LTCcovid Country Profiles

Responses to 1.00. Brief overview of the Long-Term Care system

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.

 

About this question

This question provides a very brief characterisation of the long-term care system (including whether there is a national system or whether there are different systems at regional/provintial/state level), the degree of reliance on unpaid and informal care, key characteristics of the system and numbers: e.g. number of care home beds/residents, share of population living in care homes, using community based care, numbers/use of unpaid care(rs).

Overview

Definitions of Long-Term Care:

In the World Report on Ageing and Health published in 2015 by the World Health Organization, Long-Term Care was defined as  “the activities undertaken by others to ensure that people with, or at risk of, a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity”. This definition supports the idea of a system to enable people to live their best lives, irrespective of their disabilities and health conditions.

Long-term care “systems”

In practice, long-term care covers a wide range of services and activities that can take place in various settings, including the beneficiary’s home, their neighbourhood, hospices, residential settings and day-care facilities.

Long-term care benefits, services and activities typically span multiple government departments (health, social welfare, labour, housing) and levels (national, regional, local, community and family), which leads to fragmentation of responsibility, difficulties in coordination and, from the point of view of the persons who could benefit from services, benefits and activities, barriers to access.

In this section we aim to provide a very brief overview of long-term care systems around the world, at national or sub-national level. The term system is used as in the WHO World report on Ageing and Health, to refer to: all caregivers and settings where care is provided, as well as the governance and support services that can help them in their roles. This definition includes care provided in the formal and informal sector, paid and unpaid, publicly and privately provided and delivered, in people’s own homes, in the community and in institutional settings.

This is a comprehensive definition of long-term care covering care and support in the community and in congregate (“institutional”) settings, by formal care providers and by unpaid carers, and for younger and older adults. Some of the definitions used in the reports from the different countries may vary in terms of the groups and types of care included.

It is important to emphasise that experiences of a “long-term care system” (and care outcomes) differ, not only depending on which country/region they live in, but also by their local context (which is why there is growing use of the term “care ecosystem” see for example Dessers & Mohr, 2020), and of their own individual and family circumstances.

References:

Dessers, E. and Mohr, B. J. (2020) ‘An ecosystem perspective on care coordination: Lessons from the field’, International Journal of Care Coordination, 23(1), pp. 5–8. doi: 10.1177/2053434519896523.

 

International reports and sources

OECD countries

The Organisation for Economic Co-operation and Development (OECD) publishes regularly international reports and data on long-term care (click here).

WHO data

Some data on long-term care, for example on the numbers of countries that have a long-term care policy/plan/strategy is also available from the WHO’s Ageing Data portal (click here).

European countries

For European countries, the European Centre for Disease prevention and control (ECDC), also publishes data on the numbers of people in Long-Term Care Facilities (ECDC), and on number of beds (click here) There are country reports from EU countries (2018) on EU website:  (click here).

Latin American and Caribbean countries

the Interamerican Development Bank has developed the Panorama of Aging and Long-Term Care, gathering indicators, publications and case studies to support policy development (click here).

What is understood as Long-Term Care in Australia?

In Australia the term ‘long term care’ is seldom used.  ‘Aged care’ is the more common term.

Unlike many other countries older Australians needing support and people with disabilities aged under 65 are funded and supported under two distinct Australian government policies and funding arrangements: Aged Care and the National Disability Insurance Scheme (NDIS).

Aged Care

The two main forms of government-subsidised aged care (LTC) are residential aged care and home care.

The Australian government is the primary funder and regulator of the long-term care system. The government subsidises both home care and residential care for people of all ages who have been assessed as needing care and support. There are four main types of services under aged care: the Commonwealth Home Support Programme (CHSP) Home Care Packages (HCP), residential care and flexible care. More than 1.2 million people received aged care services during 2017–2018. 77% received support in their home or other community-based settings. Of Australians over the age of 65, 7% accessed residential aged care, 22% accessed some form of support or care at home, and 71% lived at home without accessing government-subsidised aged care services (sources: Care, Dignity and Respect report; Aged Care and COVID-19 report).

The National Disability Insurance Scheme (NDIS)

The NDIS, implemented from 2013 to 2020, has established a needs-based system of care and support for people with disability with ‘permanent and significant’ disability, with assessment of need based on level of impairment. The NDIS provides individualised support for approximately 500,000 people across Australia (Hamilton et al forthcoming).

Last updated: February 15th, 2022   Contributors: Sara Charlesworth  |  Wendy Taylor  |  Lee-Fay Low  |  

Austria is a federal state and was one of the ‘early movers’ when it came to acknowledge long-term care (LTC) as a social risk that calls for solidarity and societal support for people in need of long-term care. With the introduction of the LTC allowance scheme in 1993, Austria followed its tradition as a continental, conservative welfare regime in which cash benefits dominate over the provision of social services. At the same time, the country deviated from this pathway as funding of the LTC allowances (attendance allowance) has been stipulated through general taxes rather than as a fifth pillar of the social insurance system.

With this original reform, competences between the federal state and the nine provinces were reshuffled in that the federal government became responsible for financing all cash benefits, including support for informal carers, while the provincial governments remained in charge to procure community care services and residential facilities. Indeed, home care services are almost entirely provided by private non-profit organisations (based on a long-standing tradition), while about 50% of residential facilities are managed by public entities, 25% by non-profit organisations, while the share of private for-profit providers has been increasing and is currently also at about 25%. To date, there are about 75,000 places in care homes, about 7,000 places in alternative housing and short-term facilities, while about 150,000 persons are using one or the other home care service throughout the year (Statistics Austria, 2021). As there are about 470,000 beneficiaries of the LTC allowance, it becomes evident that the large majority of people in need of care is being cared for at home with support by an informal carer, mainly by wives, daughters and step-daughters. In total, it has been estimated that there are about 801,000 Austrians involved in caring for a loved one at home, while 146,000 are supporting a family member who is living in a care home, i.e. more than 10% of the population (Nagl-Cupal et al., 2018).

A survey found that many Austrians experienced barriers to accessing care services, with availability of services being a major factor, as well as cost. Compared to other countries in the European Union, Austrians reported more concerns about the availability of residential care. This lack of availability of services translate in over-reliance on informal support and low confidence on the ability of the system to address future care needs (Ilinca et al., 2022)

Against this backdrop, a specific feature of the Austrian LTC system has developed over the past 25 years in terms of a partial replacement (or supplementation) of family care by live-in personal carers, mainly from neighbouring Eastern European countries. Although live-in migrant care is a widespread phenomenon across Europe, the so-called ‘24-hour care’ model in Austria has a special status with dedicated legal regulations and funding since 2007 (Schmidt et al., 2016). ‘Personal carers’ are registered as self-employed at the Austrian Chamber of Commerce, although most of them are also dependent on specialised brokering agencies in their home country or in Austria (Aulenbacher et al., 2020). Due to the geographic situation as well as to unemployment and wage differentials in neighbouring countries, the share of older people in need of care relying on migrant live-in carers has increased significantly over the past 15 years. To date, more than 66,000 personal carers accompany about 33,000 Austrians in need of care in their own households (ca. 7% of total beneficiaries of the LTC allowance).

