What Can We Learn from Long-Term Care in other Countries - Essay Example

Long Term Care The paper will review long-term care programs in other countries, compare it with the long-term care program in United States, and recommend the necessary changes. Since the initiation of long-term care program in United States, observers still believe that the services offered by the care program are not satisfactory. A focus on other countries with the same program provides a base for comparison as well as initiating new improvement. The state of long-term care provision in the United States is as follows. About 22% of United State population who are 65 and above could be under the long-term care program. This population receives the long-term care program from both informal and formal caregivers. A report released by the National Care Planning Council (NCPL) indicated that 61% of the caregivers dedicated about 20 hours per week in providing care services and 27% of the caregivers contributed about 50 hours a week in the provision of the same service1. The report further revealed that about 7% of the aging population accesses the long-term care services from formal institutions. It is evident from the report that majority of the United States population must be receiving the long-term care program privately in their homes. Such programs are unpaid for by the federal government. The long-term care program should serve the following groups mentally ill, the disabled, the elderly, and those suffering from terminal illnesses among others. Eligibility for the Medicaid services in United States varies from one state to the other. In most cases, the program pegs its eligibility individual income. These conditions tend to explain why long-term care program in the United States vary with the individual choices. NCPL report indicates that a majority of the US population that is above 75 are disabled. This means that the demand for the long-term care would increase as the population advances it age. The German and Japan long-term care depend on social insurance in providing comprehensive long-term care. The governments of these countries operate social insurance, which offers the long-term care. The Germans and the Japans are subject to contribution to the insurance scheme irrespective of the individual ability or his relative’s ability to provide the long-term care. The eligibility to the long-term care program is uniform in these nations. The community offering the care services receives a number of benefits from the insurance scheme2. The government is instrumental in influencing prices for the care giving at community or home based level. The ceiling set by the government considers the special needs, which the licensed caregivers might be experiencing. Although the government of Japan and Germany track the usage, provide licenses to caregivers, and influence the costs, they are not directly involved in offering the care services. This approach has the following advantages. First, needs determines the benefits gained from the insurance scheme. Second, it has special provisions for people who fall under the low-income group. Third, the process is competitive thereby offering high quality. Fourth, the program relieves the government from using taxpayers’ money to foot the budget of the scheme3. The features of long term care program in Japan and German provides an opportunity for the government to monitor the quality of services offered to the concerned parties. German and Japan have a special policy that supports the caregivers who provide the services at home. This program is different from the US system where such arrangements occur at the convenient of the family. Although Japan and German share some similarities in their long-term care program, there are some differences in policies or mode of provision. German policy objective tend to route support for caregivers at family level while the Japan policy tend to unburden caregivers at the family level. In Germany the law influence spending set a side for care giving while in Japan the expenditures in care giving tend to increase with an increase in funds availability. The population covered by the care program is quite different with Germany covering all ages while Japan setting no conditions for population above 65 and limiting the service in relation to diseases that are age related. The mode of service delivery tends to take shape from regional negotiation in Germany and national negotiation in Japan. The features of long-term care program in the two countries have following lessons. The CLASS Act, which defines the provision of the long-term care, offers an opportunity for maximization of the consumers’ choice45. It is observable that insignificant demand for formal care would aggravate the demand for the community care thereby influencing the community ability to develop. The cash model appears to less expensive because of the payment made in relation to the services offered to the society. The features of the long-term care program in German and Japan were worth immolation because they relive the government from using the taxpayers’ money to offer the services. The second lesson that US can borrow from the German and Japan model is eligibility criteria. The Germany model of the long-term care program has provisions, which makes every individual eligible for the care. Since long-term care receives its funding from the social insurance where every individual participates, the cover spreads to everyone. It is observable from the German model that it receives very many applicants for the long-term care, which is cumbersome to manage. This makes the criteria used in determining people ineffective. A similar observation tends to appear on the Japans model. However, it is observable that strict criteria used by the Japanese to evaluate the applicants for long-term care has rejected 3% of the application it has received. The system in Japan seems to be successful because it prioritizes its coverage to the old. The third lesson is the challenge that Japan and Germany have faced with respect to old and young. Germans younger disabled received inadequate services after the introduction of the insurance policy for the long-term care. This attitude demonstrated that the politics and the policy could not work. It necessitated the creation of the cash allowance, which could address the challenges above. The last lesson learnt from Germany and Japan case is how to control the long-term care program. Japan finances its program effectively because it conducts periodical financial adjustment. The spending rules should also influence the operation, which the government would take in conducting the program. The Danish model of long-term care targets the elderly people. The Danish government policy on the elderly people tends to consider the last twenty years of the elderly life. The Danish model differs with the United State model of long-term care model in the following areas. First, the Danish model receives its funding from general taxes whereas the US model receives funding from individual contribution. The individuals who require these services in United States tend to finance the services that they receive. The second feature of the Danish long-term care model is that it offers universal cover. The citizens of Denmark are subject to the services depending on their eligibility. The third feature to the Danish model is that the government has decentralized the responsibility of offering the long-term care to municipalities. The services that its citizens receive from the municipalities include nursing home, personal care, and primary medical care among other services. These services receive funding from the government and grants. The fourth feature of the model is that the government through parliament develops policies that dictate the provision of the long-term care services. For instance, in January 2005, the government developed a policy, which gave the citizens the opportunity to choose the long-term care provider, which would be funded by the government6. In 1980s, Denmark municipalities tested the 24 hour per week