Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

Abstract

Background: The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods: This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results: The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion: The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic- and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-makers.

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“…By contrast, in the Netherlands, only 4.7% of LTC recipients aged 65 and over received a cash benefit [persoonsgebonden budget (PGB)] under the new LTC Act in 2016 (Monitor Langdurige Zorg 2018, own calcuations). The difference is even more remarkable as the average monthly cash benefit in the Netherlands is significantly higher than that in Germany (3400 euro) (Sociale Verzekeringsbank 2016; see also Mosca et al 2017). The low propensity of Dutch LTC recipients to opt for cash benefits can be explained in part by the comparatively generous in-kind allowances and in part by the tight regulation and supervision of these payments (Da Roit & Le Bihan 2010).…”

Does older adults’ use of social care influence their healthcare utilisation? A systematic review of international evidence

“…These concerns are relevant beyond the English context as high income countries contend with how best to fund long‐term care systems for growing older populations (Organisation for Economic & Co‐operative Development, ). The imbalance of public and private funding, private care market failures and a lack of clear policy direction have been noted as particular challenges for care systems in Europe (Mosca, van der Wees, Mot, Wammes, & Jeurissen, ) and North America (Galiana & Haseltine, ). The United Nations also emphasise the societal costs, especially to women, of poor provision of formal long‐term care to older people (UN Women Policy Brief Series, ).…”

Independent aging with the help op smart technology : investigating the acceptance of ambient assisted living technologies

“…To cope with the demographic pressure and the accompanying challenges, many European governments have reformed their long-term care policies over the last decades. According to the OECD, Long-term care (LTC) can be defined as (Colombo et al, 2011, p. 2): Although long-term care reforms significantly differ across Europe, some overall trends can be observed (Colombo et al, 2011;Mosca, Van der Wees, Mot, Wammes, & Jeurissen, 2016;Pavolini & Ranci, 2008;Verbeek-Oudijk et al, 2014):…”

“…Moreover, most countries do not have an adequate system in place to identify informal caregivers and their needs. Finally, according to Mosca et al (2016) many countries already rely heavily on informal care, and it is uncertain how informal caregivers can cope with the increasing demand without negative consequences, such as reduction in labormarket participation as well as physical and mental health problems.…”

“…Caring for a frail older adult can have negative consequences for the caregiver's physical health and mental well-being (Pinquart & Sörensen, 2003;Schulz & Beach, 1999). Other undesirable consequences include a reduced participation in the labor market and an increased risk for financial dependence (Colombo et al, 2011;Mosca et al, 2016). Moreover, a recent study showed that people might not be willing to take on more care tasks, especially with regard to personal and medical care (Hoefman, Meulenkamp, & De Jong, 2017).…”