Help wanted? : providing and paying for long-term care

328 Pages·2013·2.724 MB·English

by  OECD

Help Wanted?
PROVIDING AND PAYING FOR LONG-TERM CARE
As life expectancy pushes into the late 70s for men and well into the 80s for women, ever more people want
help in order to be able to live their lives to the full for as long as possible. How will demographic and labour
market trends affect the supply of family, friends and care workers available to the elderly? Will public fi nances Help Wanted?
be threatened by the future costs of care? What should be the balance between private responsibility and
public support in care giving? This book addresses these and other important questions.
TABLE OF CONTENTS PROVIDING AND PAYING FOR LONG-TERM CARE
Chapter 1. Long-term Care: Growing Sector, Multifaceted Systems
Chapter 2. Sizing Up the Challenge Ahead: Future Demographic Trends and Long-term Care Costs
Chapter 3. The Impact of Caring on Family Carers
Chapter 4. Policies to Support Family Carers
Chapter 5. Long-term Care Workers: Needed but Often Undervalued
Chapter 6. How to Prepare for the Future Long-term Care Workforce?
Chapter 7. Public Long-term Care Financing Arrangements in OECD Countries
Chapter 8. Private Long-term Care Insurance: A Niche or a “Big Tent”?
Chapter 9. Where To? Providing Fair Protection against Long-term Care Costs and Financial Sustainability
Chapter 10. Can We Get Better Value for Money in Long-term Care?
“WHO recognizes that long-term care represents a major challenge for all countries in the world, with important
implications for economic development and for the health and well-being of older people. This well-documented
book provides a comparative analysis of the common challenges and diverse solutions OECD countries are
H
adopting to respond to the growing demand for long-term care services, and particularly its implications for e
fi nancing and labour markets. It provides much needed evidence to guide policy makers and individuals.” lp
W
Dr. John Beard, Director, Department of Ageing and Life Course, World Health Organization a
n
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“This carefully researched book offers invaluable data and insights into the organization and fi nancing of e
d
long-term care in OECD countries. The book is an indispensable resource for anyone interested in international ?
long-term care.” P
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O
Dr. Joshua M. Wiener, Distinguished Fellow and Program Director of RTI’s Aging, Disability, and Long-Term Care V
ID
Program, United States IN
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www.oecd.org/health/longtermcare N
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Please cite this publication as: G
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Colombo, F., et al. (2011), Help Wanted?: Providing and Paying for Long-Term Care, OECD Health Policy Studies, E
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OECD Publishing. M
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http://dx.doi.org/10.1787/9789264097759-en A
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This work is published on the OECD iLibrary, which gathers all OECD books, periodicals and statistical databases. E
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of the European Union
81 2011 03 1 P

Help Wanted?
PROVIDING AND PAYING
FOR LONG-TERM CARE
Francesca Colombo,
Ana Llena-Nozal,
Jérôme Mercier,
Frits Tjadens
This work is published on the responsibility of the Secretary-General of the OECD.
The opinions expressed and arguments employed herein do not necessarily reflect the
official views of the OECD or of the governments of its member countries or those of the
European Union.
Please cite this publication as:
Colombo, F. etal. (2011), Help Wanted? Providing and Paying for Long-Term Care, OECD Health Policy
Studies, OECD Publishing.
http://dx.doi.org/10.1787/9789264097759-en
ISBN 978-92-64-09758-2 (print)
ISBN 978-92-64-09775-9 (PDF)
Series: OECD Health Policy Studies
ISSN 2074-3181 (print)
ISSN 2074-319X (online)
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of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli
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FOREWORD
Foreword
T
here comes a time in many people’s lives when their functional and physical abilities decline. To
continue to live an active and fulfilling life, people need help –from family, friends, or from people
employed to help.
This report is about how countries can provide that help. Most caring is provided by family and
friends out of love or duty. Some additional support to such carers can have a big effect, at relatively
low cost. Workers to fill caregiving jobs can be found, as long as policy makers and employers take
steps to improve the dismal image of caregiving as being low-paid, hard, and low-skilled. Providing
adequate financial protection for those needing care is possible, in a way that does not unduly stretch
public financing. But getting these policies right needs to start now, because the challenge to
implementing sustainable, responsive and fair long-term care policies is only going to get bigger and
bigger, as populations age. Learning from other countries’ experiences, both good and bad, might
save much money and grief.
