Is Care Affordable for Older People?

Is Care Affordable for OlderPeople? Is Care Affordable for OlderPeople? This work is published under the responsibility of the Secretary-General of the OECD. The opinions expressed andarguments employed herein do not necessarily reflect the official views of the Member countries of the OECD. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty overany territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use ofsuch data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements inthe West Bank under the terms of international law. ISBN 978-92-64-45124-7 (print)ISBN 978-92-64-63561-6 (PDF)ISBN 978-92-64-66532-3 (HTML)ISBN 978-92-64-83672-3 (epub) OECD Health Policy StudiesISSN 2074-3181 (print)ISSN 2074-319X (online) Photo credits:Cover © Halfpoint/shutterstock.com. Attribution 4.0 International (CC BY 4.0)This work is made available under the Creative Commons Attribution 4.0 International licence. By using this work, you accept to be bound by the terms of this licence(https://creativecommons.org/licenses/by/4.0/).Attribution– you must cite the work.Translations– you must cite the original work, identify changes to the original and add the following text:In the event of any discrepancy between the original work and thetranslation, only the text of original work should be considered valid.Adaptations– you must cite the original work and add the following text:This is an adaptation of an original work by the OECD. The opinions expressed and arguments employed inthis adaptation should not be reported as representing the official views of the OECD or of its Member countries.Third-party material– the licence does not apply to third-party material in the work. If using such material, you are responsible for obtaining permission from the third party and forany claims of infringement.You must not use the OECD logo, visual identity or cover image without express permission or suggest the OECD endorses your use of the work.Any dispute arising under this licence shall be settled by arbitration in accordance with the Permanent Court of Arbitration (PCA) Arbitration Rules 2012. The seat of arbitration shallbe Paris (France). The number of arbitrators shall be one. Foreword Demand among older persons (65yearsandover)for long-termcare (LTC)–that is, for assistance witheveryday activities–is gradually increasing throughout OECDcountries as populations grow older andhousehold structures change. At the same time, there are rising expectations for quality, affordable, andwidely available LTC services. Population ageing and societal changes will lead to significant increases inLTC expenditures. On average, LTC spending is projected to at least double by2050. Growing demand for care and the associated costs present a significant challenge for social protectionsystems throughout the OECD, as they need to ensure that LTC needs do not go unmet while balancingfiscal sustainability. Currently, there is little comparative information on how LTC spending matchesindividuals’ actual costs of care.This report seeks to shed light on the adequacy and effectiveness of publicsocial protection systems in reducing the burden of the high costs of LTC on the individual and theassociated increase in poverty risk. To do so, thereport defines a set of“typical cases of LTC needs”. Thetypical cases describe an older person in terms of the types and severity of their LTC needs, based ontheir limitations in performing basic activities, such as bathing, dressing,cooking, and cleaning. The typicalcases alsodescribe the amount of time ofprofessional services they require to provide help. This approachallowsto comparethe level of publicbenefits and servicesin different countries for a defined level of LTCneeds. This report examines the generosity of public systems in helping older people meet the costs of care. Itprovides a comparison of the share of LTC costs that are covered by the public system and what is left forindividuals to pay out-of-pocket, for different degrees of needs and means (income andwealth). It pointsto gaps in generosity, with a number of countries leaving individual with severe needs and low incomeswith high out-of-pocket costs. The report also assesses how effective systems are in reducing poverty risksdue to LTC and how this is related to different aspects of the LTC system. While public social protectionreduces the poverty risks associated with LTC, it is not enough in many countries. Finally, the report alsoassesses the implications of population ageing in terms of expenditures and of possible ways to raisefunds. Additionally, it examines the impact policy reforms seeking to improve affordability for users, andthose looking at the