Advertisement

Provision of Health Services: Long-Term Care

  • Vincent MorEmail author
  • Anna Maresso
Reference work entry
Part of the Health Services Research book series (HEALTHSR)

Abstract

This chapter examines the financing, organization and regulation of long-term care in OECD countries. Historically, long-term care services and supports constitute a blending of social welfare benefits and health care provision. Depending on the complexity and severity of care recipients’ needs, delivery is characterized by both specialized nursing and medical care and personal and home-help services such as assistance with meals, grooming and household chores. The delivery of long-term care is accomplished via institutional (residential) care, formal home care services, as well as through informal care provided by family members or hired care givers. In line with the preferences of older people to remain in their own homes, the past decade has seen a substantial shift in most OECD countries towards more home and community based care. This trend has regulatory and cost implications for monitoring the quality of care, which in the past has focused predominantly on institutions. Moreover, increased demand for formal services, in both residential and home care settings, due to ageing population pressures, also has implications for the long-term care workforce, with shortages anticipated over the next 20–40 years.

While funding of long-term care services comes mainly from public sources, there are very large variations between OECD countries in the resources dedicated to this sector. Eligibility for coverage also varies between countries, ranging from universal systems - based solely on need and not on income - to long-term care systems that apply means testing and safety-net principles to determine who qualifies for publicly-provided long-term care services and benefits. However, irrespective of financing model, all countries use some form of needs assessment to judge an applicant’s level of functional impairment and care needs. Financial support is provided via in-kind services or through cash benefits to recipients to purchase the services they need (with varying degrees of restrictions). Cost-sharing, in the form of user charges, play a role in all countries, to different degrees, with service users, unless they are destitute, having to meet a proportion of the cost of their care from their own private resources.

The chapter also looks at the regulatory mechanisms used across a selection of countries to monitor the quality of long-term care, particularly in residential facilities, identifying three broad quality assurance approaches. The chapter ends with a discussion of key challenges in quality monitoring and its role in enhancing user choice and stimulating improvements in providers’ performance.

