INTERNATIONAL REPORTS

Responses to 3.04. Financial measures to support users and providers of Long-Term Care


Australia

On March 11, 2020, the Australian government announced $440 million Australian Dollars (AUD) to train aged care staff in infection control, to increase the number of staff, and for telehealth services. Additionally, $234.9 AUD was included as a COVID-19 retention bonus to ensure adequate staffing in the workforce. Additional funding was announced on August 31, 2020, where $563.3 million (AUD) was provided to reinforce the aged care sector’s response to COVID-19. This second phase of funding included $245 million AUD for COVID-19 support payments to aged care providers. The government also introduced an entitlement of up to 2 weeks of paid pandemic leave for aged care workers as well as a pandemic leave disaster payment, which is a lumpsum of $1500 to help staff after isolation or quarantine (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf).

The Australian Aged Care Quality and Safety Commission phoned all home care services to offer support during COVID-19. There has been $59.3 million AUD of funding from the government allocated to meals on wheels, $50 million AUD to fund home-delivered meals, and $9.3 million AUD on emergency food supply boxes. Additionally, $10 million AUD has been allocated to the Community Visitors Scheme, which facilitates telephone calls and virtual friends for socially isolated people in community based aged care (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf).

Last updated: September 10th, 2021


Austria

In Austria, some of the €100 million allocated to support the LTC sector were earmarked for expanding residential care bed capacity for people who could not be cared for sufficiently in their own home because of the complexities of delivering home care during the pandemic (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf). People with care needs can receive cash-for-care allowances following a needs assessment (Source: https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).

Last updated: September 10th, 2021


Canada (British Columbia)

At the beginning of the pandemic, LTC and assisted living providers reported spending an excessive amount on COVID-related expenditures and were unsure as to whether they would be reimbursed, because the Ministry of Health had not provided clear guidelines or timelines. Providers also reported lost revenue from an increased vacancy rate.

After the province announced additional funding to meet demands, LTC operators found funding distribution to be problematic. LTC operators were not sure how the funding was allocated and distributed. Additionally, privately-owned sites were not included in wage levelling and did not qualify for pandemic pay despite filling the same role. Managers and leaders were not included in pandemic pay, and in some instances, managers were paid less than the people working under them.

Despite supplemental funding totalling 1.3 full time equivalent per full-time staff person in order to cover additional staffing demands, operators found it difficult to fill the extra hours due to staffing shortages (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Last updated: September 10th, 2021


Chile

In early March 2020, the National Service of Older People (Servicio Nacional del Adulto Mayor, SENAMA) led a public-private partnership that raised approximately $15 million for COVID-19 measures for publicly subsidized care homes. This funding was used to provide on-site technical support, PPE, to provide back up staff, to transfer residents with COVID-19 to isolation facilities, and for testing. In mid-June additional funding for this project made it possible to extend the support to “non-luxury” for-profit care homes (where the average fee per resident is lower than $USD 850). By mid-July 2020, this initiative was estimated to have reached 85% of the most vulnerable for-profit care homes (Sources: https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Chile-24-July-2020-3.pdf).

Last updated: September 10th, 2021


Denmark

Employers will be reimbursed for any sick pay they have had to pay out due to COVID-19, an employee’s illness, unavailability due to quarantine responsibilities, or if a person has had to stay at home because they or their relatives are in a risk group. This has been extended to July 31, 2021 (source: https://www.aeldresagen.dk/viden-og-raadgivning/penge-og-pension/arbejdsliv/gode-raad/corona-nye-regler-for-udvidet-sygedagpenge).

More funds have been given to municipalities as well as to the NGO’s to provide information and individual advice to debilitated older people, including those with dementia and their relatives, on how to deal with the consequences of COVID-19. Funds have also been allocated for telephone counselling which targets older isolated people (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

Last updated: September 16th, 2021


Denmark

The National Association for Elderly Care has published information on the extension of sickness benefits and financial support for older people (Source: https://www.aeldresagen.dk/viden-og-raadgivning/penge-og-pension/arbejdsliv/gode-raad/corona-nye-regler-for-udvidet-sygedagpenge).