This phenomenon contributes to additional complexity in the already fragmented structural framework of LTC in Austria. The lack of coordination among different LTC settings, and in particular between these and the acute health sector, has been a constant criticism over the past decades, and related caveats became even more evident since the onset of the SARS-CoV-2 pandemic and related measures such as travel restrictions and the closing of borders (Leichsenring et al., 2021).

Current initiatives are striving to address shortcomings in information, communication and coordination by means of a pilot project to establish 150 community nurses at municipal level. However, the imminent shortage of workforce in the LTC sector and related challenges of sustainable funding are calling for urgent and more far-reaching reforms. There are currently about 60,000 professionals working in the various settings of LTC. It has been forecasted that a minimum of 30,000 additional professionals would be necessary until 2030 to replace retiring staff and to satisfy the growing demand of formal care (Rappold & Juraszovich, 2019).

References

Aulenbacher, B., Leiblfinger, M. & Prieler, V. (2020). “Jetzt kümmern sich zwei slowakische Frauen abwechselnd um meinen Vater …” Institutionelle Logiken und soziale Ungleichheiten in der agenturvermittelten 24h-Betreuung. In: Seeliger, M., Gruhlich, J. (Hg.). Intersektionalität, Arbeit und Organisation. Weinheim and Basel: Beltz Juventa.

Ilinca S., Simmons C., Leichsenring K., Kadi S., Ondas K. & the InCARE team (2022) Attitudes, experiences, and expectations on long-term care in Austria. InCARE Factsheet No.1.

Leichsenring, K., Schmidt, A.E., Staflinger, H. (2021). Fractures in the Austrian model of long-term care: What are the lessons from the first wave of the COVID-19 pandemic? Journal of Long-Term Care, 2021, 33-42. DOI: https://doi.org/10.31389/jltc.54

Nagl-Cupal, M., Kolland, F., Zartler, U., Mayer, H., Bittner, M., Koller, M., Parisot, V., Stöhr, D., Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz (Hg.) (2018). Angehörigenpflege in Österreich. Einsicht in die Situation pflegender Angehöriger und in die Entwicklung informeller Pflegenetzwerke. Wien: Universität Wien/BMASGK.

Rappold, E. & Juraszovich, B. (2019). Pflegepersonal-Bedarfsprognose für Österreich. Wien: Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz.

Schmidt, A.E., Winkelmann, J., Leichsenring, K. & Rodrigues, R. (2016).  Lessons for regulating informal markets and implications for quality assurance – the case of migrant care workers in Austria.  Ageing & Society, 36(4), 741-763.

Statistics Austria (2021) Betreuungs- und Pflegedienste, available at http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/soziales/sozialleistungen_auf_landesebene/betreuungs_und_pflegedienste/index.html

Last updated: March 22nd, 2022   Contributors: Kai Leichsenring  |  

The majority of people with support needs receive care from their family members, mostly women.

There is some provision of subsidized institutional care. In principle all long-term care facilities should be registered with the Ministry of Health and subject to staffing requirements. However, it has been estimated that half of all care homes are not registered or unregulated.

References:

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Browne, J., Palacios, J., Madero-Cabib, I., Dintrans, P. V., Quilodrán, R., Ceriani, A., & Meza, D. (2021). Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile. Journal of Long-term Care, 114–123. DOI: http://doi.org/10.31389/jltc.72

 

Last updated: February 16th, 2022

Long-term care is mostly provided by family and other unpaid carers, with some provision by paid carers for those who can afford it. The Government covers the costs of care for people who fit the “Three No’s” category: no ability to work, no income and no family. Relying on families as the main source of care is increasingly under question given demographic and social changes resulting in smaller and geographically dispersed families. In response to this, the government has increased its focus on developing a formal long-term care system, initially through encouraging the rapid development of a private institutional care sector, setting targets for numbers of beds. This took place before developing regulation and quality assurance mechanisms and has led to the lack of development of community-based care. There are shortages of trained care professionals. There have been pilots of social long-term care insurance in 16 cities since 2016, with strong policy interest on these as a mechanism for long-term care financing. For a good overview read Feng et al. (2020).

Last updated: January 6th, 2022

Informal care constitutes a major part of care provided to older and dependent people. It is estimated that roughly 52% to 75% of care is provided by relatives, at home. The introduction of care allowance in 2007 has been the most significant change in the social services system since the 1990s, and the allowance has been used to compensate informal carers. Formal LTC is based on a two-tiered system of regulation, funding, and services provision—separate for the health sector and for the social services sector and some private provision of LTC services have been developing, including a rise of unregistered LTC services (Sowa-Kofta et al., 2017).

References:

Sowa-Kofta, A., Wija, P. (2017). Czech Republic: Emerging policy developments in long-term care. CEQUA country report.

Last updated: February 3rd, 2022

The Long-Term Care (LTC) system in Denmark is a universal and primarily public system. Access to LTC services is at no cost for home-based care, and with a means-tested co-payment for residential care. The LTC system has strong public and political support. It is a highly decentralized system, organised, and financed at the municipal level. Provision is mixed, with public and for-profit providers providing home care, and in the residential sector, non-profit providers also operate.

There is historically a strong emphasis on community-based care, integration, prevention and  professionalization of care staff (WHO, 2019). The development of long-term care for older people has in Denmark been heavily influenced by the various reports from the National Commission on Ageing in the 1980s. The policy recommendation was here not least to encourage the increasing use of private resources, such as the involvement of voluntary organizations, but also referred to ensuring self-care (hjælp-til- selvhjælp) in old age, and in this way encourage a more preventive and rehabilitative approach. The reports also introduced principles of continuity and normalization, meaning that regardless of need for care the provision of care should aim at ensuring the continuation of the older person’s preferred way of living. From the 1990s onwards, marketisation and, more implicit, privatisation has been encouraged (Rostgaard, 2007).

In 2015, reablement was introduced in the legislation and must be offered instead of conventional home care is the older person is assessed to have so-called potential for this intervention (Rostgaard et al, 2023).

The main law regulating social service provision and, implicitly, LTC provision is the Social Services Act, which passed in 1998. The Social Services Act emphasizes the users’ right to influence social service provision and enshrines the highly decentralized nature of the system, putting municipalities in a key position to shape long-term care. As health care provisions are under the scope of the Health Care Act, there is political awareness of the problems of coordinating interventions and time-consuming double documentation. At present (2022), work is therefore carried out to reform the legislation and combine the two laws under one, a Senior Citizens’ Act.

