"What will happen to my child when I die?"

This anxious question weighs on most parents, and even more so on parents of children with disabilities wherever high support is needed. Social protection policies in many countries aim to address the challenges of disability and aging in their many forms, but the vast majority of care - whether in the developed or developing world - is still provided by family members.

Persons with disabilities are at far greater risk of poverty and marginalization. Often earning less because of barriers to education, training and jobs, they also face higher costs for essentials like healthcare, mobility or adapted housing. Unpaid family caregiving also hits household income, and since women provide most of this support, gender inequalities are reinforced.

"This has relatively little to do with actual disabilities, and a lot to do with market, institutional and policy failures," said Indhira Santos, the World Bank's Lead Economist for Human Development in Europe and Central Asia (ECA). "Prioritizing disability inclusion and long-term care is essential for the future of our societies."

At the same time, aging populations are reshaping the landscape of care and support. Europe and Central Asia is aging faster than other regions: today 15% of the population is over 65, but low fertility rates and longer lives mean nearly one in four will be seniors by 2070. Family carers increasingly need support themselves, and the rising number of older people with disabilities is ramping up pressure on formal care services as working-age populations shrink.

Making inclusion happen

Social protection works to remove the barriers that lead to exclusion. In the European Union, people with disabilities are 50% more likely than the general population to be at risk of poverty and social exclusion, but social protection reduces that risk threefold.

Still, too many people with disabilities have little say in how they live, learn, work, or lead their lives. Existing models often perpetuate segregated services such as hospitals and care homes rather than community services. In Europe and Central Asia, children with disabilities are 6 to 30 times more likely to be placed in residential institutions due to gaps in other forms of support.

Even integration, for example through special classrooms in mainstream schools, can fall short of the commitment enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD) as the "equal right of all persons with disabilities to live in the community, with choices equal to others."

Recognising this, many countries in the region are making ambitious reforms to their social protection, care and support systems to make them truly inclusive for people with disabilities and older adults, addressing inequalities and putting the individual at the heart of the process. Investing in disability-inclusive systems not only strengthens participation and autonomy, but creates decent jobs in the care economy, fosters growth and helps reduce gender disparities.

"Disability-inclusive social protection is not a technical choice - it's a human rights obligation", said Pamela Dale, ECA Regional Advisor for Social Policy and Economic Analysis at UNICEF. "None of these changes are simple, and no country has completed the full journey yet - but every country has lessons to share."

Strengthening rights-based support systems

To meet this pressing challenge, nearly 30 government specialists from 13 countries across the ECA region joined other international experts for a core course on Disability-Inclusive Social Protection Systems and Long-Term Care, held in Vienna on October 20-24, 2025.

Organized by the World Bank and UNICEF and hosted by the Vienna Development Knowledge Center, the course encouraged participants to share their experience of disability-inclusive reforms in the region. Sessions fleshed out what a disability-inclusive social protection system can actually look like, drawing on multiple case studies.

For example, experts stressed that although individual support requires public investment, the idea that it's purely a drain on resources is a myth. On the contrary, when people with disabilities get the support they need to participate, it benefits not only them but their families, communities and society.

Sometimes a simple solution like buying an assistive technology device can prevent higher costs later on. And spending more doesn't necessarily mean better care. Participants heard about a costing tool in the United Kingdom that determines fair prices for individual care, enabling one local authority to negotiate a 30% reduction in fees to a private service provider.

More real-life examples of successful innovations and reforms:

• In a successful pilot in Romania, simple, colour-coded forms for disability assessment replaced piles of medical documents, showing that the process can be made easier for doctors and reduce the risk of error or fraud.
• Uzbekistan's full digitalization of its disability assessment system gives people a choice of how to apply: through a government online platform, a local social worker, district social services or their family doctor.
• Based on an assessment of the extra costs faced by people with disabilities and their families, Georgia has developed a comprehensive support package that aims to address specific needs and barriers.
• In Sweden, people with disabilities with high support needs have a legal right to personal assistance, enabling them to lead independent lives. The JAG cooperative works to make this a reality by allowing them to choose and manage this assistance, supported by close relationships with representatives who safeguard their interests.
• In Spain, a phone app channels job-specific training or step-by-step reminders to people with disabilities, opening the door to more autonomy and better work prospects in mainstream employment.
• In Belgium's Flanders region, jobseekers with disabilities receive an individual "backpack" of subsidies that they can take either to mainstream employers or specialized social enterprises.

Slavica Milojevic of Serbia's Republic Institute for Social Protection said talking to colleagues from across the region opened her eyes to new ways of thinking about issues such as accessibility or finance.

"I learned so much," she said. "Even though I've been working in the disability area for more than 20 years, I never raised some of these questions."