Last updated: September 10th, 2021


England (UK)

The action plan for social care, published on April 15 2020, confirmed the announcement in March of £2.9 billion of funding ‘to strengthen care for the vulnerable’. Of the £2.9 billion, £1.3 billion was earmarked for collaborative efforts between the NHS and local authorities, particularly to fund additional support following hospital discharge, and £1.6 billion of the funding was allocated to support local government with the provision of services, including adult social care. The Action Plan outlines that local authorities are expected to use the additional funding to ‘protect providers’ cash flow, monitor ongoing cost of care delivery, and ‘adjust fees to meet new costs’. It is anticipated that this funding covers the cost for additional personal protective equipment (PPE) required (Source: https://www.gov.uk/government/publications/coronavirus-covid-19-personal-protective-equipment-ppe-plan/covid-19-personal-protective-equipment-ppe-plan). Furthermore, the government suggests that the additional money provided could also be used for backfilling shifts as well as to maintain income for workers unable to work due to physical distancing measures as far as possible. This is intended to financially support workers who may have to stop working temporarily because they are unwell or self-isolating. Furthermore, the plan made a plea for donations to support social care workers who may experience financial difficulties, similar to the donations that NHS charities have received (Source: https://www.gov.uk/government/publications/coronavirus-covid-19-personal-protective-equipment-ppe-plan/covid-19-personal-protective-equipment-ppe-plan). A survey examining funding access found that only 30% of care home managers reported receiving a financial uplift at the time, with 73% stating that they needed more funding.

On May 15, 2020, a £600 million Infection Control Fund was introduced as part of a wider package of support for care homes to help providers reduce the rate of transmission in and between care homes and support wider workforce resilience (Source: https://www.gov.uk/government/news/care-home-support-package-backed-by-600-million-to-help-reduce-coronavirus-infections). The funding is being paid in 2 tranches. The first was paid to local authorities on May 22. The second tranche was paid in early July (Source: https://www.gov.uk/government/publications/adult-social-care-infection-control-fund/about-the-adult-social-care-infection-control-fund). This money has been allocated to Local Authorities and is in addition to the funding already provided to support the Adult Social Care sector during the COVID-19 pandemic. Local authorities are expected to pass 75% of the initial funding directly to care homes in their area for use on infection control measures, including to care homes with whom the local authority does not have existing contracts. The second payment will be contingent on the first being used for infection control. The remaining 25% must also be used for infection control measures, but local authorities are able to allocate this based on need (Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/885214/14_May_2020_-_MSC_letter_-_support_for_care_homes_1.pdf).

Local authority directors responsible for administering this new fund have expressed “deep concern” that it apparently cannot be used by homes to purchase PPE, requires detailed and prescriptive accounting and reporting, does not cover domiciliary care and supported living schemes, resulting in “a confused and overly bureaucratic system, which makes it difficult for providers to claim and impossible for local authorities to deliver within the required timescales” (Source: https://www.adass.org.uk/media/7909/200529-adass-letter-to-minister-of-state-re-infection-control-fund.pdf). An independent analysis commissioned by local authorities estimated that providers could face over £6bn in additional costs during April to September 2020, because of higher staffing costs (mainly due to cover staff who are ill or self-isolating), PPE, and extra cleaning and overhead costs (Source: https://www.local.gov.uk/lga-social-care-providers-face-more-ps6bn-extra-covid-19-costs).

On October 1, 2020, the Department of Health and Social Care (DHSC) announced a second round of funding worth £546 million for the Adult Social Care Infection Control Fund. This is to be extended until March 2021, following on from May 2020, when the fund was initially worth £600 million. The purpose of this fund is to support adult social care providers to reduce the rate of COVID-19 transmission within and between care settings, in particular by helping to reduce the need for staff movements between sites. Half will be paid on October 1, 2020, and the other in December 2020. Local authorities should pass on 80% of this to care homes on a per bed basis and CQC-regulated community care providers on a per user basis, both of which must be within the local geographical area. The other 20% should be used to support care providers, allocated at the discretion of the local authority. This allocation cannot be used to pay for the cost of purchasing extra PPE. Local authorities must write to DHSC by October 31, confirming they have put in place a winter plan, and that they are working with care providers in their area on business continuity plans (Source: https://www.gov.uk/government/publications/adult-social-care-infection-control-fund-round-2).

