OECD (16.06.2025) As populations age, the demand for long-term care (LTC), encompassing a range of personal care and assistance services, is steadily increasing across OECD countries. Care needs assessments and eligibility criteria determine who is entitled to access publicly funded LTC services, and thereby have a direct impact on public expenditures. This paper compares needs assessment approaches across OECD countries including the criteria, tools and responsible actors, as well as the broader eligibility rules such as age and place of residence and explores the means-testing rules that determine the degree of cost-sharing applicable to LTC users. To demonstrate the impact of needs assessments and eligibility criteria on the public coverage of people in need of LTC support, the paper examines reforms (of eligibility criteria and their consequences on accessibility in five countries (Denmark, Germany, the Netherlands, New Zealand and Spain).