Long-Term Care in 5 European Countries

Trends in long-term care spending and use has been rising over time.  The graphs below, from Nadash et al. (2012) demonstrate this trend between 2000 and 2008.

Annual Expenditures Long-Term Care Expenditures

Annual Enrollment in Long-Term Care Programs

Today, I review the long-term care systems in five European countries: Austria, England, France, Germany, and the Netherlands.

Austria

• Financing: 100% from general revenues
• Eligibility: Most individuals are eligible.  Austrian cash allowance is available regardless of age or type of disabling condition, but until recently it has primarily benefited the elderly.
• Cash Benefit
  • Cash Benefit Name: Pflegegeld
  • Average Cash Payment: 642 USD
  • Range of Cash Payments: $222-$2385
  • Cash Benefits Vary by: functional/health status
  • Caregiver Benefits: Money for dementia care, supplement for 24 hour care, pension credits

England

• Financing: 100% from general revenues
• Cash Benefits
  • Cash Benefit Name: Direct Payments
  • Average Cash Payment: N/A USD
  • Range of Cash Payments: $71-$1410
  • Cash Benefits Vary by: income (means-tested and charges apply) and functional/health status
  • Caregiver Benefits: Means-tested Carer’s Allowance, pension rights

France

• Financing: a large majority of premiums from general revenues.  Copayments depend on income low-income elders pay no co-payments, while higher income individuals pay co-payments of up to 90 percent.
• Eligibility: covers non-institutionalized individuals 60 and older.  Has a a separate (smaller and older) scheme for younger disabled adults.
• Cash Benefits
  • Cash Benefit Name: Allocation Personnalisée d’Autonomie
  • Average Cash Payment: 711 USD
  • Range of Cash Payments: $39-$1780
  • Cash Benefits Vary by: income (copayments up to 90%) and functional/health status
  • Caregiver Benefits: Tax benefits, 3 months of unpaid leave

Germany

• LTC insurance is mandatory
• Financing: solely from individual contributions
• Eligibility: weighted towards those with needs for “hands-on” physical assistance and/or protective oversight related to dementia. Favors age-related disabilities.
• Cash Benefits
  • Name: Pflegegeld
  • Average Cash Payment: N/A
  • Range of Cash Payments: $324-$986
  • Cash Benefits Vary by: Functional/Health Status only
  • Caregiver Benefits: Up to $2,117 to cover respite for 4 week vaciation, 6 months of unpaid leave, Social Security Benefits

Netherlands

• Financing: In “AWBZ” program, about a third of the financing comes from general revenues, two-third from individual contributions of 12.5% of income split between employer and employee (up to a maximum of $474).
• Eligibility: Covers people of all ages with all types of disabilities and conditions (including psychiatric conditions) in a range of settings, from institutions to homes
• Cash Benefits
  • Cash Benefit Name: Persoonsgebonden Budget
  • Average Cash Payment: 1741
  • Range of Cash Payments: $600-$6600
  • Cash Benefits Vary: Yes – by income (copayments) and functional/health status
  • Caregiver Benefits: $360 annual allowance, savings plan (1% of salary), 2 weeks of leave at 70% of wages, 12 weeks unpaid leave

Source:

• Nadash, P., Doty, P., Mahoney, K. J. and Von Schwanenflugel, M. (2012), European Long-Term Care Programs: Lessons for Community Living Assistance Services and Supports?. Health Services Research, 47: 309–328. doi: 10.1111/j.1475-6773.2011.01334.x