RESEARCH PAPER SERIES, 2016–17              28 June 2017

International aged care: a quick guide

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

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[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.