A/HRC/39/32 nursing teams with rehabilitation staff, which conducted round-the-clock home visits to older patients. 26. The experience and research had proved that the best option for older persons was to live with family members and not in isolation, especially for older persons with disabilities. Home care reduced the feeling of isolation and psychological depression. Still, social changes, and the reduction of social links, posed challenges for older persons. As older persons’ interactions became increasingly limited to closer relatives, it was the role of family to help them link with the wider society, for example by visiting heritage sites and participating in neighborhoods councils for older persons established by the State. Families should participate in those initiatives by the State aimed at promoting the involvement of older persons in society, and encourage older persons to participate, taking into account the valuable experience they had accumulated over the years. Finally, older persons should have access to social and legal services. 27. Xenia Scheil-Adlung, a health and long-term care policy adviser, described the global deficits regarding coverage and access to long-term care for older persons. Studies had shown that almost half of the world population that was aged over 65 lived in countries without any right to long-term care. Over 46 per cent of the world population lived in countries where policies demanded poverty as an eligibility requirement to receive longterm care. Just over 5 per cent of the world population aged over 65 lived in countries with universal long-term care systems. The population aged over 65 suffered exclusion from long-term care due to deficits in public expenditure. The unaffordability of those services implied the potential for impoverishment for many older persons in countries without universal coverage. In addition, significant workforce shortages in long-term care excluded people from accessing quality services. She noted that there was a gap of over 13 million long-term care workers globally. 28. There was therefore a need to define the role of family carers, while analysing who was filling the workforce gap to make services available and affordable. Studies had concluded that only 20 per cent of the long-term care workforce was composed of paid formal workers. The rest were unpaid informal workers; mostly female family carers aged over 40, caring for one or two persons. In high-income countries, family members provided up to 90 per cent of care, exceeding by far the number of formal care workers. In low- and middle-income countries the number of family carers was even higher, due to the lack of formal long-term care workers and infrastructure. 29. The high levels of reliance on family care had implications. For family carers, caregiving was highly demanding physically and mentally, sometimes resulting in burnout and ill-health due to lack of training and decent working conditions. It could result in loss of income or social protection, when it necessitated ending or reducing paid employment and no compensation was available. Work-family conflicts and risk of job loss could happen when providing care in addition to carrying out paid employment. For long-term care recipients, it implied an increased level of dependence due to physical and mental deterioration in the absence of quality services, high costs and potential impoverishment due to lack of income from family carers, and increased risks of abuse and violence due to family carers being overburdened as well as to lack of training. There were socioeconomic implications too, such as foregone economic growth and higher unemployment, higher public expenditure, increased income and gender inequities, and failure to comply with labour regulations. 30. Policy considerations to address those issues included public investment in creating jobs for formal long-term care workers, which would have multiplier effects in productive sectors, reduce unemployment and create economic growth and development. Similarly, investing in support for informal carers would avoid negative socioeconomic impacts. While the policy priority should be for home-based care, there was a need to ensure the rights of older persons by providing adequate access to long-term care, including universal coverage through fair financing mechanisms; and making quality services available by increasing the formal long-term care workforce. Moreover, it was necessary to establish support measures, such as funding for the delivery of long-term care services, cash benefits or income replacement, and social protection coverage, including leave time from care duties, training, and being replaced during vacations. 8