As recently as November 3, 2020, 75 care organisations called on the government to align the Carers Allowance with Universal Credit, as it is currently in Scotland, to recognise the disproportionate impact of the pandemic on carers (Source: https://www.disabilityrightsuk.org/news/2020/november/75-organisations-again-call-government-make-carer%E2%80%99s-allowance-fairer-carers; https://www.nuffieldtrust.org.uk/news-item/what-are-carers-entitled-to).

On December 23, 2020, DHSC announced £149 million to support the rollout of Lateral Flow Device (LFD) testing in care homes. This funding will be paid in January 2021. All funding must be used to support increased LFD testing in care settings. Local authorities should pass on 80% of this to care homes on a per bed basis, which must be within the local geographical area. The other 20% should be used to support care providers to implement increased LFD testing, allocated at the discretion of the local authority (Source: https://www.gov.uk/government/publications/adult-social-care-rapid-testing-fund/adult-social-care-rapid-testing-fund-guidance).

On January 13, 2021, NHS England (NHSE) announced that the amount that local vaccination services could claim for delivering COVID-19 vaccinations in care home settings was increasing from the original £12.58 Item of Service fee and an enhanced payment of £10. This has been increased so that first doses delivered in a care home setting from December 14, 2020, to close January 17, 2021, will carry an enhanced additional payment of £30, and doses delivered in the week beginning January 18 a payment of £20. The £10 will continue to apply for all COVID vaccinations in a care home setting between January 25 and 31, as well as for the second dose for all patients and staff who received their first dose on or before January 31. Primary Care Networks (PCNs) bringing in additional workforce between now and the end of January will be eligible to claim up to £950 per week (a maximum of £2500 per PCN grouping) (Source: https://www.england.nhs.uk/coronavirus/publication/covid-19-vaccination-in-older-adult-care-homes-the-next-stage/).

On January 17, 2021, DHSC announced the Workforce Capacity Fund, worth £120 million, which was to support local authorities in boosting staffing levels and deliver measures to supplement and strengthen adult social care staff capacity to ensure that safe and continuous care is achieved (Source: https://www.gov.uk/government/news/social-care-to-receive-269-million-to-boost-staff-levels-and-testing). This funding is available until March 31. The first £84 million (70%) will be paid in early February and the second £36 million (30%) will be paid in March (Source: https://www.gov.uk/government/publications/workforce-capacity-fund-for-adult-social-care).

On March 12, 2021, Nuffield Trust released analysis explaining that there was no mention of social care in the budget announced by the Chancellor. Short-term emergency support (the Rapid Testing Fund, the Infection Control Fund, and the Workforce Capacity Fund) was crucial in enabling the social care sector to function throughout the pandemic, and is due to expire at the end of March (Source: https://www.nuffieldtrust.org.uk/news-item/social-care-reform-running-out-of-time-and-money).

On March 18, 2021, LaingBuisson reported that an extra £341 million was to be provided to support adult social care with the costs of infection prevention control and testing so that visits can be carried out safely. This commitment was for a three-month period. There was no mention of an extension to the Workforce Capacity Fund (Source: https://www.laingbuissonnews.com/care-markets-content/news/adult-social-care-to-receive-extra-funds/). On the same day, the National Care Forum reported that there were announcements around additional funding for hospital discharge (Source: https://www.nationalcareforum.org.uk/press-releases/ncf-response-to-341m-additional-funding-for-adult-social-care/).

Last updated: September 10th, 2021


France

An investment of €6bn was made in July 2020 to enable renovations and technology upgrades across the health and social care sectors (Source: https://www.lefigaro.fr/flash-eco/castex-annonce-6-milliards-d-euros-d-investissement-dans-le-systeme-de-sante-20200715). Additionally, €7.6bn was secured for an increase in base salary for workers in public hospitals and care homes of €182/month, and €160/month in private settings, as well as a revision of salary bands by Spring 2021, maximum hours for overtime, and investment in recruitment policies (Source: https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf).

Last updated: September 10th, 2021


Germany

In March 2020, the government announced that care facilities will be reimbursed through the LTC Insurance system for additional costs (e.g. personal protective equipment) or loss of income due to the pandemic (Sources: https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/2020/1-quartal/corona-gesetzespaket-im-bundesrat.htmlhttps://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf) .