References

  1. Alakeson V. International development in self-directed care. Issue Brief (Commonw Fund). 2010;78:1–11.Google Scholar
  2. Angelelli J, Mor V, et al. Oversight of nursing homes: pruning the tree or just spotting bad apples? Gerontologist. 2003;43(2):67–75.CrossRefGoogle Scholar
  3. Bettio F, Solinas G. Which European model for elderly are? Equity and cost-effectiveness in home based care in three European countries. Econ Lavoro. 2009;43(1):53–71.Google Scholar
  4. Carpenter I, Hirdes J. A good life in old age: monitoring and improving quality in long term care. OECD Health Policy Studies, OECD Publishing; 2013.  https://doi.org/10.1787/9789264194564-en
  5. Columbo F, Llena-Nozal A, Mercier J, Tjadens F. Help wanted? Providing and paying for long-term care. Paris: OECD Publishing; 2011.CrossRefGoogle Scholar
  6. Dale S, Brown R, Phillips B, Carlson BL. How do hired workers fare under consumer-directed personal care? Gerontologist. 2005;45(5):583–92.CrossRefGoogle Scholar
  7. Damiani G, Farelli V, Anselmi A, Sicuro L, Solipaca A, Burgio A, Iezzi DF, Ricciardi W. Patterns of long term care in 29 European countries: evidence from an exploratory study. BMC Health Serv Res. 2011;11:316.CrossRefGoogle Scholar
  8. Doty P, Mahoney KJ, Sciagaj M. New state strategies to meet long-term care needs. Health Aff. 2010;29(1):49–56.CrossRefGoogle Scholar
  9. Duyvendak JW, Grootegoed E, Savernije MT, Tonkens E. Day 1: long-term care in Europe, the state of the art. Presentation given at does Europe care? European Conference on Long-Term Care and Diversity, Amsterdam; 2009. http://www.careconference.eu/site/sites/default/files/Part201.pdf.
  10. European Commission. Long-term care in the European Union. Brussels: Commission of the European Communities, DG Employment, Social Affairs and Equal Opportunities; 2008.Google Scholar
  11. Feng Z, Lepore M, Clark MA, Tyler D, Smith DB, Mor V, Fennell ML. Geographic concentration and correlates of nursing home closures: 1999–2008. Arch Intern Med. 2011;171(9):806–13.CrossRefGoogle Scholar
  12. Fernandez JL, Forder J, Trukeschitz B, Rokosová M, McDaid D. How can European States design efficient, equitable and sustainable funding systems for long-term care for older people? Copenhagen: World Health Organization and World Health Organization on behalf of the European Observatory on Health Systems and Policies; 2009.Google Scholar
  13. Foster L, Dale S, Brown R. How caregivers and workers fared in Cash and Counseling. Health Serv Res. 2007;42(1 Pt 2):510–32.CrossRefGoogle Scholar
  14. Grabowski DC, Cadigan RO, Miller EA, Stevenson DG, Clark M, Mor V. Supporting home- and community-based care: views of long-term care specialists. Med Care Res Rev. 2010;67(Suppl 4):82S–101S.CrossRefGoogle Scholar
  15. Hutchinson AM, Milk DL, Maisey S, Johnson C, Squires JE, Teare G, Estabrooks CA. The resident assessment instrument-minimum data set 2.0 quality indicators: a systematic review. BMC Health Serv Res. 2010;10:166.  https://doi.org/10.1186/1472–6963–10-166.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Ikegami N, Fries BE, Takagi Y, Ikeda S, Ibe T. Applying RUG-III in Japanese long-term care facilities. Gerontologist. 1994;34(5):628–39.CrossRefGoogle Scholar
  17. Ikegami N, Morris JN, Fries BE. Low-care cases in long-term care settings: variation among nations. Age Ageing. 1997;26(Suppl 2):67–71.CrossRefGoogle Scholar
  18. Ikegami N, Ishibashi T, Amano T. Japan’s long-term care regulations focused on structure – rationale and future prospects. In: Mor V, Leone T, Maresso A, editors. Regulating long-term care quality: an international comparison. Cambridge: Cambridge University Press; 2014.Google Scholar
  19. Jung H-Y, Jang S-N, Seok J-E, Kwon S. Quality monitoring of long-term care in the Republic of Korea. In: Mor V, Leone T, Maresso A, editors. Regulating long-term care quality: an international comparison. Cambridge: Cambridge University Press; 2014.Google Scholar
  20. Kane RA, Kane RL, Ladd RC. The heart of long-term care. New York: Oxford University Press; 1998.Google Scholar
  21. Katz MB. In the shadow of the Poorhouse: a social history of welfare in America. Tenth anniversary edition. New York: Basic Books; 1996.Google Scholar
  22. Kellogg DO. The pauper question. Atl Mon. 1883;51(307):638–652.Google Scholar
  23. Larson Allen L. Mapping the future: estimating Florida aging service needs 2008–2030. Tallahassie: Agency for Health Care Administration; 2008.Google Scholar
  24. Miller EA, Mor V, Clark M. Reforming long-term care in the United States: findings from a national survey of specialists. Gerontologist. 2010;50(2):238–52.CrossRefGoogle Scholar
  25. Miller EA, Tyler DA, Rozanova J, Mor V. National newspaper portrayal of U.S. nursing homes: periodic treatment of topic and tone. Milbank Q. 2012;90(4):725–61.CrossRefGoogle Scholar
