Ageing policies in developed countries : discord or convergence?
- Lorenzo Lanteri
- 6 oct. 2015
- 6 min de lecture
The ageing of the population combined with the weakening of family solidarity, which itself is linked to an increasing urbanization, make the old age dependency a common issue for all European countries.
The responses to the risk of old age dependency appear at first sight quite different from one country to another. Nevertheless, all the different European models are converging since two decades. On one hand, countries inclined to ensure a broad public coverage of the loss of autonomy does not fully cover beneficiaries anymore. On the other side, countries where most of the cost of old age dependency was supported by families have become more willing to implement public support.
Although the differences between the different models have gradually blurred, three types of model can still be isolated. The first type corresponds to systems where public protection against the old age dependency has been since a long time a national priority (Germany, Denmark). The second type, are countries where public support has been thinking as a compensation to the family and private caregivers (Spain, Italy). There is also a third types of models, those where public intervention is limited to a form of social assistance, covering the needs of the poorest people (United Kingdom), but I’m not going to deal with it in that paper.
Japan: a decentralized insurance- public system.
Japan can be regarded as a model because long term care insurance is universal. It addresses all elderly dependent persons over 65 years (age limit can be reduced to 40 years depending on the origin of the loss of autonomy) regardless of their income level. In addition, long term care insurance not specifically targets highly dependent elder. The system also aims to provide care and prevention services to limit heavier levels of care in the future. Funding for this insurance is provided equally by the state and by the insured themselves with distinction based to age:
The people over 65 contribute about 19% to the financing (by direct contributions levied on pension benefits).
The people between 40-64 contribute to 31% to the financing of care insurance through premiums (civil servants, employees, freelancers )
The insurance system ensured to beneficiaries also three types of services:
- Prevention with local devices that offer fitness and prevention programs against malnutrition under the supervision of local authorities.
- Home care and temporary accommodation: people who ask for care givers benefit of a home visit that can help them to achieve the tasks of everyday life. They have the right to borrow home equipment. To enable the patient to recover a relative autonomy, there are structured day-care centres opportunities in specialized services and accommodation for a very short duration (less than one month).
- Accommodation for a temporary duration. Elderly dependent persons but relatively autonomous and retirees concerned for their health can opt for a nursing home with a special service for old age dependency, or rent housing furnished specifically for the elderly. People whose degree of dependence is higher wishing to benefit from rehabilitative care before returning home have the option of entering the nursing units for hosting period limited to 24 months.
Since 2006, the cost for food and accommodation is in charge of the patient. According to the Ministry of Health, Labour and Welfare, ¾ of ageing care are delivered at home and the remaining quarter in specialized institutions. For the poorest people, other aid has been also planned.
- At local level, there are several additional aids whose form varies according to local authorities (easing the level of contributions for care insurance, grants, benefits and additional service).
- At national level, a public assistance device the "Seikatsu Hogo" guaranteed a minimum income, which is not specific for people in situations of dependency. It compensates household resources if they are below a certain threshold set by the Ministry of Health, Labour and Welfare. The amount of aid is related to household composition, income, place of residence and assets held by the applicant for aid (including in particular resources from Social Security, pensions etc ..)
Denmark: universal welfare model funded by taxes.
The Danish experience proves only insofar that ageing care did not require the implementation of a specific device. It was the result of a progressive extension and a gradual adaptation of health and social services to the needs of an ageing population context. The law on social services provides that any person can receive free services it needs to maintain its quality of life, stay at home as long as possible and maintain its capacity, physical as intellectual. The financing of the entire management system of elderly dependent persons is provided by local taxes and by state subsidies.
Municipalities ; are responsible to implement the home care services, construction of homes or provision of suitable housing, day care facility, etc ... These social services are granted free of charge regardless the financial situation of the potential beneficiaries. The social services of the municipality decide the nature of the services required, but there is no formal needs assessment tool.
Communication and Information; since 1996, in each municipality, citizens over 60 years elect a "council of senior citizens" that council has to be consulted before making a decision on any ageing policy. In an information concerns, municipalities have to deliver two annual visits to anyone aged over 75 years without existing aids.
- Help for caregivers; No cash benefits are paid for elderly dependent persons, but an allowance may be granted to family caregivers.
Housing; since 1987, the law on social services prohibits the construction of new nursing homes care. However, housings suitable for disabled and dependent persons were built.
Beneficiaries can freely choose their providers and it include private companies. With the growing economic pressure upon municipalities and the new political goodwill towards private providers, have recently led to the conclusion of a series of contracts with private companies for the management of retirement homes.
Spain : Public and family support
In Spain, the ageing care policy can be defined as a subsidiarity policy between the State and the Provinces. The coverage of old age dependency thus based on three pillars:
public assistance, organized mainly by the Law to Promote Personal Autonomy and Care for People in Situations of Dependency (LAAD).
private funding, remained marginal but should be brought to develop in the coming years.
Family support, friends and neighbors, especially important within the Spanish society.
The increasing number of person facing a loss of autonomy in Spain is at the origin of the Law to Promote Personal Autonomy and Care for People in Situations of Dependency (LAAD) in 2006. Persons in need of care have right to access to services and economic benefits based on their degree of dependency. The care of the elderly dependent person by the family induced an individual financial aid and job recognition as a non-professional care-giver.
The SAAD (System for Autonomy and Dependency Care) expands and supplements the action of the State and the Social Security system and it contains:
- 5 services (Services to prevent situations of dependency and promoting personal autonomy; tele-assistance service, home help service, day and night centre services, day centre for the elderly.) ;
- 3 economic benefits: benefits payments linked to a service, benefits payments for care within the family and support for non-professional care givers and benefits payments to care givers.
The amount of benefit is determined according to the beneficiaries’ economic resources. In reality, the amount of aid is deeply related to the degree of dependency.
Historical patterns and efficient coverage
This short view of different models for covering the loss of autonomy enables to identify a common feature: a financial suitability issue. Given the significant differences in terms of socio-cultural context, institutional behavior, population structure and care supply capacity between the three types the full generalization of one model to another is not an option at the European level. However, we can identify a few good practices to improve the management of the loss of autonomy in Europe:
- Prevention through the implementation of local devices can be seen as a good model to promote.
- Combining public spending and with benefits for non-professional caregivers when it’s possible.
- The generalization of "Senior Council" could be one of the major elements of the future reform in Europe. This system has no cost and must be effective for direct communications.
-developing Télé-assistance and home help service
The rapid demographic ageing is one of the main factors determining future EU and global economic development. It is a major societal challenge as well as a major opportunity for economic growth and jobs
Comentarios