In recent years there has been a decrease in the number of people who receive home care services, which resulted in unmet need and more burden placed on unpaid carers (WHO, 2019; Rostgaard, 2022 et al).

References:

Rostgaard, T., Tuntland, H. and Parsons, J., (eds.) (2023) Reablement in Long-Term Care for Older People – International Perspectives and Future Directions. Bristol: Policy Press.

Rostgaard, T., Jacobsen, F., Kröger, T. & Petersen, (2022) ‘Revisiting the Nordic long-term care model for older people— still equal?’ in European Journal of Ageing. 19, 2, pp. 201-210.

Rostgaard T. (2020), The COVID-19 Long-Term Care situation in Denmark. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 25 May 2020.

Rostgaard T. (2016) Socially investing in older people – reablement as a social care policy response? Res Finnish Soc. 2016;9:19–32.

Rostgaard, T. (2007) Begreber om kvalitet i ældreplejen. Temaer, roller og relationer, Socialforskningsinstituttet 07:13. København: Socialforskningsinstituttet.

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019.

Last updated: June 28th, 2023

Care for older people in Finland is primarily delivered at home and in the community. Over 90% of the older population (75+) live in their own home, with the majority receiving no formal care (~75%), some receive regular home care, or informal care. Less than 10% of the older population receives some kind of 24-hour sheltered housing or institutional care (source: https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view).

Last updated: January 6th, 2022

Currently, there are 7,502 residential long-term care facilities welcoming 610,000 residents. Of these, 50% are public, 31% are not-for-profits and 24% are for-profit. There are 2,294 supported living settings. Hospitals also offer long-term care units, where there were 32,790 patients recorded in end-2015. There are approximately 886,000 people in receipt of domiciliary care, most of which are older people. Nursing and polyvalent domiciliary care services provide services to 125,7000 service users, and domiciliary care services provide care to 760,000 people (source: https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf).

In 2015 there were 1.25M beneficiaries of the personal autonomy allowance for people over 60 in need of assistance with activities of daily living. (8% of over-60s)

The domiciliary care sector is extremely fragmented, with one department (local authority) having over 100 agencies. Financing is unprofitable. The difference between hourly rates under the personal autonomy allowance  and minimum hourly rates to cover costs were of 2.2€/hour in 2017.

Health policies are implemented by the Regional health agencies at the regional level (ARS, created in 2009). Social policies are under the responsibility of the local authorities at the local decentralized level. There is a joint responsibility for tariff setting and financing of operations in care homes. ARS do not have oversight of domiciliary care, except where a nursing component is involved.

Last updated: February 16th, 2022   Contributors: Camille Oung  |  

In 1995/96, a statutory Long-Term Care Insurance (LTCI) Scheme has been established in Germany. LTCI is mandatory to the population. Approximately 88% of the population is insured by the social LTCIs, 11% by private funds (Blümel et al., 2020). LTC benefits based on the LTCI are not means-tested.

In 2019, there were about 4.13 million beneficiaries of the LTCI that have been allocated into care grades 1 to 5. Out of these, approximately 0.91 million people were living in residential care homes, while most people receive care and support at home (80%). Those living in their own home may choose between cash and in kind-benefits from LTCI. More than 60% receive cash benefits to be supported by informal carers only while almost 30% choose in kind-benefits, partly mixed with cash-benefits, to use also formal care. Approximately 80% of people with LTC needs living at home have a level 2 and 3 care need (Destatis, 2020).

References

Blümel, M., Spranger, A., Achstetter, K., Maresso, A. & Busse, R. (2020) ‘Germany Health system review‘ Health Systems in Transition, 22(6). Available at: https://apps.who.int/iris/bitstream/handle/10665/341674/HiT-22-6-2020-eng.pdf?sequence=1&isAllowed=y (Accessed 11 February 2022).

Destatis (2020) Pflegebedürftige nach Versorgungsart, Geschlecht und Pflegegrade. Available at: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Pflege/Tabellen/pflegebeduerftige-pflegestufe.html(Acessed 31 January).

Last updated: February 16th, 2022   Contributors: Klara Lorenz-Dant  |  Thomas Fischer  |  Kerstin Hämel  |  

Particularly in rural communities in Ghana, children are expected to provide care for their parents if they need it when they are older. However, people who have no children or cannot have their support have difficulties accessing care should they need it (Deku et al., 2020).

References:

Deku, C. S., Forkuor, J. B., & Agyemang, E. (2021, March 1). COVID 19 meets changing traditional care systems for the elderly and a budding social work practice. Reflections for geriatric care in Ghana. Qualitative Social Work. SAGE Publications Inc. https://doi.org/10.1177/1473325020973323

Last updated: February 16th, 2022   Contributors: William Byrd  |  

Care for older people in Iceland is delivered at local level through community based services such as home health (covering personal care and nursing) and social social care services (help with domestic tasks, meals and wheels, etc), funded by the municipalities. There are also service and day care centres to support people who live in their own homes. Responsibility for home health is with the home health district and responsibility for social services with the municipalities. Residential and nursing homes are provided by both public (usually municipal) providers and private non-profit and for-profit providers, the state pays the greatest share or the cost of running care homes.

In 2011-12, 21% of older people aged 80 or more were living in institutional facilities and 43% were receiving home home help, the share of older people in institutional facilities is higher than in other Nordic countries and this has been attributed to an incentive for the municipalities to shift costs to the state.

References:

Sigurveig H. Sigurdardottir, Omar H. Kristmundsson & Steinunn Hrafnsdottir (2016) Care of Older Adults in Iceland: Policy Objectives and Reality, Journal of Social Service Research,42:2, 233-245, DOI: 10.1080/01488376.2015.1137535

Last updated: February 16th, 2022

There is no formal or organized public LTC system in India, however a number of schemes cover some aspects of care for older people or people with disabilities and mental health conditions. Families (particularly women) are the main source of care, as well as untrained care workers such as “home attenders”. It is common to live in multigenerational households which providers opportunities for the rotation of carers and sharing of tasks, however, there are growing number of nuclear families, suggesting that this model of care will become less important over time (Rajagopalan et al., 2020).

There are some formal care services available, mostly provided by private and not-for-profit organisations, these include residential care, day care centres, geriatric care in some government and private hospitals and services by non-governmental organisations (Ponnuswami et al., 2017).

There are several policies and public programmes that aim to promote the welfare of older people and people with disabilities providing the legal framework. Social Welfare is implemented by the States, which means that there are important variations in the implementation of measures to support older and disabled people (UNESCAP, 2016).

References:

Ponnuswami I. and Rajasekaran R. (2017) Long-term care of older persons in India: Learning to deal with the challenges. International Journal on Ageing in Developing Countries, 2(1):59-71.