  26. Mor V, Miller EA, Clark M. The taste for regulation in long-term care. Med Care Res Rev. 2010;67(Suppl 4):38S–64S.CrossRefGoogle Scholar
  27. Mor V, Leone T, Maresso A, editors. Regulating long-term care quality: an international comparison. Cambridge: Cambridge University Press; 2014.Google Scholar
  28. Mot E, Willemé P, editors. Assessing needs of care in European nations, ENEPRI policy brief no. 14, vol. 2012. Centre for European Policy Studies: Brussels; 2012.Google Scholar
  29. Mukamel DB, Weimer DL, Harrington C, Spector WD, Ladd H, Li Y. The effect of state regulatory stringency on nursing home quality. Health Serv Res. 2012;47(5):1791–813.CrossRefGoogle Scholar
  30. OECD. Ensuring quality long-term care for older people. Paris: OECD Publishing; 2010. Policy Brief.Google Scholar
  31. OECD. Recipients of long-term care. In: Health at a glance 2013: OECD indicators. Paris: OECD Publishing; 2013a.  https://doi.org/10.1787/health_glance-2013-75-en
  32. OECD. OECD health data: long-term care resources and utilisation. Paris: OECD; 2013b.Google Scholar
  33. OECD/European Commission. A good life in old age? Monitoring and improving quality in long-term care, OECD health policy studies. Paris: OECD Publishing; 2013.  https://doi.org/10.1787/9789264194564-en
  34. Phillips B, Schneider B. Commonalities and variations in the Cash and Counseling programs across the three demonstration States. Health Serv Res. 2007;42(1 Pt 2):397–413.CrossRefGoogle Scholar
  35. Rothgang H. Long-term care for older people in Germany. In: Comas-Herrera A, Wittenberg R, editors. European study of long-term care expenditure. Investigating the sensitivity of projections of future long-term care expenditure in Germany, Spain, Italy and the United Kingdom to changes in assumptions about demography, dependency, informal care, formal care and unit costs. Report to the European Commission, Employment and Social Affairs DG: 24–42. 2003. http://ec.europa.eu/employment_social/soc-prot/healthcare/ltc_study_en.pdf
  36. RWJF – Robert Wood Johnson Foundation. Executive summary: cash and counseling program. Princeton: Robert Wood Johnson Foundation; 2013. Available at: http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2013/rwjf406468/subassets/rwjf406468_1
  37. Simmonazzi A. Home care and cash transfers. Effects on the elderly care-female employment trade-off. Cost Conference. Rome; 2009.Google Scholar
  38. Sloane PD, Zimmerman S, Gruber-Baldini AL, Hebel JR, Magaziner J, Konrad TR. Health and functional outcomes and health care utilization of persons with dementia in residential care and assisted living facilities: comparison with nursing homes. Gerontologist. 2005;45 Spec No 1(1):124–32.CrossRefGoogle Scholar
  39. Smith DB, Feng Z, Fennell ML, Zinn JS, Mor V. Separate and unequal: racial segregation and disparities in quality across US nursing homes. Health Aff. 2007;26(5):1448–58.CrossRefGoogle Scholar
  40. Stevenson DG, Grabowski DC. Sizing up the market for assisted living. Health Aff. 2010;29(1):35–43.CrossRefGoogle Scholar
  41. Swartz K. Searching for a balance of responsibilities: OECD countries’ changing elderly assistance policies. Annu Rev Public Health. 2013;34:397–412.CrossRefGoogle Scholar
  42. Tarricone R, Touros AD, editors. The solid facts: home care in Europe. Copenhagen: World Health Organization Regional Office for Europe and Universita' Commerciale Luigi Bocconi; 2008.Google Scholar
  43. Ungerson C, Yeandle S. Cash for care in developed welfare states. Houndmills: Palgrave Macmillan; 2007.Google Scholar
  44. van Hooren F. Bringing policies back in: How social and migration policies affect the employment of immigrants in domestic care for the elderly in the EU-15. Paper presented at Transforming elderly care at local, national and transnational level, International Conference at the Danish National Centre for Social Research (SFI), Copenhagen; 2008.Google Scholar
  45. Werner RM, Konetzka RT. What drives nursing home quality improvement under public reporting? An examination of post-acute care. Chicago: AcademyHealth; 2009.Google Scholar
  46. Werner RM, Konetzka RT, Stuart EA, Norton EC, Polsky D, Park J. Impact of public reporting on quality of postacute care. Health Serv Res. 2009;44(4):1169–87.CrossRefGoogle Scholar
  47. Wiener JM. Commentary: cash and counseling in an international context. Health Serv Res. 2007;42(1 Pt 2):567–76.CrossRefGoogle Scholar
  48. Wirrmann Gadsby E. Personal budgets and health: a review of the evidence. London: PruComm. Policy Research Unit in Commissioning and the Health Care System, Department of Health; 2013.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health Services, Policy and PracticeBrown University School of Public HealthProvidenceUSA
  2. 2.European Observatory on Health Systems and PoliciesLondon School of Economics and Political ScienceLondonUK
  3. 3.Providence Veterans Administration Medical CenterCenter on InnovationProvidenceUSA

Personalised recommendations