Georgia’s population is ageing rapidly. The long-term care sector remains fragmented, underregulated, and invisible to quality assurance systems. PHIG maps the gap and the pathway forward.
“Long-term care is not a welfare sector. It is a health sector with welfare dependencies. Treating it otherwise condemns older persons to a parallel system where clinical standards do not apply.”
WHO. Integrated Care for Older People (ICOPE): Guidelines on Community-Level Interventions. Geneva: WHO; 2017.[1]
Introduction
Georgia’s demographic transition is accelerating. The population aged 65 and over reached 16.2% in 2024, up from 13.4% in 2014, and is projected to exceed 22% by 2040.[2] This shift creates an exponentially growing demand for long-term care (LTC) services — residential nursing homes, day care centres, home care services, and memory care facilities — at a time when the LTC sector is poorly regulated, minimally quality-assured, and largely absent from the national health reform agenda.
This analysis maps the current LTC landscape in Georgia, identifies critical quality and safety gaps, and evaluates the readiness of the sector for standards-based improvement.
The Georgian LTC Sector: Current State
As of 2024, Georgia had approximately 187 registered LTC facilities, including state-run social service homes, private nursing homes, and mixed facilities.[3] Total registered LTC beds stood at 8,200, a ratio of approximately 7.4 beds per 1,000 population aged 65+. The EU-27 average for LTC beds is 50 per 1,000 population aged 65+.[4] This 6-fold gap is not merely quantitative — it reflects a system that has historically relied on family-based care as the default, with formal LTC as a last resort for those without family support.
| Indicator | Georgia | Armenia | Estonia | EU-27 Avg | WHO Target |
|---|---|---|---|---|---|
| LTC beds per 1,000 pop. 65+ | 7.4 | 11.2 | 38.4 | 50.0 | 40+ |
| % with quality certification | 6% | 9% | 74% | N/A | N/A |
| Registered LTC facilities | 187 | 241 | 312 | N/A | N/A |
| Social care spending (% GDP) | 0.4% | 0.6% | 2.1% | 3.8% | N/A |
| Staff-to-resident ratio (nursing homes) | 1:8 | 1:6 | 1:3 | 1:3 EU target | 1:4 |
| Dementia care facilities | 8 | 12 | 48 | N/A | N/A |
Sources: WHO European Health Information Gateway 2024; MoLHSA Georgia 2024; Eurostat 2024.[2,3,4]
Quality and Safety: Critical Gaps
PHIG’s 2024 assessment of 24 Georgian residential LTC facilities — a purposive sample covering state, private, and mixed facilities across four regions — found critical quality and safety failures across all facility types.
Medication management was the most alarming finding: 67% of facilities had no pharmacist or trained nurse responsible for medication review, and polypharmacy (defined as ≥5 regular medications) was unreviewed in 81% of residents assessed.[5] Nutritional assessment was absent in 72% of facilities. Fall prevention protocols were documented in only 17% of facilities. Pressure ulcer prevalence was 12.4% — compared to an EU benchmark of 5–7% in regulated facilities.[5,6]
Figure 1. Key Quality Indicators: Georgian LTC Facilities vs. EU Benchmarks 2024 (%)
Sources: PHIG LTC Facility Assessment 2024 (n=24); European Centre for Quality in Long-Term Care benchmarks 2023.[5,6]
| Standard Domain | ASF Requirement | Current Georgian Practice | Gap Level |
|---|---|---|---|
| Resident Assessment | Comprehensive admission assessment within 48hr | Not systematically performed | Critical |
| Medication Management | Pharmacist-led medication review quarterly | No pharmacist involvement in 87% of facilities | Critical |
| Nutritional Care | Dietitian assessment; malnutrition screening on admission | Absent in 72% of facilities | Critical |
| Dementia and Cognitive Care | Specialised dementia care pathway | Absent in all but 4 facilities | Critical |
| Infection Prevention | HAI monitoring; vaccination status tracking | Ad hoc; no systematic monitoring | High |
| Palliative and End-of-Life Care | Structured palliative protocol | Absent in 91% of facilities | High |
| Staff Competency | Annual competency assessment for all care staff | No requirement; no system | High |
Sources: ASF Long-Term Care Standard 2024; PHIG assessment.[3,5]
Figure 2. Georgian Population Aged 65+ vs. LTC Bed Supply 2014–2040 (Projected)
Sources: Geostat Population Projections 2024; MoLHSA LTC registry data; PHIG projections.[2,3]
Conclusion
Georgia’s long-term care sector is on a collision course between rapidly growing demographic demand and severely lagging quality and supply infrastructure. The 2025–2030 Social Protection Reform Strategy provides a legislative window for introducing mandatory LTC quality standards. PHIG recommends adopting the ASF Long-Term Care Standard as the reference framework for this reform, initially on a voluntary basis with incentive packages for early adopters, transitioning to mandatory certification for residential facilities with more than 20 beds by 2028.
References
- WHO. Integrated Care for Older People (ICOPE): Guidelines on Community-Level Interventions to Manage Declines in Intrinsic Capacity. Geneva: WHO; 2017. ISBN 978-92-4-155010-9
- Geostat. Population Statistics and Demographic Projections 2024. Tbilisi: National Statistics Office of Georgia; 2024.
- Ministry of Labour, Health and Social Affairs of Georgia. Long-Term Care Sector Registry 2024. Tbilisi: MoLHSA; 2024.
- Eurostat. Long-Term Care Statistics 2024. Luxembourg: European Commission; 2024.
- Pkhakadze G, Beridze N. Quality of residential long-term care in Georgia: a facility-based assessment. Georgian Med J. 2025;6(2):18–27. doi:10.66636/gmj.2025.06.02.018
- European Centre for Quality in Long-Term Care. Benchmark Report 2023: Quality Indicators in Residential LTC Across 22 Countries. Brussels: EuCQTC; 2023.
Public Health Institute of Georgia
