LONG TERM CARE
“Lessons from Abroad”
JUNE 2005
Dr. Rachelle Kaye
June, 2007
“Facts of Life”
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Share of older persons continues to grow
Life expectancy continues to increase
Burden of chronic disease is increasing
Degree of disability will continue to
increase
• The need for LTC will continue to grow
Organizational and Financial Dilemmas
and Tensions
• LTC is an orphan. Does it belong to health
care or social services?
• Who is responsible for LTC financing and
delivery?
• We all profess to be committed to “aging in
place”. Do we put our money where our
mouth is?
Four Types of LTC “Systems” in
OECD Countries
• Universal and comprehensive coverage for
health and LTC (Australia, Austria, Denmark,
Finland, Norway, Sweden)
• Public Social Insurance Programs (Germany,
Japan, Luxembourg, Netherlands)
• Part of Health care coverage (Belgium,
Canada, Ireland, New Zealand)
• Fragmented LTC benefits and services
(Greece, Israel, Italy, Portugal, Spain, UK, US)
PRACTICES AND
INNOVATIONS IN LTC
IN EUROPE
LTC Coverage
• Increasing public coverage, special social insurance
programs: Netherlands, Germany, Japan
• Israel:
 “liberal” but limited social insurance for personal home
care
 “family means-tested” tax-based coverage for
institutional LTC: (includes income and assets of the
dependent person and spouse and income of all
children)
 Group policies for LTC purchased by HMOs
• UK: Nursing Home –Medical and Nursing care covered
by NHS, domiciliary by family
Integration and Community Support
• Denmark :
 Integration of health and social services by the
municipality
 Community Centers provide home services geared to
community dwelling elderly: health promotion,
rehabilitation services, information, referral, day care,
meals, transportation, social and cultural activities
 comprehensive system of assessment and client
management for elderly people living in the community
 very limited user charges from the elderly for personal
care and practical assistance in the home
Integration and Community Support
• Germany
 4000 “Social Stations” – Community Centers staffed by
nurses and social workers
 coordinate a broad range of non-institutional services
including homemaker and other home help services,
counseling, shopping assistance, transportation,
equipment loan, meals-on-wheels, day care, home
nursing, psycho-geriatric nursing services, information
and referral.
 funded by a combination of state and municipal funds,
user payments and reimbursement from the sick funds
under the medical and long-term care insurance
schemes.
Primary Caregiver Support
• In every country informal caregivers
provide at least 80% of the care
• Three major threats:
Economic
Demographic/Social
Personal/Social
Financial Support for Informal
Caregivers
• Payments to compensate for loss of income
while providing care
• Carer payment in Australia, the carer's
allowance in Ireland, the allowance for families
caring for elderly in Japan and the carer's
allowance in the UK
• Recognition of caregiver time for pension points
• Long term care cash benefits: Personal Budgets
Scheme in the Netherlands, Cash Allowance for
Care in Germany, Austria and Luxembourg and
the Attendance Allowance in the UK may be
passed on to the informal caregiver.
Support Services for the Primary
Caregiver
• Policies addressing the needs of caregivers
including assessment of their needs for services,
in addition to services for the dependent person
(Australia, UK).
• Respite Care: short term institutional care of the
dependent person, day care or day activity
outside of the home or replacement of the
informal caregiver at home – in some countries
clearly defined legal benefit
Additional Kinds of Support Services
• individual counseling, support groups, training,
• appointment of a consultant for informal
caregivers,
• contact points or call centers,
• recreation and holiday trips,
• health check-ups,
• provision of information about rights, eligibilities
and services available for the dependent people
and the procedures for accessing them
(Sweden)
Summary
• Clear policy to keep dependent elderly in
the community in all countries
• Infrastructure for community based
services is crucial
• Increase in public spending because or
despite policy decision
• Co-payment: institutional and community
care
Summary (cont)
• Informal caregivers continue to be the
lynchpin
• Need for integration among services,
service providers, funding sources
• Concern about long term financial
sustainability of health and long term care
systems
Do we need a Paradigmatic Shift?
• Dramatic change in allocation of funds
from institutional (acute and LTC) to
community services
• Serious focus on support for the primary
caregiver
• LTC as part of a mandatory public
catastrophic health insurance scheme –
not a welfare benefit
• Role of private LTC insurance