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Long-term care – where do we stand today?

Long-term care covers a wide range of services and they can be provided – as in Germany – both in kind, in cash or as a combination of both. The projections are limited to public expenditure.


There is also a not inconsiderable privately financed share. Currently, on average in Europe, about 20 per cent of care costs are financed privately, usually as supplementary payments (“out of pocket”. In Germany, the figure is almost 30 per cent; also because long-term care is designed according to the “partial cascade principle” and is not fully insured.


Therefore, it is only natural that the long-term care report dealt extensively with the affordability of quality care services. Adequate access is restricted by many factors, not least the financial barriers. In most systems, people in need of care have to pay high personal contributions, often supplemented by unpaid informal care work. An OECD model study came to the conclusion that in many of the countries they looked at in the case of a moderate need for care, not even 40 per cent of the care costs are covered by public social protection systems, while the income and assets situation of those affected played a major role. But also in the case of severe care needs, the personal contribution can quickly approach or even significantly exceed a median income. Therefore, the major challenge here is to reduce the personal contributions from those who cannot afford it. This problem is all the more urgent because it is apparent that it is people in low-income groups who have a greater need for care.


Much of the report was devoted to the issue of the working conditions of nursing staff, not least because of the strain on their health. In a 2015 survey, 37 per cent said their job had a negative impact on their health as compared to 25 per cent in other occupations. The consequence, according to a 2020 study by Eurofound (European Foundation for the Improvement of Living and Working Conditions): 38 per cent do not think they will be able to hold their jobs until they are 60. This is a worrying prospect if you consider the already decided upon or planned increases in the statutory retirement age that will go well beyond the age of 65. Even if the particular stresses are typical of the job, they can at least be alleviated through specific measures such as better staffing, according to the long-term care report.


Reference has already been made to informal, unpaid care, which is typically provided in the context of family or friends. This is a reality that is highly critical with regard to follow-up costs. After all, the number of informal carers in the EU is currently estimated at 53 million. In most cases, carers do not have appropriate training and they are not in an employment relationship with the person being cared for. However, most Member States provide informal carers with pension rights, similar to Germany. Cash benefits paid to informal carers are also not uncommon, either directly (9 Member States) or, as in Germany, indirectly through cash benefits paid to the care recipient (11 Member States). The direct costs of state benefits to this group of people are estimated at 0.2 per cent of GDP across Europe. It is twice as much in Germany. The care report ends at this point with the appeal to provide more social security and other assistance for informal caregivers but not at the expense of expanding formal care.