In Belgium, the landscape of services for the elderly is characterized by strong regionalization. The responsibilities related to senior assistance are divided among the federal government, the Regions, and the Communities, resulting in different systems, points of contact, and access criteria depending on whether one resides in Wallonia, Brussels, or Flanders. This administrative fragmentation complicates the clarity for families seeking appropriate support.
Allowance for Elderly Assistance: Procedures Vary by Region
The Allowance for Elderly Assistance (APA) is one of the main financial levers for maintaining home care. Its principle remains the same everywhere: to partially compensate for the loss of autonomy with an income supplement. However, the organization to contact differs completely from one Region to another.
In Wallonia, the application goes through AVIQ or the beneficiary’s mutual insurance. In Brussels, it is Iriscare that manages the system, with a procedure accessible via the myIriscare platform. In Flanders, one must contact a care insurance fund (zorgkas).
This disparity means that a senior moving from one Region to another must restart all their procedures with a new contact person. To quickly identify the services offered by Senior Belgium, a centralized directory can save considerable time in the face of this institutional fragmentation.
- Wallonia: AVIQ or mutual insurance, on-site medico-social assessment
- Brussels: Iriscare, online application via myIriscare
- Flanders: zorgkas, with the gradual deployment of the BelRAI-screener as an assessment tool
BelRAI-screener: The New Tool Conditioning Access to Aids in Flanders
As of March 1, 2026, access to the Flemish zorgbudget is conditioned by the BelRAI-screener, a standardized tool for assessing autonomy and care needs. This change marks a turning point in how authorities measure the dependency of an elderly person.
The BelRAI-screener is a shortened questionnaire that evaluates the functional, cognitive, and social capabilities of the senior. The result directs towards the appropriate level of care and determines the amount of the care budget to which the person is entitled.
Its deployment is gradually continuing in Wallonia and Brussels. Field feedback varies on this point: some home care professionals welcome the standardization, while others point out the risk of reducing complex situations to a numerical score. The assessment of autonomy is becoming more uniform, but not yet harmonized between Regions.
For families, the practical consequence is direct: in Flanders, without going through the BelRAI-screener, there is no access to the care budget. Checking if this protocol applies in their Region before starting the procedures avoids weeks of delay.
Leave for Family Caregivers: An Expanded System but Under Strict Conditions
Maintaining home care often relies on the involvement of a relative. Belgium expanded the leave for family caregivers in 2026, a mechanism that allows for the reduction or temporary suspension of professional activity to assist a senior experiencing loss of autonomy.
The leave is reserved for caregivers recognized by their mutual insurance. This recognition requires filling out a file attesting to the relationship with the person being assisted and the reality of the support provided. Compensation is then paid by ONEM.
The system covers several forms of work-time adjustment:
- Complete career interruption for a defined period
- Reduction to part-time or one-fifth of working time
- Possible combination with other thematic leaves under certain conditions
The available data do not allow for a conclusion on the exact number of beneficiaries in 2026, but the system remains underutilized compared to the number of people who play a caregiving role daily. Lack of awareness of the recognized caregiver status hinders access to the leave, even though it represents a concrete lever to prevent caregiver burnout.
Home Care Services in Belgium: Beyond Housekeeping
Home assistance for seniors is not limited to housekeeping tasks. The range of available services is broad: nursing care, physiotherapy, occupational therapy, medical equipment loan, administrative support, or even teleassistance.
The right contact person depends on the need. Home care and service coordination centers play a pivotal role, directing families to the appropriate providers. These centers exist in each Region, but their names and operations vary. In Wallonia, the coordination centers approved by AVIQ fulfill this function. In Brussels, equivalent structures fall under Iriscare.
Distinguishing between family assistance and housekeeping assistance is a prerequisite before any request. Family assistance involves overall support (hygiene, meals, social connection, procedures), while housekeeping assistance focuses on maintaining the home. Both fall under distinct funding and approval circuits.
For nursing care at home, the primary step remains the prescription from the attending physician. Reimbursement by health insurance covers a large part of the services, but the specific conditions depend on the INAMI nomenclature and any flat rate related to the degree of dependency.
Nursing Homes and Residential Alternatives: What the Choice Entails
When home care reaches its limits, residential structures take over. Belgium distinguishes between nursing homes (MR) and nursing and care homes (MRS), the latter accommodating residents requiring heavier medical supervision.
Service residences represent a third option, intended for seniors who are still autonomous but wish for a secure environment with à la carte services. This type of housing does not fall under the same regulatory framework as nursing homes, and the approval conditions vary by Region.
The monthly cost of a nursing home in Belgium varies significantly depending on location and level of care. Regional aids (APA, intervention from CPAS in certain cases) can reduce the out-of-pocket expenses, but total coverage remains rare. Comparing prices, included services, and admission conditions before committing remains the most protective approach for the senior and their family.
The Belgian landscape of services for seniors is gaining standardized tools and support systems for caregivers, but regional fragmentation remains the main obstacle to seamless care. Systematically checking the rules specific to one’s Region, identifying the right point of contact from the start, and anticipating evaluation timelines are three reflexes that can prevent months of administrative blockage.