home care7. The experiment obtained an impressive result where central call centre could respond to the needs of the elderly. The effectiveness of the program improved especially when the municipalities integrated the services offered by the municipality nurses and the home caregivers’ organizations. Stuart and Hansen observed that the pilot program was a success because today the Danish government has adopted the same program. The second test that the municipalities conducted in 1980s was to build nursing homes. The project was expensive because it required facilities to run. The Danish government responded to the challenges of the project by passing a legislation in 1988, which stopped the municipalities from developing nursing homes. Instead, the policies rooted for building of assisted units where the elderly could acquire assistance from their dwelling place. The research on the above project conducted in 1995 indicated that the elderly adapted well in their dwelling areas. Lessons from Danish long term care program; first, the program has been effective for the last 12 years. Voluminous services provided to the frail elderly belong to the caregivers from various municipalities. This contrasts the United State approach where voluminous work to the frail elderly largely depends on the contribution of the family members. Second, a comparison between Danish and United State long-term care expenditure per capita shows that the two countries spend almost the same amounts. However, service provision in United States contrast the Danish case where long term care provision to the frail elderly is universal and efficient in terms of service delivery. Third lesson is that Denmark does not over rely on the services of nursing as opposed to United States where frail elderly spend time in the nursing home. Further, the care provided to the frail elderly in Denmark in relation to family contribution shows that family members are not directly involved in offering care to frail elderly. This contrasts the United States situation where family members demonstrate concern to frail elderly living within their units. Denmark has concentrated in housing program where housing units for the frail elderly are within the reach of the family members. The approach contrasts the United State method of constructing nursing homes for the long-term care provision. Funding the long-term care program seems to differ in various European countries. The concern on many policy markers in European countries is how to sustain the funding for the long-term care program. Some countries such as Denmark, Norway, and Sweden among others have developed universal system of funding where the frail elderly do not pay for the care services at point of use8. The public sector funds the long-term care service in these countries, thereby offering an opportunity for the society to acquire the services. Critics of the universal funding system argue that the system can apply expenditure constraints, which will enable the program to be sustainable9. The major difference that exists between countries employing the universal funding system is the model of their service delivery. A comparison between Denmark and Germany indicate that the model for the service delivery differs. Germany employs the social insurance to fund the long-term care program while Denmark long-term care model uses the taxpayers’ money to do the same. However, the two countries demonstrate equity in provision of the social care. The long-term care scheme in Austria provides an opportunity for to all Austrian citizens without considering their age, the disability type, income, or other special factor. The model provides money to the recipients who can choose how to utilize the funds. It is important to note that the funding in the Austrian model does not cater for every need of the recipient. However, it covers costs, which emanate from long-term care needs. Austrian system has provisions, which allow recipients of long-term care services to seek government support through provincial assistance when they are unable to fund cost of the long-term care. The provincial authorities have set the subsidized services. Lesson learnt from the Austrian model of long-term care is that the program is universal. It does not have restrictive eligibility criterion. These features enable the recipients of the long-term care services to apply for care services. Since the recipient of the long-term care have the opportunity to chose the caregivers, it is probable that the care offered is satisfactorily. The model contrasts the United State long-term care model because it caters for all ages. Further, eligibility is open to every individual irrespective of income that an individual was earning. The reception of the long-term care program depends on the contribution that it would offer to the society. The Austrian people have accepted the model because it offers services that measures to what the citizens contribute through taxes. The long-term care program in France takes the progressive Universalist approach. Since its introduction in 2002, the model directs its services to the frail elderly10. The allocation of the long-term care depends on eligibility criteria that test the needs of the recipients and follows the national rules. The program receives its funding from the general taxation. It is important to note that individual contribution towards the funding kitty depend on income ability of the individual. The low-income persons receive coverage through states schemes. The France model of long-term care provision tends to be similar to schemes offered in Germany, Japan, and Austria. Funding system for the long-term care program tends to be contentious issue to policy markers. The design for funding the long-term care policy is critical because the programs involve subscriptions from the public covers. It is evident that Denmark and Austria use the taxpayers’ money to fund the system. On the other hand, countries such as Germany and Japan have developed social insurance schemes, which fund the long-term care program. These countries have demonstrated that they are able to balance the needs of the long-term care recipients and the social insurance funds11. The long-term care programs in Austria, Germany, France, Denmark, and Japan have devised various models, which define the eligibility for the program. However, the provision of the long-term care in these countries has been successful. The features of long-term care provision do not match the system employed in United States. The United States is experiencing a growth in number of the frail elderly. However, it does not have a comprehensive policy, which would cater for the long term care services that the population would need. A review on long-term care model in German and Japan has revealed that social insurance can fund the long-term care program without burdening the taxpayers. Conversely, the Danish and the Austrian model of long term care provision has revealed that the government can be able to fund the universal long term care because it would be using tax payers money. The Danish model of long term care seems to be very effective and could be applicable to United States because it does not channels funds for Nursing homes; instead, it encourages nursing units in residential apartments. It is important to observe that the cost incurred by the United States in providing long-term service to the frail elderly is comparable to the Danish budget. This means that United States can adjust its policies to adapt the Danish model. This paper proposes that United States should adopt the Danish model of long-term care because it is effective and it unburdens the family members from assuming responsibilities, which could be provided through social and nursing departments. The United States should consider the social insurance model as a means that could enable it to create a universal long-term care as observed in Germany and Austria. Countries such as Germany and Japan conducted an experiment on the social insurance policy and realized it could serve best the interest of their citizens. Read More