Long-Term Care around the World

The developed world is in the midst of a demographic transition caused by increasing life expectancy and falling fertility. It will bring new challenges associated with caring for a rapidly aging population. Long-Term Care around the World documents and compares long-term care programs in 10 developed countries of varying sizes and with different healthcare structures. Drawing on original analyses of survey data and government statistics, the researchers show that the costs of long-term care are beyond the financial means of a large fraction of the elderly population in most countries, particularly the oldest and most disabled. As a result, public systems bear most of the cost of formal long-term care, such as care in an institution and or paid home care. Most countries spend more on nursing homes than on home care, but the relationship between the two varies widely — as does the mix of care needs and resources that are used to define eligibility for public funding. At the same, most care is provided informally, through family or unpaid caregivers. Estimates of the cost of informal care, which include the foregone earnings of caregivers, suggest that it accounts for at least one-third of all long-term care spending — and averages 50 percent of spending — in every country. Given its importance, any estimate of the social costs of long-term care must account for the implicit costs of informal care.