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Care and Health Observatory
ESEN

Costa Rica

Care support and access. Emerging evaluation evidence.

National profile

Sources reviewed 13 November 2026

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In brief

Costa Rica’s SINCA framework recognizes caregiver support, quality of life and training. Current plans add stress management and respite targets, while two strands of evaluation reporting provide evidence to examine carefully.

For policy practice

Check eligibility, actual service assignment and the outcome being measured. Registration does not guarantee immediate support, and a small pilot does not establish the effects of the national system.

Caregiver health in policy

Scroll across the table to read all three columns.

Documented support and evidence status
Support or measureWho it addressesEvidence status
Self-care and burnout preventionCaregivers addressed by action 5.1.52024–2026 plan commitment
Training and respiteHeredia trainees and proposed municipal respite-centre usersTargets, not verified achievements
Severe-dependency benefitHouseholds with a male or female caregiver and a co-resident person assessed with severe dependencyCurrent IMAS benefit rule

Some professional-college training is restricted to nursing professionals or assistants. It cannot all be counted as support for unpaid family caregivers.

Time devoted to unpaid care

In Costa Rica’s 2022 time-use survey, women who actively cared for a totally dependent household member aged 12 or older reported more time in that activity than participating men. Active care is direct care; simultaneous monitoring while doing something else is measured separately. The averages describe people who performed the activity, not all adults.

INEC estimated that 2.6% of the surveyed population lived in a household with a totally dependent person aged 12 or older. Among people aged 12 or older, 2.0% of women and 1.3% of men participated in this care. INEC marks the men’s participation estimate as unreliable (coefficient of variation 25.8%). Neither figure measures receipt of a SINCA service.

Weekly active care of a totally dependent household member, October–November 2022
Participants aged 12 or olderAverage hours:minutes per week
Women13:32
Men6:25

Average among people who performed this activity, by sex. The person receiving care was aged 12 or older. The male time estimate is imprecise: 47 survey respondents, 95% confidence interval 4:04–8:47, coefficient of variation 18.8%.

Policy and institutions

Law 10.192

A national framework

SINCA’s technical secretariat sits in IMAS. Regulation 44.242 prioritizes dependency and, within equal dependency, socioeconomic vulnerability.

2024–2026

An adopted action plan

Monitoring duties and dependency-assessment obligations are documented. A subsequent four-year plan was being formulated in October 2026; it is not substituted for the adopted plan here.

Eligibility and finding support

The IMAS procedures manual approved in March 2026 describes the severe-dependency benefit category for a female or male caregiver who lives with the household member assessed as severely dependent. The dependency assessment and other applicable rules determine eligibility; a category description alone does not guarantee a benefit.

IMAS says Cuidar.cr, launched at the end of 2024, lets households find trained individual caregivers and care organizations or businesses to contact for hiring. It also offers the Cuidar+ credential. A directory entry does not itself provide a public subsidy or guarantee availability.

Implementation and financing

The action plan targets 150 participants in Heredia caregiver training across 2024–2026 and two municipal Casa cuidador respite centres, one each in 2024 and 2025. Completion has not been verified in this review.

Read these figures with their scope

Training and respite targets are not verified achievements. Registration does not guarantee immediate service assignment, which depends on resources and technical assessment.

Financing

The 2025 annual report’s severe-dependency-only category lists 6299 households, 6311 persons and CRC 5,261,251,885. A separate combined severe-dependency/basic-needs category lists 10 households and CRC 6,480,000. The categories may overlap and are not summed here. These are program figures, not total SINCA expenditure. The table’s footer says March 2025, while matching totals point to year-end 2025. IMAS has not confirmed the reference period, which remains unresolved.

From a local pilot to a system

An IMAS report covering April 2023 to December 2024 recorded 214 Heredia teleassistance devices installed and 103 pending at its reporting snapshot. It said the remaining installations would follow completion of the control group. The report also describes coordination with San José and Cartago to consider implementation in 2025; it does not confirm deployment there.

The 2024–2026 action plan assigned Heredia targets of 150 caregiver-training participants and two municipal Casa cuidador respite centres. These are planned targets; the sources reviewed do not establish completion.

The same IMAS report documents work to apply the dependency assessment in several regional areas, including Heredia and an Indigenous territory, and to integrate assessment records into SINIRUBE. It describes these actions during the 2023–2024 management period; it is not a census of people currently served.

Findings and limits

Testing cash and teleassistance

The cash pilot preceded SINCA. Its small sample, short follow-up and self-reported outcome questions limit interpretation.

A randomized cash-for-care pilot surveyed 46 unemployed women caring for a co-resident, with 23 in each group. The intervention provided USD 141 monthly for four months; surveys took place in November 2021 and February 2022. The authors reported reduced distress, but their table shows the treatment group’s affirmative responses for fear, stress, feeling depressed and anguish rising from pre-test to post-test. This unresolved inconsistency prevents a reliable conclusion about the direction of those outcomes. The authors found no significant within-group gain in employment or leisure; their spending question compared intended with actual use of the transfer, not whether basic needs were adequately met.

A 2026 Heredia municipal announcement reports a randomized teleassistance evaluation with 636 people, while a 2025 conference abstract reports 634 older adults and family caregivers. The full 2026 article was not accessible for appraisal, and the caregiver outcome denominator, instruments and attrition remain unclear. The reports may concern the same trial.

The 2025 teleassistance abstract reports reduced caregiver burnout, but gives no usable effect size or separate caregiver denominator.

The cash pilot used simple yes-or-no questions about feelings attributed to caregiving, including exhaustion and feeling depressed. These responses can reveal experiences within the study, but they are not clinical diagnoses. Treatment and control groups also differed in household size and the availability of another caregiver at baseline.

The table’s control group also shows rising affirmative counts, often by more than the treatment group: fear 11 to 18 versus 10 to 17, stress 6 to 19 versus 9 to 18, depression 9 to 19 versus 7 to 14, and anguish 7 to 19 versus 5 to 13. The post-test between-group contrasts and the authors’ reduction narrative therefore need to be read together with the unresolved coding or reporting problem; these counts alone do not demonstrate harm.

Local cases

Territorial perspective / Costa Rica

Heredia

The caregiver-training target and teleassistance evaluation identify a useful local setting. Their populations and activities differ; they should not be combined into a single measure of municipal performance.

The Heredia case describes a local service; it does not establish national coverage.

Heredia’s teleassistance service

A 2025 national mapping study reported 317 users of Heredia’s municipal teleassistance and estimated a local-government cost of CRC 8,900 per user per month in its study context. The count matches the 214 installed and 103 pending devices in the IMAS report; their overlap with the trial’s intervention group has not been independently established. In October 2026, the municipality reported that it had subsequently added the former control group as active users. The historical count does not establish current availability.

The IMAS management report also describes an institutional service catalogue by dependency level and a georeferencing tool for care organizations. The underlying datasets were not retrieved, so their coverage and present availability remain unverified.

Sources

National survey results, local service reports and small trials describe different populations. The available sources do not provide a national service register or comparable measures of access, spending and caregiver-health outcomes.

What the figures represent

The time-use results come from a national household survey; the Heredia service milestones come from local administrative and study reports. They measure different populations and cannot be added together. The cash pilot measured individual questionnaire responses over a short period, rather than clinical diagnoses or national programme outcomes.