As gains in basic health care increase life expectancy, more people live past the age of 65, a time when the risk of dementia and other degenerative diseases is higher and people are more likely to require long-term care (LTC) services. Whether at home or in an institution, such care is an important way to protect the lives and dignity of a country's elderly citizens. Unfortunately, the cost of LTC, especially in institutions, can be catastrophic for families. Without public social protection systems many people cannot afford the care they need or the high cost of care sends them and their families into poverty. Thus, LTC is not only a health issue, but also a fiscal issue and as the European population ages, it is crucial for states to develop comprehensive LTC systems that address this interrelated issue. The next section explores the demographic background of the Bulgarian population, which is one of the fastest aging in Europe. This is followed by s short-description of the macro-economic and fiscal framework in post-crisis Bulgaria. Next, an overview of LTC service provisions is given, followed by a section on financing of LTC services. The last section concludes by introducing some guiding principles for future policy reforms.