Rajagopalan. J., Huzruk. S., Arshad. F., Raja.P., Alladi. S. (2020). The COVID-19 Long-Term Care situation in India. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 30th May 2020. https://ltccovid.org/wp-content/uploads/2020/05/LTC-COVID-situation-in-India-30th-May.pdf

UNESCAP (2016) Long-Term for Older Persons in India. SDD-SPPS Project Working Papers Series: Long-Term Care for older persons in Asia and the Pacific.

Last updated: February 16th, 2022

Most LTC in Ireland is provided by unpaid carers supplemented by home care services. There are more public resources available for residential care than for home care services. By December 2018, 581 nursing homes in Ireland registered with the Health Information and Quality Authority offered 31,250 places for people with care needs. More than 460 of the homes are operated by private or voluntary (not-for-profit) providers), supporting 25,000 people. Ireland also has some ‘psychiatry of later life units’. Most of the residents are 65 years and older. Publicly funded support for home care can be obtained following a needs assessment conducted by a healthcare professional. So far financial means are not taken into consideration. Most home care services are provided by private providers, but these providers are contracted by the State. The role of the public sector in the delivery of home care is relatively small (Pierce et al., 2020).

References:

Pierce, M., Keogh, F., O’Shea, E. (2020). ‘The impact of COVID-19 on people who use and provide long-term care in Ireland and mitigating measures.’ Country report available at LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 13 May 2020

Last updated: February 16th, 2022

Israel has a fragmented LTC system with the National Insurance (NI), the Ministry of Health and the Ministry of Welfare and Social Affairs, holding different yet overlapping responsibilities for publicly funded LTC (source: Taub Centre).

Notably, Israel was one of the first countries to introduce publically financed LTC insurance. Still, it is not universal and is of partial coverage for the mild and severely disabled older people. Most of the LTC treatment in Israel is community-based. At the beginning of 2020, some 220,830 older people received publicly funded LTC services at home (source: National Insurance Institute of Israel).

Last updated: February 11th, 2022   Contributors: Sharona Tsadok-Rosenbluth  |  

The public system of LTC in Italy is underdeveloped and characterised by a high degree of institutional fragmentation, as sources of funding, governance and managerial responsibilities of public services are spread over local (municipal), regional and national authorities, with different methods according to the institutional models of each region (Gabriele et al., 2014). This fragmentation relates to the fact that the LTC sector originates from multiple legislative interventions over a period of more than 30 years.  Unpaid carers as well as care assistants privately hired by households,  represent the bulk of LTC provision (Fosti et al., 2021). There is no official data on the number of unpaid family carers, but estimates from 2018 suggest that about 2.8 million people aged 18-64 were involved in caregiving for their older or disabled relatives (ISTAT, 2019). Also the total number of home care assistants (privately employed, primarily migrant care workers) is unknown, but it has been estimated that this involves over 1 million people (Fosti et al., 2021).

References:

Barbarella F, Casanova G, Chiatti C and Laura G (2018), ‘Italy: emerging policy developments in the long-term care sector’.  Retrieved from: CEQUA LTC network report.

Fosti G, Notarnicola, E. and Perobelli, E. (2021), Le prospettive per il settore socio-sanitario oltre la pandemia. Rapporto Osservatorio Long Term Care 3. CERGAS, Università Bocconi. Retrieved from: il+welfare+e+la+long+term+care+in+europa+cover.pdf (unibocconi.it)

Gabriele S and Tediosi F (2014), Intergovernmental relations and Long Term Care reforms: Lessons from the Italian case. Health Policy 116 (1) 61-70. https://doi.org/10.1016/j.healthpol.2014.01.005

ISTAT (2019): CONCILIAZIONE TRA LAVORO E FAMIGLIA. Retrieved from: https://www.istat.it/it/files//2019/11/Report-Conciliazione-lavoro-e-famiglia.pdf

Rotolo, A. 2014. ‘Italia.’ In Fosti, G and Notarnicola, E, (eds). Il Welfare e la Long Term Care in Europa. Modelli istituzionali e percorsi degli utenti, 93–114. Egea, Milano. Retrieved from: il+welfare+e+la+long+term+care+in+europa+cover.pdf (unibocconi.it)

Last updated: February 16th, 2022   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

There is relatively little published information on the long-term are system in Jamaica. An article that set out to map long-term care in Jamaica found that care is largely provided by informal carers (both unpaid and paid). There is a high prevalence of unregulated care homes and limited formal home and community-based services. NGOs and places of worship are an important part of the few community-based services available (Goviat et al., 2021).

References:

Govia I, Robinson JN, Amour R, Stubbs M, Lorenz-Dant K, Comas-Herrera A, Knapp M. Mapping Long-Term Care in Jamaica: Addressing an Ageing Population. Sustainability. 2021; 13(14):8101. https://doi.org/10.3390/su13148101

 

Last updated: February 16th, 2022

Most of Japan’s LTC services are covered by the mandatory long-term care insurance (LTCI) introduced in 2000. Japan’s LTCI—which is administered by municipal governments—is operated independently of the medical insurance system and subsidizes non-medical benefits-in-kind including residential (long-term and short-term) day care services and home care services, as well as the cost of home adjustments to enable older citizens to live in their homes safely. When an insured person requires services, the municipal government evaluates and determines the level of care to be covered by LTCI. Insured persons then contract any service provider of choice within the municipality and pay a 10% co-payment. The remaining 90% of the service cost is reimbursed directly to the service providers by the municipal LTCI (Estévez-Abe and Ide 2021a).

The Japanese publicly-funded LTC system consists of residential and non-residential care sectors. The Japanese LTCI subsidizes day care services and home care services in addition to residential care services.  Unlike many European countries, the Japanese LTC system does not offer cash benefits to people in need of care (Estévez-Abe and Ide, 2021b).  Families do not receive any compensation for providing care and support to their relatives and there is almost no reliance on informal paid care by natives or migrants (Estévez-Abe and Caponio 2022).

Residential LTC facilities are broadly divided into quasi-public facilities and for-profit facilities. The LTCI subsidizes the cost of care provided in all quasi-public facilities and a sub-section of for-profit facilities (Estévez-Abe and Ide 2021a, 2021b). The quasi-public facilities include: (i) Special nursing homes; (ii) Long-term care health facilities; (iii) LTC medical facilities; (iv) Sanatorium medical facilities; (v) Social welfare facilities for older citizens. The first category of facilities provides non-medical nursing care for older people who require highest level of LTC. The second category are facilities that provide nursing care to older people who are undergoing rehabilitation with the goal of returning home. Although the official goal is that patients do not stay in these facilities for more than 3 months, many of them stay for more than 6 months. The third and fourth categories are hospitals for elderly patients requiring nursing care in addition to medical care. (The third category will be phased out and integrated into the fourth type.) The fifth category are residential social welfare facilities for older people who find it difficult to live at home due to non-age-related disabilities, lack of economic means and/or family support. Traditionally, the non-profit sector has dominated this particular LTC sector because of the quasi-public nature of the services.

