, continuity, equity and lived experience. This is particularly important where a good result may involve maintaining function rather than producing measurable improvement. For a person with progressive frailty, preventing deterioration for six months may represent a meaningful outcome.

The Quality Dashboard Builder offers one way for organisations to structure a balanced evidence set, although indicators must always be adapted to the relevant Lithuanian or other national context. The transferable principle is that activity, quality and outcomes should be visible together.

This strengthens assurance and governance by changing what leaders can see. A system that reports rising service volumes without showing unmet need or independence may appear successful while demand continues to move downstream.

The future system needs a stronger feedback loop from local experience to national policy

Lithuania's reforms involve national ministries, agencies, the National Health Insurance Fund, municipalities, health organisations, social-service providers, community organisations and families. No single institution can observe the whole system directly.

That makes feedback architecture essential.

Frontline practitioners see emerging complexity before national statistics do. Municipalities see waiting pressures and provider-market problems. Hospitals see patients whose discharge is delayed by inadequate community support. Families see gaps that may never appear in formal service records. National agencies see patterns across municipalities that local organisations cannot.

The future governance model needs to connect these perspectives.

This does not require collecting every possible piece of data. Excessive reporting can consume the workforce that reform is trying to protect. The objective is to identify information that changes decisions.

A mature feedback loop would allow local evidence to influence national policy while national analysis helps local systems recognise patterns they cannot see alone. Persistent workforce shortages might trigger training or migration policy. Repeated transitions into institutional care after falls could strengthen prevention investment. Geographic differences in access might lead to targeted support or inter-municipal solutions.

Organisations examining whether responsibility, escalation and evidence connect effectively can use the Governance Maturity Assessment as a structured analytical framework. It does not represent Lithuanian governance requirements. Its relevance lies in testing the same fundamental question: can information travel far enough through the system to reach someone capable of acting on it?

Scenario: forecasting changes a municipality's investment decision

A Lithuanian municipality notices steady growth in home-support demand. The immediate response under consideration is to increase the annual home-care budget by a fixed percentage.

Before doing so, the municipality combines population projections with service-entry patterns, workforce age, hospital transitions and the distribution of older residents across its territory.

The analysis shows that demand is not increasing uniformly. One group is entering long-term support after preventable deterioration associated with falls and deconditioning. Another requires high-intensity support following hospital discharge. A third lives in remote communities where travel makes existing provision increasingly inefficient.

The municipality therefore avoids treating one demand trend as one problem.

Some additional home-care capacity is funded. Preventive activity is targeted towards neighbourhoods showing higher rates of functional decline. Discharge coordination is strengthened with health partners. Workforce routes are redesigned for rural areas. The municipality also establishes measures that show whether these interventions delay higher-intensity care rather than simply recording the number of people contacted.

The example illustrates the future relationship between data, quality metrics and decision-making. Forecasting becomes useful only when it changes resource allocation.

For Lithuania, the strategic opportunity is to move progressively from describing ageing after it happens towards anticipating where its service consequences are likely to appear.

Independence should become a central measure of system capacity

Long-term-care debates often define capacity through beds, places, workers and hours. These measures will remain necessary because services cannot operate without physical and human resources.

Yet Lithuania's wider reform direction suggests another form of capacity: the capacity of people themselves to remain active participants in everyday life.

Disability reforms have strengthened attention to participation and individual assistance. Community services aim to support people outside institutions. Assistive technology and housing adaptation can reduce environmental barriers. Prevention can protect function. Personal assistance can enable activities a person could not otherwise undertake independently.

Together, these developments suggest that the future system should measure not only how much care it provides but what that care enables.

For one person, the outcome may be continuing to prepare meals. For another, it may be leaving home, maintaining employment, participating in community life or living with a partner rather than moving prematurely into institutional care.

This does not mean independence should become an expectation that people manage without support. Independence can be created through appropriate assistance. The relevant question is whether support expands or unnecessarily contracts the person's control over life.

That is why outcomes, independence and community inclusion are strategic measures rather than simply person-centred values. Every additional period of safe, chosen independence can matter to the individual while also changing future demand for intensive services.

Future resilience will depend on recognising shocks as well as trends

Demography is relatively predictable compared with many other pressures. Lithuania's long-term-care system must also be capable of responding to events that cannot be forecast precisely.