This book is the result of a two-year project conducted between2009 and2010 by the
OECDHealth Division and Social Policy Division. The study points to key polices and strategies that
can help address future demand for care and respond to the implications this will have for long-term
care workforce and financing. It highlights examples of useful country experiences, but it also warns
about the dearth of evidence on cost-effective policies in a number of areas, making a strong plea for
advancing evidence-based research on long-term care (LTC).
The study used a mix of quantitative and qualitative methods. Qualitative information was
collected through a fact-finding and policy questionnaire covering 29OECD countries, complemented
by selected country missions. Quantitative data were gathered from OECD databases and
longitudinal surveys on health, retirement and ageing in Europe, Australia, the United States, the
United Kingdom, and Korea. Projections of LTC costs were based on an update and expansion of
earlier projections by the OECD and the European Commission.
HELP WANTED? PROVIDING AND PAYING FOR LONG-TERM CARE © OECD 2011 3
ACKNOWLEDGEMENTS
Acknowledgements
This book is the result of work undertaken at OECD and the product of truly concerted
efforts between the OECD Secretariat, governmental delegates and experts from many
OECD countries. Within the OECD Secretariat, two Divisions of the Directorate for
Employment, Labour and Social Affairs –the Health Division and the Social Policy
Division– collaborated on the project.
The report was developed by Francesca Colombo, who acted as project leader, and by
AnaLenaNozal, JérômeMercier and FritsTjadens. LihanWei provided statistical and
research assistance throughout the project. Many interns contributed to the analysis and
drafting process at various stages, especially MargaritaXydia-Charmanta, as well as
KaterinaGousia, ElizabethSugarman, Y-LingChi, Anna-MariViita and LilianChiYan Li. The
report benefited from invaluable comments and suggestions especially from MarkPearson,
MonikaQueisser and John Martin, as well as RieFujisawa and JonathanChaloff. Many
thanks also to MarlèneMohier for her editorial contribution in preparing the document for
publication and to JudyZinneman for assistance.
The project would not have been possible without the help of country experts and
delegates, including representatives from Health and Social Policy Ministries in
OECDcountries, who provided technical input, background information, and feedback. An
expert meeting discussed the draft report on 15-16November 2010 in Paris. Comments on
the report were also received from the European Commission, the World Health
Organization, and the Business and Industry Advisory Committee to the OECD (BIAC).
The project was supported by a grant from the Directorate General for Health and
Consumers Affairs of the European Commission. It benefited from voluntary contributions
from Belgium, France, Japan and the Netherlands.
4 HELP WANTED? PROVIDING AND PAYING FOR LONG-TERM CARE © OECD 2011
TABLE OF CONTENTS
Table of Contents
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Summary and Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Chapter 1. Long-term Care: Growing Sector, Multifaceted Systems . . . . . . . . . . . . . . . 37
1.1. Scope of this report: How do OECD societies address the growing need
for long-term care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
1.2. What is long-term care?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
1.3. Who uses formal LTC services?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
1.4. Who provides long-term care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
1.5. Who pays for long-term care, in what settings and at what cost?. . . . . . . . . . 46
1.6. What services are provided? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
1.7. How did countries get here? Where are they going? . . . . . . . . . . . . . . . . . . . . . 54
1.8. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Chapter 2. Sizing Up the Challenge Ahead: Future Demographic Trends
and Long-term Care Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
2.1. Future demographic trends: Growing LTC demand . . . . . . . . . . . . . . . . . . . . . . 62
2.2. The pool of family carers is likely to decrease . . . . . . . . . . . . . . . . . . . . . . . . . . 64
2.3. How much will long-term care cost? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
2.4. Conclusions: Policies to address future pressures on long-term
care systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Chapter 3. The Impact of Caring on Family Carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
3.1. Addressing caring responsibilities: The impact on informal carers . . . . . . . . 86
3.2. Most carers are women, care for close relatives and provide limited hours
of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
3.3. High-intensity caring can lead to reduced rates of employment
and hours of work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
3.4. For those of working age, caring is associated with a higher risk
of poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