The LTCI only subsidizes the cost of care provided in for-profit facilities that are specifically licensed by municipal governments (Estévez-Abe and Ide 2021a). In light of its rapidly aging population, the Japanese government is giving financial incentives to for-profit eldercare facilities to convert to proper nursing homes (Aramaki 2020).

Using the data presented in Estévez-Abe and Ide (2021a) and the population data from the Japanese government (Stat.go.jp)  we can estimate that there were roughly 26 LTC beds for every 1,000 people aged 65 and older in 2017 when we adopt the narrowest definition of LTCF—that is, excluding the second and third categories mentioned earlier (OECD estimates it to be 24.1, see OECD 2019 Figure11.26).  When we include all five categories of LTCFs, the number of beds increases to 38. When we further include the number of beds in for-profit eldercare homes not licensed to provide nursing care, the number goes up to 57.

In Japan, the non-residential care sector is significantly bigger than the residential sector. In 2014, 7.8% of those aged 65 or older used day care in Japan. According to Maeda (2020), 4 million older persons used day care facilities in 2019. This roughly translates to 11% of the population aged 65 and older.

References:

Aramaki, Seiya. 2020. “The content of the latest revision of fee schedule for for-profit nursing homes.” https://kaigo.jp/column/entry/497/ accessed on March 16, 2022.

Estévez-Abe M and Hiroo I (2021a) “COVID-19 and Long-Term Care Policy for Older People in Japan,” Journal of Aging & Social Policy, 33:4-5, 444-458, DOI: 10.1080/08959420.2021.1924342

Estévez-Abe, Margarita and Hiroo Ide. (2021b). ““COVID-19 and Japan’s Long-Term Care System.” LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, February 27, 2021. Retrieved from: ltccovid.org

Maeda K. Outbreaks of COVID?19 infection in aged care facilities in Japan. Geriatr. Gerontol. Int. 2020;20:1241–1242. 10.1111/ggi.14050. https://onlinelibrary.wiley.com/doi/10.1111/ggi.14050

OECD. 2019. Health at a Glance 2019. Paris: OECD.

Statistics 65: http://www.stat.go.jp/data/jinsui/2017np/index.html

Last updated: January 20th, 2023

The main players in the provision of formal LTC are: the national government, 119 local governments and 110 municipalities. In 2015, the 15-state financed social care institutions provided LTC social services for 5,353 clients; 86 local government and other organization social care centres provided LTC social services for 6,134 clients. Additionally, there were 83 such institutions in the country provided by local government in 2010, and the number increased to 86 institutions by 2015 (Calite-Bordane, 2017).

References:

Calite-Bordane, D. (2017). ‘Latvia: Emerging policy developments in long-term care’. Retrieved from: CEQUA Latvia Country report

Last updated: February 16th, 2022

The Maltese long-term care system is not even, in that service delivery for the older person requiring care, is spread across 3 Ministries, (a) Ministry for Health in Malta, (b) Ministry for Senior Citizens and Active Ageing in Malta, and (c) Ministry for Gozo, (source: https://www.gov.mt/en/Government/Government%20of%20Malta/Ministries%20and%20Entities/Pages/default.aspx). In the case of Public Private Partnership (PPP) agreements for private and church-run insitutions, 3 separate admission/assessement/care criteria and contractual obligations are therefore employed in lieu of the differing Ministries.  The Ministry for Health is responsible for offering services to circa 314 older persons through the PPP scheme; the Ministry for Senior Citizens and Active Ageing offers a service to approximately 3148 older persons through state run and private and church-run care homes employing the PPP agreement; and the Ministry of Gozo provides a service to around 53 older persons, through the PPP scheme, within a church-run care home, (source: https://ltccovid.org/wp-content/uploads/2020/06/LTC-covid-situation-in-Malta-6-June-2020.pdf).

No information is available on the websites for the Ministry of Health and the Ministry of Gozo in respect of the eligibility criteria, assessment, successive admission of older persons to the long-term care sector, as well as to contractual obligations for the service user and service provider, with no reference to service delivery within care homes, (source: https://www.gov.mt/en/Government/Government%20of%20Malta/Ministries%20and%20Entities/Pages/Ministries%202020/health.aspx), (source: https://www.gov.mt/en/Government/Government%20of%20Malta/Ministries%20and%20Entities/Pages/Ministries%20Nov%202020/Gozo.aspx).

The Ministry for Senior Citizens and Active Ageing, through the Active Ageing and Community Care (AACC), is responsible for the state run homes and other care homes employing the PPP scheme, (source: https://activeageing.gov.mt/active-ageing-and-community-care/?lang=en). Service delivery within the long-term care sector at AACC, is mainly centred around the levels of care the older person would be in need of as of the time of assessment, as follows, (a) Level 1 care, where long-term care services with only minimal basic care is provided and (b) Level2 care, where the level of care required for the older person and as indicated by the Interdisciplinary Assessment Team goes beyond the minimal basic care, (source: https://activeageing.gov.mt/wp-content/uploads/2021/05/LN-151-2018.pdf).

Older persons, (a) over the age of 60 years, (b) live with dementia, (c) require long-term care, and (d) can no longer live within their own home environment are eligible to apply for the state run (and PPP) long-term care services, (source: https://activeageing.gov.mt/residential-care/?lang=en).

Once an application for long-term care is compiled by the older person and/or next of kin/guardian, the Multidisciplinary Team, analyses aspects of the older person’s (a) Medical Report that would have been filled by the General Practioner, (b) social and wel-being, (c) cognitive difficulties, (d) mobility and dependency levels and (e) support network, (source: https://activeageing.gov.mt/residential-care/?lang=en).  Through this assessment, the Team decides on the level of care required, considering also the priority and urgency of the case in respect of the admission to long-term care, (source: https://activeageing.gov.mt/residential-care/?lang=en).

Saint Vincent de Paul (SVP) long term-care facility is on other state facility falling within the remit of the Ministry for Senior Citizens and Active Ageing, but autonmous from the AACC mentioned earlier, (source: https://activeageing.gov.mt/st-vincent-de-paul-long-term-care-facility/?lang=en). With a population of circa 1500 older persons, SVP offers high dependency chronic care services for the older person, through the Level 2 care  tier referred to previously, (source: https://activeageing.gov.mt/wp-content/uploads/2021/05/LN-151-2018.pdf), (source: https://ltccovid.org/wp-content/uploads/2020/06/LTC-covid-situation-in-Malta-6-June-2020.pdf).

The Maltese long-term care system also offers private self-funded care by the older person herself/himself through a number of private run organisations, (source: https://www.caremalta.com/our-homes/), (source: https://simblijacarehome.com/why-simblija/), (source: https://casa-antonia.com.mt/), (source: https://goldencare.com.mt/). These care homes advertise service provision to ‘patients’ falling within the medium to high dependency category, as well as older persons requiring respite care, or to older persons needing help to perform normal activities of daily living because of cognitive difficulties or loss of muscular strength or control).

