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This brief is the ninth in a series discussing long-term care financing in low- and middle-income settings. The focus is workers in the formal long-term care system.
This brief is part of a series about financing health and social long-term care: lessons for low- and middle-income countries (LMICs). The number of people aged 65 years and older will increase in LMICs, where most older people will be living by 2050. Many people in LMICs will experience the onset of age-related health problems before the age of 65 years. Long-term care (LTC) can include some acute care medical services delivered in health facilities, but it primarily refers to support provided outside of the health system by caregivers in institutions or at home to allow people to maintain their routine activities. Individuals’ unmet needs increase the demand for LTC. Without formal LTC services and systems, the costs of LTC shift to the family. Informal caregivers, primarily women, may need to reduce their working hours or leave the labour force prematurely, placing pressure on the economy and household resources. The availability of informal caregivers has declined along with decreases in fertility and family sizes, and increased opportunities for women in the formal workforce. In the absence of formal LTC services and systems, individuals seek care in the acute care medical system, which can increase health care costs while offering suboptimal care for older adults. People underestimate their need for LTC, even though many may require intensive support or institutional care that may exceed their income. Given the market failures of LTC insurance, public intervention is well-justified to meet this demand.
This brief is the seventh in a series discussing long-term care financing in low- and middle-income settings. The focus is quality and value in long-term care.
This brief is part of a series about financing health and social long-term care: lessons for low- and middle-income countries (LMICs). Countries take a universal or selective approach, or some mix of the two, in identifying the population that will be covered under LTC programmes. Decisions are based on the economic and social contexts, and LTC is designed with consideration of the existing infrastructure for delivering health and social care. Universal approaches are grounded in the principle of ensuring equal access to health and social care. Selective approaches focus on those in greatest need, primarily those who are low-income. While selective approaches are perceived to cost less, the total costs may be offset by the high cost of implementing means-testing to identify beneficiaries. The selective approach may also result in high levels of unmet needs among people who do not meet the low-income thresholds. Mixed universal and selective approaches enable universal coverage for some services or populations and means-tested eligibility for others; thus, older people may face high payments for some needed services. Many LMICs have initiated mixed approaches to LTC, using public and private resources while building the policies, systems and infrastructure for universal coverage of LTC.
Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.