Long-Term Care in Ageing Populations

Abstract

Long-term care (LTC) involves a range of services that help people live independently and safely when they can no longer carry out routine activities on their own. This chapter focuses on LTC for older persons. Many countries, particularly in the developing world, rely on household members and the local community for most LTC services. However, as populations age, countries face increased demands at acute care facilities, reductions in supply of informal caregivers, and the need for alternatives in managing chronic and social problems. With increasing pressure on health systems, governments play a larger role in organization and funding formal LTC services and institutions. LTC has been organized and financed in different ways to meet the needs of older persons. There are differences in whether systems are formalized, rely on informal care providers, or are publicly financed. These differences reflect varying demands for health and social services, as well as different economic levels, political systems, and cultures. Based on equity and efficiency reasons, many governments have shifted toward universal LTC systems in which all older people have the right to needed benefits. Financing LTC has posed many challenges, and there are ongoing efforts to reduce the growth in costs while ensuring access to LTC services for those in need. However, even with the expanded role of government in LTC, a strong role remains for households and the community to complement formal care. LTC planning requires consideration of the formal LTC systems and financing as well as support to informal caregivers.

Glossary

Activities of daily living (ADL)

include bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom. ADLs can be referred to as “personal care.”

Adverse selection

occurs when people at low risk drop out of an insurance pool, leaving only high-risk individuals that tend to have higher care costs. Adverse selection can make it difficult to sustain private insurance markets.

Cash benefits

include cash transfers to the care recipient, the household or the family caregiver, to obtain LTC services.

Formal care

includes all care services that are provided in the context of formal employment regulations, such as through contracted services, by contracted paid care workers, declared to social security systems.

Functional ability

attributes that enable people to function and determined by the combination of their physical and mental capacities, their environments, and the interaction between individuals and these environments.

Informal caregivers

individuals (frequently spouses, family members, and friends) that provide LTC services on a regular basis and are usually unpaid.

In-home LTC

provided to people with functional restrictions who mainly reside in their own home. It also applies to the use of institutions on a temporary basis to support continued living at home – such as in the case of community care and day-care centers and in the case of respite care. Home care also includes specially designed, “assisted or adapted living arrangements” for persons who require help on a regular basis while guaranteeing a high degree of autonomy and self-control.

Instrumental activities of daily living (IADL)

include help with housework, meals, shopping, and transportation. IADLs may be referred to as domestic or home care assistance.

Long-term care (LTC)

a range of services required by persons with reduced physical or cognitive functional capacity and who are consequently dependent for an extended period of time on help from others with basic ADLs. Support for ADLs is frequently provided alongside help with basic health or nursing care, prevention, rehabilitation, or palliative care. LTC services can also be combined help with IADLs.

LTC institutions

nursing and residential care facilities (other than hospitals) which provide accommodation and LTC as a package to people requiring ongoing health and nursing care due to chronic impairments and a reduced degree of independence in activities of daily living (ADL). These establishments provide residential care combined with either nursing, supervision, or other types of personal care as required by the residents. LTC institutions include specially designed institutions where the predominant service component is LTC and the services are provided for people with moderate to severe functional restrictions.

LTC workforce

nurses, personal care workers, or people providing routine personal care, such as bathing, dressing, or grooming, to elderly, convalescent, or disabled persons in their own homes or in institutions (other than hospitals).

Market failure

occurs in health care when a person has insufficient information about quality, efficiency, or other aspects of care, or when health care is not paid for even though it would be society’s interest to provide it.

Moral hazard

occurs when individuals use more health-care services when they are not insured or not paying for the care themselves. This may result in overconsumption or inappropriate consumption of health care that is not medically necessary.