A number of small church-run institutions for older priests and religious (around 9, source: https://ltccovid.org/wp-content/uploads/2020/06/LTC-covid-situation-in-Malta-6-June-2020.pdf ) are scattered across both islands of Malta and Gozo. No information on the Archidiocese of Malta or the Diocese of Gozo websites is available in respect of assessment and admission criteria or to the level of care offered to the older priests and religious.

Last updated: February 16th, 2022   Contributors: Maria Aurora Fenech  |  

Since 2015, LTC is governed through three separate legal acts: the Long-term Care Act (WLZ 2014), the Social Support Act (WMO 2015) and the Health Expenses Act (Zvw 2008). As a result, there are different rules and funding streams for care-related (LTC insurance), social support related (municipalities) and health and nursing related (health insurance) services. LTC is needs assessed, access to institutional care is not means-tested, however residents have to contribute to their board and lodging- co-payments depend on their income (Bruquetas-Callejo and Böcker, 2021).

References:

Bruquetas-Callejo, M., Böcker, A. (2021) Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future MC Covid 19 Working Paper 11/2021

Last updated: January 23rd, 2023

By law and by tradition, families are primarily responsible for care provision, with social institutions’ intervening when families are incapable of undertaking adequate care measures and LTC is provided mostly by unpaid carers in Poland. Some home care as well as residential care services are however also available through health and social care sector and more recently day care centres have gained prominence in providing support for people with LTC needs (Golinowska et al. 2017).

The rate of long-term care beds in Poland is  low, even though it has increased from 65 877 in 2011 to 76 090 in 2019 (source: Statista: Poland long-term care beds). There geographical distribution is uneven: in 2019, nearly one-fifth of counties had no access to long-term residential care. About 2.7 % of older people are in institutional care settings and 3.4 % use home care services. Some families draw on migrant carers, mostly from Ukraine, who tend to provide round-the-clock care (source: 2021: Ageing policies – access to services in different EU Member States).

References:

Golinowska, S., Sowa-Kofta, A. (2017) ‘The Polish policy landscape. Retrieved from CEQUA: Poland Country Report

Last updated: July 18th, 2022   Contributors: Joanna Marczak  |  

Long-term care in Portugal is mainly provided by unpaid (mostly family and mostly women) carers, as well as a mix of public and private providers, with a strong role for non-profit providers.

In 2006 the Ministry of Health and the Ministry of Labour, Social Solidarity and Social Security established a National Network of Long-Term Integrated Care (Portuguese acronym: RNCCI), with the aim of providing care, health and social support to persons with functional dependency, with an emphasis on integrated care.

In parallel, there is a Network of Social Services (RSES) affiliated to the Ministry of Labour, Social Solidarity and Social Security, which provides social services to people with low resources or who experience social exclusion.

There is currently no mechanism for joint provision of services between the RNCCI and the RSES, but there are efforts to coordinate care happen at local level. There are concerns that the current system leads to over-institutionalisation and duplication of provision and that not enough support is in place for unpaid carers.

References: 

Lopes, S., Mateus, C. & Hernandez-Quevedo, C. (2018). Ten years after the creation of the Portuguese National Network for Long-Term Care in 2006: Achievements and challenges. Health Policy 122, 210-6. doi: 10.1016/j.healthpol.2018.01.001

Tello, J.E., Pardo-Hernandez, H., Leichsenring, K., Rodrigues, R., Ilinca, S., Huber, M., Yordi Aguirre, I. & E. Barbazza (2020). A services delivery perspective to the provision of long-term care in Portugal, Public Policy Portuguese Journal, Vol. 5(1), 8-25. Retrieved from: European Centre for Social Welfare Policy and Research

Last updated: February 10th, 2022

In 2008, South Korea introduced a universal, public long-term care insurance to complement the existing national health insurance. The LTCI covers residential, domiciliary and community-based care. By the end of 2018, approximately 9% of the population aged 65 and older were eligible for LCTI coverage (source: https://www.tandfonline.com/doi/full/10.1080/01634372.2020.1797977).

A shortage of qualified home-based care services in South Korea means that most older people have no choice but to depend heavily on residential institutional care. From 2012 to 2017, the number of long-term residential care facility beds per thousand people aged 65 years old and over significantly increased from 51.1 to 60.9, and the number of beds in long-term care hospitals was  36.7 per thousand people, the highest among OECD countries  (source: https://www.tandfonline.com/doi/full/10.1080/01634372.2020.1797977).

Long-term care hospitals (LTCHs) under the national health insurance play a role in long-term care provision; the average length of stay at such hospitals was about 168 days per year in 2016 Lengthy hospitalizations are likely a result of residential institutional care being financially supported by the national health insurance (NHI) and Long-Term Care Insurance (LTCI) (source: The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

Last updated: January 6th, 2022

The Romanian long-term care system is rooted in Law 17/2000 on Social Assistance for Older People, the first national legal act to regulate the provision of support services for older individuals with care needs. Subsequent legislation in 2003 and 2006 defined basic organization and functioning norms for home-based and residential care delivery at national level. In 2011, Law 292/2011 on the Social Assistance Framework defined the characteristics and the boundaries of Romania’s long-term care system, establishing eligibility criteria, the settings in which long-term care can be provided and the care services included in the service package. Since 2006, responsibilities for social service planning, financing and provision were transferred to local authorities, lead to increased fragmentation in care delivery and to large disparities in the geographical distribution and availability of services.

The Romanian LTC system emphasizes cash benefits to the detriment of service provision, which remain severely undersized with respect to care needs and distributed across the territory. Particularly weak is the provision of home and community based care, leading to increased demand for residential care services, in turn insufficiently developed to appropriately respond to population needs. As a result, the long-term care system overwhelmingly relies on the provision of care by family member and other informal caregivers.

While data on LTC coverage are insufficient and of poor quality, available evidence indicates long-term care coverage to be very low with respect to most European countries.

References: 

World Health Organization (2020) Romania. Country case study on the integrated delivery of long-term care. WHO Regional Office for Europe series on integrated delivery of long-term care. Copenhagen: WHO European Office. Retrieved from: WHO/Europe | Healthy ageing – Romania

Luana Pop (2018) ESPN Thematic Report on Challenges in long-term care Romania.

Last updated: February 10th, 2022   Contributors: Stefania Ilinca  |  

Singapore’s approach to Long-Term Care (LTC) focuses on integrated care and active care management and coordination, aiming to reduce unnecessary utilization of institutional care. The approach is nested with an overarching Action Plan for Successful Ageing, as part of a policy shift towards a population health approach.

