A long-term care crisis is brewing around the world: who will provide and pay for LTC? Health Care Advice

A long-term care crisis is brewing around the world: who will provide and pay for LTC?

Statistically, in today’s world, 1 in 5 LTC users is under 65 years of age; one-half are over 80. Most of the LTC services paid-for are based in institutions: 62% of total LTC expenditures occur in institutional settings, not at home.

That simple aging demographic is the first aspect to consider: in 1950 under 1% of the global population was over 80. By 2050, that share will increase from 4% in 2010 to 10% in the OECD countries.

Today, it is informal, unpaid caregivers — usually family carers — who bear the brunt of long-term care.

Supporting family caregivers is key to strengthening the backbone, and financial health, of long-term care infrastructures around the world. OECD’s solution is several-fold:

First, to design financial support programs for caregivers in the form of allowances and cash benefits that would be paid to care recipients, which would increase the supply of family care.
Second, to promote better work-life balance through family leave programs. While childcare leave is fairly common in most countries, family care (say, for aging parents) is not. Flexible work arrangements are a core part of this solution for carers working in full-time jobs. Care leave is most prevalent in Denmark, Poland, Finland, the Netherlands, Hungary, Sweden and Belgium.
Third, support services such as respite care, training and counseling are key to managing eventual carer burnout and loss of personal control.

Still, even with these supports, OECD believes that over-reliance on family carers is not optimal. It’s the formal, labor-intensive LTC sector, that needs addressing. Currently, that sector is marked by high turnover and low retention, largely due to low pay, and lack of professional training and recognition and lack of technology support.

Improving job quality is key for LTC workers. The technology aspect could greatly turbocharge worker productivity and enhance job satisfaction, which better managing costs that are currently eaten up in institutional care. Implementing remote health monitoring, electronic health records, and personal safety response systems would keep older people safer and healthier at home, while enabling care workers to truly care and reduce their paperwork load and administrative hassle. Financing policies that speak to infrastructure-independent health care — not tethered to institutions — would move care back into peoples’ homes, where most would prefer to be to age in place and continue to be part of their local communities. Home care is a lower-cost alternative to institutional care today. As technology evolves to provide more care in home settings, evidence is gathering to prove cost-effectiveness of these approaches for chronic conditions like heart failure, COPD, and cancers. Furthermore, peer-to-peer care via online social networks can help homebound people feel and be connected with both people like them and caregivers.

While home-based LTC may not be clinically appropriate for very sick and/or frail seniors, appropriate utilization of institutional settings could be sorted out using clinical protocols and assessment tools.

Virtual Health Center