28 June 2017
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Kate Roberts
Social Policy Section
Introduction
Aged care, as it is known in Australia, is usually called ‘long-term
care’ or ‘social care’ in other countries.[1]
It is organised, funded and delivered in many different ways. Not all countries
provide public support, and levels of social
protection (public coverage of care costs) vary widely. There is also
significant international variation in the terms used for different types of
care, and these can even vary within the same country. This quick guide provides:
- English terms that may be used to describe aged care in other
countries[2]
- a basic indication of funding arrangements, lead government agencies
and primary legislation in selected countries, and
-
links to further information.
This guide focuses on formal,
government-approved care for older people. It does not cover informal care (such
as care provided by relatives) or retirement villages. For a guide to aged care
in Australia, see Aged
Care: a quick guide.
What is long-term care and social
care?
The Organisation for Economic Co-operation and Development
(OECD) defines long-term care
as ‘care for people needing support in many facets of living over a prolonged
period of time’. This includes what we know as aged care, but in some countries
can also include other types of care, such as care for adults with a
disability. However, older people are the primary recipients of long-term care.
Social
care is a term used predominately in the United Kingdom to describe formal
care for all people who require support with daily living. This includes older
people, but can also include people with a disability and children at risk of
harm.
As in Australia, long-term care and social care includes
assistance with ‘instrumental activities of daily living’ (such as cleaning and
shopping); ‘activities of daily living’ or ‘personal care’ (such as eating,
showering, dressing, and toileting); and usually also includes medical care. It
can be delivered in the home, in short-term settings (such as respite
facilities) or in permanent residential care homes. Consumer preferences for
home-based care and greater choice and control are increasing in other
countries as well as Australia.
How is it funded?
The systems
that OECD countries have adopted to fund aged care fall broadly into four
categories, as described by Raphael Wittenberg, Associate Professorial Research
Fellow at the University of Oxford:
‘social
insurance, as in Germany;
taxation
and means-tested user charges, such as in the United States and the United
Kingdom (except Scotland);
taxation
without means-tested charges, as in Austria, Denmark and Scotland; and
social
insurance and taxation, such as in Japan.’
The Australian system would best be described as ‘taxation
and means-tested user charges’.
International resources
The OECD has published several reports
on long-term
care systems and services, with a focus on care for older people. These
include reports on public funding for care, dementia, quality of care, informal
carers and workforce challenges.
The World Health Organization website includes information
about long-term care
systems and ageing.
Alzheimer Europe represents Alzheimer’s associations from
34 countries. The Alzheimer Europe website includes comprehensive information
about National
Dementia Strategies in European countries and country
comparisons of approaches to supporting people with dementia and their
carers.
The International Federation on Ageing (IFA) is a
non-government organisation (NGO) which includes government, NGO, academic,
industry and individual members from 70 countries. The IFA website includes publications on a range of aged
care-related issues.
The Parliamentary Library’s collection includes resources
that provide international perspectives on aged care, comparing approaches to issues
such as funding
models, reforms,
regulation
and human
rights.
Overview of aged care in selected
countries
The following table provides brief details of aged care in
selected OECD countries (plus Singapore). The countries were chosen on the
basis of available information in English; relevance to Australia (for example,
countries with similar systems of government); and to provide a range of examples
of aged care systems.
This information is indicative
only and subject to change. Where available, links to government information
should be consulted for recent developments. Australia is included for
comparative purposes.