Singapore’s LTC policies are based on the principle of ‘Many helping hands’ that calls for individuals, families, communities, civil society, the private sector, and government to all play a role in ensuring the wellbeing of older people.

The system is designed with the aims of maximising prevention, promoting individual and family responsibility and reduce inefficiencies, with LTC as part of a wider integrated system covering public health, primary care, acute care, rehabilitation and long-term and palliative care.

Sources:

Asian Development Bank (2021) Singapore’s Long-Term Care System. Adapting to Population Ageing.

Graham, WCK, Wong, CH. (2020) Responding to COVID-19 in Residential Care: The Singapore Experience. LTCcovid country report, International Long-Term Care Policy Network, CPEC-LSE, 27 July 2020.

Last updated: January 6th, 2022

According to the Spanish Constitution, responsibility for Long-Term Care in Spain is mainly at the regional level (Autonomous Communities), although provincial and local authorities also have a role in care provision. Each autonomous community has legislated and designed its own care and social services systems.

The 2006 ‘Dependency Act’ (law 39/2006)  aimed to create new public national care coverage as the ‘fourth pillar of the welfare state’. The Act aims to guarantee the rights of citizens to personal autonomy and care to people in a situation of dependency, through the creation of the System for Autonomy and Dependency Care (SAAD). This is carried out with the collaboration and participation of all public administrations, and the central government guarantees minimum common rights for all citizens in any part of the territory of the Spanish State.

The Act established two types of long-term care benefits: 1) in-kind services, and 2) economic benefits, and gives priority to the former. All benefits and services established in the law are integrated into the social services provided through the autonomous regions (Guillen et al. 2017).

The catalogue of services and economic benefits of the Law is as follows:

Services :

a) Services for the prevention of situations of dependency and those for the promotion of personal autonomy .

b) Telecare Service.

c) Home Help Service (help with home tasks and personal care);:

  • Attention to the needs of the home.
  • Personal care.

d) Day and Night Centre Service :

  • Day Centres for the older people.
  • Day Centres for those under 65 years of age .
  • Specialized Day Care Centres.
  • Night Centres.

e) Residential Care Service :

  • Residential care for the older people in a situation of dependency .
  • Care centres for people in a situation of dependency, due to the different types of disability.

Economic benefits :

a) Cash benefits linked to the service.

b) Economic provision of personal assistance.

c) Cash benefits for care in the family environment.

The economic services and benefits that the autonomous communities may recognize for people in a situation of dependency in their territory, are integrated into the network of social services of each autonomous community.

References:

Montserrat Guillen, Ramon Alemany, Manuela Alcañiz, Mercedes Ayuso, Catalina Bolancé, Helena Chuliá, Ana M. Pérez-Marín, and Miguel Santolino (2017). Country Report: Spain. Retrieved from European Network on LTC (CEQUA).

 

 

Last updated: November 3rd, 2022   Contributors: Sara Ulla Díez  |  Esther Pérez de Vargas Bonilla  |  

Long-term care provision has remained mainly with families, and formal LTC service provision is considered inadequate to meet even current needs and demand.  Home and community-based care services that support aging in place for elders with limitations in
ADL and IADL are rare; residential care is not appropriate in terms of available services or eligibility. Informal care at home is often provided by family members, usually,  a female relative. Untrained domestic workers are sometimes hired as caregivers.

Last updated: January 6th, 2022

In 2019, over 160 000 of older people were provided with services and care in their own home and around 82 000 were provided with institutional care. A wave of closures of municipal institutional beds since the 2000s has resulted in a reduction of nearly 40% of all municipal places (source: Johansson and Schön, 2021).

References:

Johansson L. and Schön, P. (2020), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Sweden’, MC COVID-19 working paper 14/2021. http://dx.doi.org/10.20350/digitalCSIC/13701

Last updated: February 10th, 2022

The public Long-Term Care system in Taiwan has been in development since the 1990s. Although a social insurance system was planned, public LTC in Taiwan is funded through taxes. In 2017 the government launched LTC 2.0, a new policy aiming to develop a universal LTC system with an emphasis on home and community-based care and better integrated with the health care system, particularly with primary preventive care and home-based hospital care following hospital discharge (Hsu and Chen, 2019).

References:

Hsu HC and Chen CF (2019) LTC 2.0: The 2017 reform of home- and community-based long-term care in Taiwan. Health Policy 123:10, 912-916. https://doi.org/10.1016/j.healthpol.2019.08.004

Last updated: March 2nd, 2023   Contributors: Adelina Comas-Herrera  |  

Families provide most of the care given to older persons, at home and without payment. Home-based care provided by trained volunteers or paid caregivers is growing, and helps to support informal care-support systems (source: Country Diagnostic Study on Long-Term Care in Thailand | Asian Development Bank (adb.org).

Last updated: January 6th, 2022

There is no long-term care (LTC) insurance system in Turkey. Until recently, long-term care infrastructure has been scarce; Turkey has a familialist welfare system with the majority of the elderly population being taken care of by their families (in particular, by female family members) (Oglak et al., 2017). In fact, the Turkish Civil Code involves intergenerational obligations for family members to look after dependents. However, to some extent this system is beginning to erode, and as such that has been an expansion of LTC services in the past two decades. (Akkan & Canbazer, 2020).

A fraction of older people in Turley (0.4%) live in care homes. Of these, 61% are in public nursing homes and the remainder in private ones. Private entities were only allowed to open nursing homes from 2008, but since then the sector has been rapidly expanding. In 2020, 247 of the 426 nursing homes were private, and 179 public. Apart from these care homes, the state also provides community-based care facilities, care and rehabilitation centres (which may also be run by private entities), and day-centres  (Akkan & Canbazer, 2020).

References:

Akkan, B. (2017). “The politics of care in Turkey: Sacred familialism in a changing political context”, Social Politics: International Studies in Gender, State & Society, 25(1), 72–91, https://doi.org/10.1093/sp/jxx011.

Akkan B and Canbazer C (2020) The Long-Term Care response to COVID-19 in Turkey. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 10 June 2020.

Oglak, S., Canatan, A., Tufan, I., Acar, S., & Avci, N. (2017). Long-Term Care in Turkey: Are We Ready to Meet Older People’s Care Needs?  Innovation in Aging, 1(suppl_1), 566–566. https://doi.org/10.1093/GERONI/IGX004.1991

Last updated: January 26th, 2022   Contributors: Daisy Pharoah  |  

The majority of long-term care in England is provided by unpaid carers. Formal long-term care in England is provided by a complex system involving organisations in charge of health, social care, housing and other services. There is an important distinction between means-tested social care (non-medical services aimed at supporting people with LTC needs with their daily living activities) and health care services, which are free at the point of use and funded from general taxation.