3.5. Intensive caring has a negative impact on mental health. . . . . . . . . . . . . . . . . . 97
3.6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
HELP WANTED? PROVIDING AND PAYING FOR LONG-TERM CARE © OECD 2011 5
TABLE OF CONTENTS
Annex 3.A1. Data Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Annex 3.A2. Additional Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Annex 3.A3. Estimating the Impact of Caring on Work Characteristics
of Carers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Annex 3.A4. How to Measure the Impact of Caring on Wages . . . . . . . . . . . . . . . . . 120
Chapter 4. Policies to Support Family Carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
4.1. Improving carers’ role and wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
4.2. Helping carers combine caring responsibilities with paid work. . . . . . . . . . . . . . 122
4.3. Improving carers’ physical and mental wellbeing . . . . . . . . . . . . . . . . . . . . . . . 127
4.4. Compensating and recognising carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
4.5. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Annex 4.A1. Summary Table: Services for Carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Annex 4.A2. Leave and Other Work Arrangements for Carers . . . . . . . . . . . . . . . . . 141
Annex 4.A3. Financial Support for Carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Chapter 5. Long-term Care Workers: Needed but Often Undervalued . . . . . . . . . . . . . 159
5.1. How many long-term care workers are there? . . . . . . . . . . . . . . . . . . . . . . . . . . 160
5.2. Who are the LTC workers?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
5.3. What are the working conditions in long-term care? . . . . . . . . . . . . . . . . . . . . 169
5.4. Foreign-born workers play a substantial and growing role
in some countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
5.5. Changes in LTC policies affect LTC labour markets . . . . . . . . . . . . . . . . . . . . . . 179
5.6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Chapter 6. How to Prepare for the Future Long-term Care Workforce? . . . . . . . . . . . . 189
6.1. The future challenge for the long-term care workforce. . . . . . . . . . . . . . . . . . . 190
6.2. Improving recruitment and retention: Overview of national policies. . . . . . . 190
6.3. Ensuring an adequate inflow of long-term care workers . . . . . . . . . . . . . . . . . 193
6.4. Improving retention: Valuing work, building careers. . . . . . . . . . . . . . . . . . . . . 199
6.5. Increasing productivity among LTC workers?. . . . . . . . . . . . . . . . . . . . . . . . . . . 206
6.6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Chapter 7. Public Long-term Care Financing Arrangements in OECD Countries . . . . 213
7.1. Collective coverage of long-term care costs is desirable on efficiency
and access grounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
7.2. Public long-term care coverage for personal care can be clustered
inthreemain groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
7.3. Even within universal systems, the comprehensiveness of coverage
can vary significantly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
7.4. Different approaches but similar directions: Universalism
and choice-based models. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
7.5. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
6 HELP WANTED? PROVIDING AND PAYING FOR LONG-TERM CARE © OECD 2011
TABLE OF CONTENTS
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Chapter 8. Private Long-term Care Insurance: ANiche or a “Big Tent”? . . . . . . . . . . . 247
8.1. Asmall number of OECD countries account for the largest markets . . . . . . . 248
8.2. Market failures and “consumers myopia” explain why the private
LTC insurance is small . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
8.3. Policy and private-sector initiatives to increase take up. . . . . . . . . . . . . . . . . . 253
8.4. Conclusions: Private long-term care insurance has some potentials
but is likely to remain a niche product. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Chapter 9. Where To? Providing Fair Protection Against Long-term Care Costs
and Financial Sustainability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
9.1. Why provide financial protection against long-term care cost?. . . . . . . . . . . . 264
9.2. Improving protection against catastrophic care cost calls for universal
LTC entitlement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
9.3. Universal care does not exclude targeting: What benefits and for whom? . . 266
9.4. Board and lodging costs in institutions are the main costs that
LTC users face. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
9.5. Matching care need with finances: Policies for the future . . . . . . . . . . . . . . . . 278
9.6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Chapter 10. Can We Get Better Value for Money in Long-term Care?. . . . . . . . . . . . . . . 295
10.1.What is value for money in long-term care?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
