Around the world, wealthy countries are struggling to afford long-term care for rapidly aging populations. Most spend more than the United States through government funding or insurance that individuals are legally required to obtain. Some protect individuals from exhausting all their income or wealth paying for long-term care. But as in the United States, middle-class and affluent individuals in many countries can bear a substantial portion of the costs. Here’s how five other countries pay for long-term care.
Japan
Long-term care insurance is mandatory for Japanese citizens age 40 and over, while in the United States only a small portion of people voluntarily obtain coverage. Half the funding for Japan’s program comes from tax revenues and half from premiums. Older adults contribute 10% to 30% of the cost of services, depending on their income, and insurance picks up the rest. There is a maximum amount people must spend from their income before the insurance covers the remainder of the cost. Workers can also take up to 93 days of paid leave to help relatives with long-term care needs. Japan assigns a care manager to each person using services; each manager oversees about 40 older adults. In 2020, Japan spent 2% of its gross domestic product on long-term care, 67% more than the United States spent that year.
The Netherlands
The Dutch have included long-term care in their universal health care system since 1968. One public insurance program pays for nursing homes and other institutional settings, and another pays for nursing and personal care at home. Enrollment is mandatory. Dutch taxpayers contribute nearly 10% of their income toward insurance premiums, up to a set amount. Out-of-pocket payments amount to about 7% of the cost of institutional care. General taxes pay for a third program in which municipalities provide financial assistance and social support for older people living at home. There is no private long-term care insurance. The Netherlands spent 4.1% of its gross domestic product on long-term care in 2021, more than any other country tracked by the Organization for Economic Cooperation and Development, and four times the amount the United States spent.
Canada
Provinces and territories fund long-term care services through general tax revenue. Money budgeted is not always enough to cover all services, and some localities give priority to those with the greatest needs. The amount of subsidies people can receive, the costs they have to pay out-of-pocket, and the availability of services vary by province and territory, as they do in the United States with state Medicaid programs. The mix of providers also varies regionally: For instance, nursing home care in Quebec is mostly run by a public system while homes in Ontario are mostly for-profit. Notably, Canada’s long-term care system is separate from its national health care system, which pays for hospitals and doctors with no out-of-pocket costs to patients. In 2021, Canada spent 1.8% of its GDP on long-term care, 80% more than the United States spent.
United Kingdom
Local authorities pay for most long-term care through taxes and central government grants. Private providers usually supply services. Government contributions are based on financial need, with copayments usually required. As in the United States, middle-class and wealthy people pay most or all of the costs themselves. Unlike in the United States, the government provides payments directly to lower-income people so they can hire workers to care for them in their homes. The U.K. has also taken steps to shield people from losing all their wealth to pay for long-term care. It subsidizes care for people with savings and property of less than about $30,000, while in the United States most people don’t qualify for Medicaid until they have run through all but $2,000 to $3,000 of their assets. In 2022, the British government proposed extending subsidies to people who have as much as $105,000 of wealth and property, with a lifetime cap of about $100,000 on how much anyone spends on long-term medical care, excluding room and board in a nursing home. But the plan has been postponed until 2025. In 2021, the United Kingdom spent 1.8% of its GDP on long-term care, 80% more than the United States did.
Singapore
Singapore recently instituted a system of mandatory long-term care insurance for those born in 1980 or later. Citizens and permanent residents are automatically enrolled in an insurance plan called CareShield Life starting at age 30. They must pay premiums until they retire or turn 67 (whichever comes later) or are approved to use services. The government subsidizes 20% to 30% of premiums for those who earn around $2,000 a month or less. Monthly payouts start at about $440. Government subsidies for nursing homes and other institutional care can range from 10% to 75%, depending on ability to pay. Those who make more than $2,000 a month receive no subsidies. CareShield is optional for Singaporeans born in 1979 or earlier; they are covered under an older, voluntary plan. Singapore also provides a means-tested monthly cash grant — this year about $290 — to help with caregiving expenses.
Sources: The National Bureau of Economic Research project on international comparisons of long-term care; Kathleen McGarry; The Commonwealth Fund; Organization for Economic Cooperation and Development; government websites.Note: Spending comparisons with the United States are based on the most recent OECD data and include spending from government and compulsory insurance programs as a percent of each country’s gross domestic product, which is the total monetary value of all the finished goods and services produced within a country’s borders. The comparisons cover people of all ages and exclude spending from voluntary insurance plans and out-of-pocket costs. All currency figures are in U.S. dollars.