The National Association of Statutory Health Insurance Funds further outlined possibilities to reimburse other people providing care for up to three months if the usual ambulatory or replacement care cannot be provided (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

The Federal Government has improved access to basic security provision (including costs for accommodation and heating) but also for lunch provision for children with relevant needs (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf). Care workers also received a one-off, tax-free COVID-19 payment. A study on LTC workers in different care settings showed that respondents highlighted the need for better pay, which could be achieved through tax exemptions. Respondents were critical of the pandemic bonus, saying they would prefer long-term improvement in pay, and some noted that the bonus should be extended to everyone working in care settings, not just care workers (Source: https://link.springer.com/article/10.1007/s00391-020-01801-7 ).

In addition, there has been criticism regarding the limited focus of COVID-19 social protection packages on people with disabilities (Source: https://www.vdk.de/deutschland/pages/presse/presse-statement/79041/behinderung_corona).

Last updated: September 10th, 2021


Germany

In March 2020, the government announced that care facilities will be reimbursed through the LTC insurance for additional costs (e.g. personal protective equipment) or loss of income due to the pandemic (Sources: https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/2020/1-quartal/corona-gesetzespaket-im-bundesrat.html; https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

The National Association of Statutory Health Insurance Funds further outlined possibilities to reimburse other people providing care for up to three months if the usual ambulatory or replacement care cannot be provided (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

The Federal Government has improved access to basic security provision including costs for accommodation and heating, but also for lunch provision for children with relevant needs. Care workers also received a one-off, tax-free COVID-19 payment (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

Last updated: September 10th, 2021


Hong Kong

Some NGOs have delivered ‘surgical masks and anti-epidemic packs’, emergency financial support, contingency supplies, and Chinese medicine treatments to people in need (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).

Last updated: September 10th, 2021


Ireland

In Ireland, financial support was given directly to care homes which were able to receive immediate temporary assistance payments to respond to a COVID-19 outbreak (Sources: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf; https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).

Last updated: September 10th, 2021


Israel

A summary of Israel’s fiscal policy response to COVID-19 is published on the IMF COVID Policy Response page. In Spring 2020, the Israeli government approved an 80 billion New Israeli Shekel (NIS) emergency package, with 11 billion set aside for health expenses, and 20 billion designated to the social safety net. The package has steadily increased since then. Over the year, approved measures have amounted to approximately 211 billion NIS. Additionally, 72 billion NIS are designated for measures planned for 2021. A translated summary of the Ministry of Finance’s COVID-19 Economic Plan has been published online.

Last updated: September 10th, 2021


Netherlands

Public authorities launched temporary compensation schemes to help nursing homes cover extraordinary expenses related to the pandemic (e.g. personal protective equipment) and compensate for loss of income (Source: https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view).

Care professionals received a bonus of €1000 in 2020. In 2021 there will also be a bonus provided (Source: https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Last updated: September 10th, 2021


Norway

In May/June, nurses working in the municipalities (nursing homes and home nursing) and hospitals have been striking, demanding higher salaries. The Norwegian Nursing Association (representing a large majority of Norwegian nurses) has negotiated with the municipalities and hospitals (state) for increasing wages for several years. This spring, the conflict has been heightened because of the pressures nurses working in health and care services have experienced. The authorities have given extra grants to the municipalities to cover extra expenses. However, it is the individual municipality that decides how the funds will be used. Therefore, it varies whether and how much extra resources nursing homes have received (Source: https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Last updated: September 10th, 2021


Sweden

In total, the government has proposed 20 billion Swedish Krona (SEK) in 2020 for the municipalities’ and the regions’ additional costs as a result of COVID-19. The Government has proposed an increase in general government subsidies, 26 billion SEK by 2020. Of these, 5 billion SEK was announced before the outbreak of COVIDD-19. The additional amounts totalling 21 billion SEK for 2020 have been made to strengthen the municipal sector’s ability to maintain socially important functions, such as schools and care. The proposals have been adopted by the Riksdag (the national legislature) (Source: https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Last updated: September 10th, 2021