10.2.Towards more efficient delivery of long-term care. . . . . . . . . . . . . . . . . . . . . . . 296
10.3.Is it possible to optimise health and care?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
10.4.Addressing long-term care systems governance . . . . . . . . . . . . . . . . . . . . . . . . 315
10.5.Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Tables
1.1. Cash-for-care schemes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
1.2. Selected LTC policy changes over the past ten years in OECD countries
at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
2.1. Public LTC expenditure expected to rise significantly by2050. . . . . . . . . . . . . . . 74
2.2. Potential impact of changing the mix of public/private financing
of LTC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
3.1. Unpaid care is mostly directed towards parents and spouses. . . . . . . . . . . . . . . 90
3.2. Carers are more likely to be home makers, less likely to be employed . . . . . . . 92
4.A1.1. Summary Table: Services for carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
4.A2.1. Leave and other work arrangements for carers . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
4.A3.1. Financial support for carers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
HELP WANTED? PROVIDING AND PAYING FOR LONG-TERM CARE © OECD 2011 7
TABLE OF CONTENTS
5.1. Evidence on ageing of the LTC workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
5.2. Initial training levels for the lower-level LTC workforce across the OECD . . . . . 166
5.3. Wages in LTC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
5.4. Foreign-born care workers in LTC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
6.1. Workforce policies to increase the supply of LTC services. . . . . . . . . . . . . . . . . . 191
7.1. Public LTC coverage: Asummary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
7.2. Universal long-term care insurance schemes in OECD countries. . . . . . . . . . . . 221
7.3. Long-term care need assessment process in selected OECD countries . . . . . . . 232
7.4. Approaches to covering board and lodging cost (B&L) in nursing homes
in OECD countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
9.1. Household composition of net-worth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
10.1. Policies to improve value for money in long-term care in OECD countries:
An overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
10.2. Policies to promote home care in OECD countries. . . . . . . . . . . . . . . . . . . . . . . . . 299
10.3. Policies to avoid the inappropriate use of acute care services
and co-ordinate LTC programmes in OECD countries. . . . . . . . . . . . . . . . . . . . . . 308
10.4. Average length of stay for dementia and Alzheimer’s disease in acute care
(in days) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Figures
1.1. Financial sustainability is the most important policy priority for LTC systems
in the OECD, 2009-10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
1.2. More LTC users receive care at home than in institutions . . . . . . . . . . . . . . . . . . 40
1.3. Most LTC users are women aged over 80years . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
1.4. Approximately half of all LTC users are aged over 80years. . . . . . . . . . . . . . . . . 41
1.5. Younger LTC users receive higher amounts of home care
than the very old ones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
1.6. LTC workers represent a small share of the working-age population, 2008. . . . 45
1.7. The size of the LTC workforce is limited compared to the number
of those in need. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
1.8. The share of public LTC expenditure is higher than that of private
LTC expenditure in OECD countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
1.9. Spending on LTC in institutions is higher than spending at home
in OECD countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
1.10. Significant variation in LTC expenditure among OECD countries. . . . . . . . . . . . 49
1.11. High LTC expenditure is associated with high LTC-worker density . . . . . . . . . . 49
2.1. The share of the population aged over 80years old will increase rapidly . . . . . 62
2.2. The shares of the population aged over65 and 80years in the OECD
will increase significantly by2050 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
2.3. The share of the working-age populations is expected to decrease by2050. . . 64
2.4. The very old-age dependency ratio is increasing rapidly . . . . . . . . . . . . . . . . . . . 65
2.5. More surviving old men for each woman by2050 . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.6. Increase in the proportion of old people living in couples, by2050 . . . . . . . . . . 68
2.7. The proportion of frail elderly either living alone or with a frail partner
will decrease, but the share of both-frail couples will increase by2050. . . . . . . 69
2.8. The projected growth in frail elderly greatly outweighs that of potential
caregivers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
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