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When it is time to seek out healthcare assistance for yourself or an older adult, there are many options. Creating a plan can be a confusing and daunting task as you try to piece together services to meet all of your needs. For family caregivers, this can be especially stressful while also balancing the needs of work and family. Many caregivers find that care coordination for their parents can be a full-time job. PACE, which stands for Program of All-Inclusive Care for the Elderly, is an option that removes the burden of care coordination for older adults and their families. PACE is an innovative model of healthcare providing wrap-around services and coordinated care all in one place, alleviating stress on the older adult and their family. PACE provides the flexibility needed to meet the health care needs of older adults to support them living successfully in the community. A unique approach for every personEvery individual who receives care and services through PACE has a unique plan of care developed by an interdisciplinary team including providers, nurses, social workers, therapists, dietitians, homecare, transportation specialists, and more. The team works with each PACE participant to create an individualized plan that cares for the whole person, including their medical, social, and mental health needs. PACE is more than a list of services; PACE is a complete solutionPACE offers a day center, where participants can receive medical care, rehab therapies, meals and socialization. The PACE Center serves as the central hub of all services, including scheduling and transportation to and from all appointments. PACEs comprehensive services and care coordination can be an invaluable solution for the older adult and their caregivers who are balancing the needs of family and work. If you think PACE may be a solution for you, please call TRU PACE at 303-665-0115. Editors Note: This article was submitted by Samantha Black, LSW, Executive Director at TRU PACE and may be reached at 303-665-0115 or by email at SamanthaBlack@TRUcare.org
Written by: Patti Chenis, WEC Team SupervisorContemplative Practices/ meditation/mindfulness are beneficial ways to strengthen our wellbeing, resilience, and develop a fuller capacity to recognize the healing power in ones heart to work with stress and difficult challenges.Mindfulness is knowing what you are doing as you are doing it. It is bringing awareness to your present moment lived experience. Bringing our attention to breathing is one of the most widely used objects of meditation and anchor for our attention. Continually coming back to the attention and awareness of our breath brings a sense of precision, (being in the present moment-connecting to our life force of breath) gentleness, (allowing whatever is arising e.g. thoughts, emotions, sensations to be as they are without judgement and returning to our awareness of breath) and openness ( being curious about the richness and fullness of our experience).Mindfulness can be developed as a formal practice on meditation cushion, chair, standing up, lying down or walking meditation. The point of meditation is to remember to bring mindfulness (that conscious awareness of being in our present lived experience) into daily life, so you could say any aspect our lives can be a mindfulness practice.Her are some thoughts about bringing mindfulness, loving kindness, self-compassion and compassion into daily life.Deep Conscious BreathsTaking some deep conscious breaths in the morning or whenever you feel stressed, anxious, overwhelmed or want a fresh restart in you daily life. Before you do something stress- full, step back and take some deep breaths; research shows deep breaths calm the nervous system.MovementWalking (especially getting out and enjoying nature), yoga, tai chi, qigong, dancing to your favorite music, laughter (full belly laughs can do wonders for the spirit-try it), singing your favorite song(s); crying (allow yourself to feel the release that crying can bring e.g. tears of sadness, joy) whatever gets your energy moving and flowing.Self-compassion and compassion practicesDispel the myths that self-compassion is selfish or that we are not worthy of love and wellbeing. Research show that offering words of loving kindness to oneself changes our brain and improves our resilience, strengthens our immune system and increases our capacity to be of benefit to others. When we feel resourced and have a sense of well-being our capacity to work with stress and difficult emotions is greater.Good morning Practice:Good morning (put your name here) I love you. You can repeat this in the morning or anytime during the day to interject some good will toward oneself or someone else in your life if it is difficult to say this about yourself at first.Compassion is not only feeling empathy and emotional connection to the suffering of others but also wanting to relieve that suffering. It is the courage to open our hearts to our own suffering as well as that of others and that we are all interconnected, in the same boat so to speak. We can offer words of care and loving kindness to ourselves, mentors (someone who has been kind to us) friends, strangers, difficult people, as well as to all beings as we open our heart of compassion to include all. May I and all beings have happiness, well-being, safety, health and live at ease and in harmony.