Formal care services include home-based care services, personal assistants, residential/institutional care, day care and professional services such as social work, occupational therapy and aids and adaptations. Most publicly funded services are commissioned at local level, but, as a large share of the population who use long-term care is not covered by the public system, a large share of care is purchased directly from private providers.

There is strong consensus on the urgent need to reform the social care system in England.

References:

Comas-Herrera, A., Glanz, A., Curry, N., Deeny, S., Hatton, C., Hemmings, N., Humphries, R., Lorenz-Dant, K., Oung, C., Rajan, S., Suarez-Gonzalez, A. (2020). The COVID-19 Long-Term Care situation in England. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE

Marczak, J. Fernandez, JL, Wittenberg, R. (2017). Quality and cost-effectiveness in long-term care and dependency prevention: English policy landscape. CEQUA report

Thorlby, R., Starling, A., Broadbent, C., Watt, W. (2018). What’s the problem with social care, and why do we need to do better?  The Health Foundation, the Institute for Fiscal Studies, The King’s Fund and the Nuffield Trust

Last updated: March 10th, 2022

In Scotland, Long-Term Care is known as social care. This care can take the form of care services delivered in a person’s own home, for example personal care support and meals services, or care provided in the community, for example day care and social work support, to care provided within a care home. Public Health Scotland estimated that in the financial year 2018/19, at least 245,650 people of all ages received social care services. Of those, over 77% were aged 65 and over.

Data from the Care Inspectorate Scotland show that at 31st March 2020 there were 1,083 registered adult care homes in Scotland, of which 817 catered for older people. Public Health Scotland (formerly Information Services Division Scotland) data from the Scottish Adult Care Home Census show that in 2017, there were 40,926 registered care home places for adults. This figure has decreased from 42,653 in 2007. Over the period 2007-2017, the number of registered places for older people has remained relatively stable at around 38,200 throughout the period. The pandemic has highlighted the data deficiencies within the care home sector The latest data available for Scotland from a report by Public Health Scotland show that in March 2017 there were 35,989 adult care home residents in Scotland (Source: Care Home Census for Adults in Scotland).

For the last two decades, Scottish policy has favoured care provision in individuals’ own homes rather than in care homes. According to the Care Inspectorate data as of 31st March 2019, there were 1,046 registered adult care at home providers in Scotland. A Public Health Scotland report on social care statistics in Scotland estimated that 91,810 people in Scotland received home care for all or some of the year ending 31 March 2019. The same report estimated that at the end of that period,  63% of adults with long-term care needs received personal care at home. Personal care is care associated with personal hygiene, feeding, toileting and appearance.  In 2017-18, 47,070 people aged 65+ were receiving personal care funded by the Scottish Government in their own homes (An Official Statistics publication for Scotland).

Last updated: March 10th, 2022   Contributors: Jenni Burton  |  David Bell  |  Elizabeth Lemmon  |  David Henderson  |  

In the United States, there are five major types of LTC services: adult day centre, home health agencies, nursing homes, hospices, and residential living facilities. As of 2016, there were approximately 15,300 nursing homes and 28,900 residential care (‘assisted living’) facilities. Approximately 24 in every 1,000 people aged 65+ use nursing homes, and 15 in every 1,000 people aged 65+ live in residential care. 75 in every 1000 people aged 65+ use home health agencies for at-home services (source: Vital and Health Statistics).

Last updated: February 11th, 2022

The rapidly growing ageing population in Vietnam poses a significant challenge to the social welfare system. There is particular concern about the high prevalence of non-communicable diseases (NCDs), which are the dominant cause of death, in the over-50 population (source: Global Burden of Diseases Project).

There is currently no legal policy on long-term care. Some policies relating to older people have been enacted; mostly relating to their healthcare. For example, The Elderly Law (2009), which emphasises the role of primary healthcare and access to quality healthcare services for these members of the population. It also highlights the role and responsibility of families, communities, and broader society in caring for elderly people (Van et al., 2021). Indeed, most senior citizens in Vietnam live with and are cared for by their families; hence the common phrase, tu dai dong duong (four generations under one roof).

However, some people have complex needs that require support beyond what family members can provide, or indeed do not have families to provide such long-term care (in part due to children modernising and moving to cities for work). There are some institutions that are run by the government that cater for the elderly, the disabled, and orphans – such as social protection centres. However, these are only available to social assistance beneficiaries; for the elderly, this covers people over age 85 without social insurance or pension, and lonely or poor older people (Dung et al., 2020). According to a recent report by The Vietnam National Committee on Aging (VNCA), only around 10,000 elderly people in Vietnam live in public social protection centres (out of approximately 11 million older persons nationwide). This means that there is great demand for private institutional care.

Indeed, there are some long-term care facilities provided by the private sector and by mass organisations, such as The Red Cross (the latter being run by volunteers). Religious groups also provide some nursing homes – which are free of charge to those in need. Privately run nursing homes are mainly aimed at wealthier members of the population who are able to afford the steep $400-$1000/month fee (VNCA). It should also be noted that the supply of private nursing homes in Vietnam is expanding relatively slowly, as loans for construction are difficult to obtain and there are no incentives (tax concessions) provided for setting them up (Dung et al., 2020).

There are significant gaps in the provision of care in Vietnam: nursing homes are mainly found in larger cities, there are a limited number of social protection centres (which are inefficient and do not satisfy all needs), and, in light of a limited government budget, high co-payments are mostly out of pocket (Van et al., 2021).

Care Preferences

In their 2012 study, Van Hoi et al assessed willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam. They found the most requested service was use of mobile team care, and that using a nursing centre was intended by the fewest respondents, although households were found to be more willing to pay for elderly day care and nursing centres than older participants. Willingness to use services decreased as potential fees rose.

References:

Dung, V., Thi Mai Lan, N., Thu Trang, V., Xuan Cu, T., Minh Thien, L., Sy Thu, N., Dinh Man, P., Minh Long, D., Trong Ngo, P., & Minh Nguyet, L. (2020). Quality of life of older adults in nursing homes in Vietnam: https://doi.org/10.1177/2055102920954710

Van Hoi, L., Thi Kim Tien, N., Van Tien, N., Van Dung, D., Thi Kim Chuc, N., Goran Sahlen, K., & Lindholm, L. (2012). Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam. BMC Health Services Research, 12(1), 1–12. https://doi.org/10.1186/1472-6963-12-36/TABLES/7

Van, P.H., K.A. Tuan and T.T.M. Oanh (2021), ‘Older Persons and Long-term Care in Viet Nam’, in Komazawa, O. and Y. Saito (eds.), Coping with Rapid Population Ageing in Asia. Jakarta: ERIA, pp.45-56. Link

Last updated: January 6th, 2022   Contributors: Daisy Pharoah  |  

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica Breuer, Jorge Browne Salas, Jenni Burton, William Byrd, Sara Charlesworth, Adelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin Hämel, Nina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’Donovan, Camille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. Schmidt, Agnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.