Country |
Commonly used terms |
Funding |
Lead agency/ies |
Primary legislation |
Further information |
Australia |
aged care, home support,
home care, residential aged care, aged care homes, consumer directed care |
Services are subsidised by
the Australian Government, costs to consumers are means-tested and subject to annual
and lifetime caps. |
Department of Health |
Aged Care Act 1997 |
Government information on ageing
and aged care My Aged Care Aged Care: a quick guide (2016) |
New Zealand |
home support services,
restorative care, long-term residential care, rest homes |
Services are funded by
district health boards; consumers can apply for a means-tested subsidy or loan to help
pay for residential care. |
Ministry of Health |
Social Security Act 1964 (Part 4) |
Government information on
the health of older people |
England |
social care, home care,
supported living services, care homes, residential homes, nursing homes |
Social care is funded by local
authorities (means-tested) and private contributions; health care is funded
by the National Health Service (NHS). |
Department of Health |
Care Act 2014 |
NHS Guide to social care Charity website ageUK |
Scotland |
social care, home care,
care at home, care homes |
Personal and nursing care is funded by local authorities and is not means-tested;
co-contributions apply for residential care. |
Health and Social Care Directorate |
Community Care and Health (Scotland) Act 2002 |
Government information on care for older people |
United States |
long-term care, community
support services, home care, custodial care, nursing homes |
Services are funded by a
combination of Medicare (federal
public insurance scheme for people over 65 and younger disabled people), Medicaid (federal-state
assistance scheme for people on low incomes), and private contributions. |
Department
of Health and Human Services |
Older Americans Act of 1965 |
LongTermCare.gov Long-term care frequently asked questions (2011) Long-term care in the United States: a timeline (1935 to 2015) Medicaid and long-term services and supports: a
primer (2015) |
Canada |
long-term care, home and
community care, nursing homes, long-term care facilities, personal care homes |
Funding arrangements vary
by province and territory (mix of local taxes and private contributions). |
Health Canada |
Provincial and territorial legislation |
Government information on home and community care Canadian Institute for
Health Information – residential care |
Singapore |
aged care, long-term care,
home care, nursing homes, ageing-in-place |
Services are funded by a
combination of Medisave
(compulsory savings scheme), Medishield Life (compulsory public insurance scheme), Medifund
Silver (endowment fund), and/or ElderShield
(public insurance for people over 40 for severe disabilities). |
Ministry of Health |
various, including the Medical and Elderly Care Endowment Schemes Act 2000 and Medishield Life Scheme Act 2015 |
Government information on long-term care services and its Action Plan for Successful Ageing Long-term care of older persons in Singapore (2015) |
Japan |
long-term care,
preventative long-term care, integrated community care system |
Long-term care insurance
(compulsory scheme) for home and residential care is funded by premiums,
taxation revenue and co-payments. |
Health and Welfare Bureau
for the Elderly, Ministry of Health, Labour and Welfare |
Long Term Care Insurance
Act |
Government information on Long-term care, health and welfare services for the
elderly Caring for an ageing population: points to consider
from reform in Japan (2013) |
The Netherlands |
long-term care, home care,
residential care, nursing homes |
Long-term care insurance
(compulsory social insurance scheme) for residential care is supplemented
with public funding and means-tested resident co-contributions. |
Ministry of Health, Welfare and Sport |
Chronic Care Act (Wet Langdurige Zorg
or WLZ) |
Government information on Nursing homes and residential care The policy and politics of the 2015 long-term care
reform in the Netherlands (2016) |
Germany |
long-term care, home care,
nursing homes |
Long-term care insurance
(compulsory) for home and residential care is funded by social insurance and
private insurance schemes. |
Ministry for
Family Affairs, Senior Citizens, Women and Youth Ministry of Health (legislation) |
Long-Term Care Act |
Government information on long-term care |
France |
long-term care, home
nursing care, nursing homes |
The social insurance
system and taxes provide ‘personal autonomy allowance’ (allocation
personalisée d’autonomie or APA); the benefit is based on level of care
needs and income. |
National Solidarity Fund for Autonomy (CNSA) (funding) |
Act on adapting society to an ageing population |
Long-term care financing: lessons from France (2015) Policy history: The long-term care system for the elderly in France (2010) |
Finland |
elder(ly) care, services
for older people, home care, sheltered housing, institutional care |
Services funded by local
authorities through local taxes and government grants are supplemented by
means tested co-payments. |
Ministry
of Social Affairs and Health |
Social Welfare Act Act on Care Services for Older People |
Government information on services
for older people and the Quality recommendation to guarantee a good quality of
life and improved services for older persons (2013) |
Denmark |
long-term care, social
care, elderly care, home care, free choice, reablement, nursing homes |
Services are funded by
local authorities through local taxes and government grants, with some means-tested
co-payments for food and accommodation; there is near-universal coverage. |
Ministry of Health |
Social Service Act |
Healthcare in Denmark – an overview (Chapter 5: elderly care) |
Sweden |
social care, elderly care,
home care |
Services are funded by
local authorities through local taxes and government grants, with some
means-tested co-payments; there is near-universal coverage. |
Ministry of Health and Social Affairs |
Social Services Act |
Public sector information on
social care/elderly care |
[1].
Or is part of long-term care/social care systems that also provide for
other target groups, such as people with a disability.
[2].
A few terms in other languages have been included, where the original-language
term is commonly used within information otherwise in English.
For copyright reasons some linked items are only available to members of Parliament.
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