Infectious-disease outbreaks, severe weather, cyber incidents, energy disruption, workforce migration or geopolitical instability can all affect continuity. Climate change may increase heat-related risks for older people and place additional demands on buildings and community response systems.

A system increasingly reliant on home care and digital coordination has different vulnerabilities from one concentrated primarily in institutions. Workers may be unable to travel. Remote monitoring may depend on connectivity and electricity. People living alone may become harder to reach.

Resilience should therefore be designed into the future model rather than treated as a separate emergency-planning exercise.

Municipalities and service organisations need to understand which people are most dependent on uninterrupted support, which services have single points of failure, how information will remain available during disruption and what mutual support can be mobilised across organisations or neighbouring areas.

This is another reason workforce continuity, interoperable information and local community infrastructure matter. The characteristics that improve routine care can also strengthen resilience when normal operating conditions change.

What might Lithuanian long-term care look like by the 2030s?

No responsible analysis can specify the exact shape of Lithuanian long-term care a decade from now. Funding decisions, migration, economic performance, technology and political priorities will all affect development.

However, the direction required by current pressures is clearer.

A more sustainable system would probably provide substantially more support outside institutions while retaining high-quality residential care for people who need or choose it. Health and social-care assessment would connect more effectively. Municipalities would remain important delivery actors but operate within stronger national evidence and equity frameworks.

Workforce roles would become more multidisciplinary and digitally enabled. Scarce professional expertise would be deployed more deliberately. Families would remain important partners but receive more explicit recognition and support. Prevention and rehabilitation would be understood as long-term-care capacity measures.

Digital infrastructure would increasingly allow relevant information to follow the person, while safeguards around privacy, accessibility and human oversight become more important rather than less. Data would be used not only for retrospective reporting but for demand forecasting and early identification of pressure.

Funding would need to become sufficiently stable to maintain services beyond temporary transformation programmes, with clearer responsibility for people whose needs cross health and social-care boundaries.

None of these developments requires Lithuania to abandon its existing institutional architecture. The stronger opportunity is to make that architecture function as a coherent system.

Internationally, Lithuania is a test of whether smaller systems can reform before demographic pressure peaks

Lithuania's experience has relevance beyond its borders because many countries face the same underlying equation: more people living to older ages, greater chronic and long-term-care need, a limited care workforce and pressure on public finances.

The Lithuanian response cannot simply be exported. Its compulsory health-insurance arrangements, municipal responsibilities, EU membership, demographic history and digital infrastructure create distinctive conditions.

The transferable lesson lies instead in sequencing.

Countries need to strengthen community alternatives before reducing institutional dependence. They need workforce plans before expanding labour-intensive entitlements. Digital infrastructure needs operating pathways around it. Rights need practical services. Prevention needs to connect with long-term-care planning. Funding reform needs to consider incentives across institutional boundaries.

Lithuania also demonstrates the value of reforming while acknowledging incompleteness. The integrated long-term-care model is developing. Geographic variation persists. Workforce scarcity has not disappeared. The presence of these challenges does not negate reform; it defines the work that remains.

For other countries, that may be the most useful perspective. Ageing does not create one moment at which a long-term-care system suddenly becomes unsustainable. Pressure accumulates gradually. That creates an opportunity to redesign services before demographic change removes more of the available choices.

Conclusion

The future of long-term care in Lithuania will be determined by whether the country can convert demographic pressure into deliberate system redesign rather than simply expanding today's arrangements. A rapidly ageing population and shrinking working-age base make that transformation necessary, but they do not determine its outcome.

Lithuania already has important foundations: strong digital capability, municipal social-service structures, expanding home and community support, disability reforms centred more strongly on participation, developing integrated long-term care and substantial experience of system transformation. The next phase is to connect those elements into a sustainable operating model.

That means treating prevention as care capacity, protecting scarce workforce time, supporting rather than assuming family care, securing recurrent financing, strengthening pathways across health and social services and using technology where it increases independence or professional capability. It also means measuring whether people experience better continuity, greater choice and longer periods of meaningful independence rather than judging reform primarily through activity.

The central challenge is therefore one of governance. National ambition must remain connected to what municipalities, professionals, families and people using services actually experience. Lithuania cannot prevent population ageing, and technology cannot remove the human work inherent in care. But the country can influence how much dependency develops, where support is provided, how scarce resources are deployed and how effectively different parts of the system work together. That is the strategic task on which the next generation of Lithuanian long-term care will depend.