Comments to Ricardo Rodrigues’ presentation on LTC expenditures Giovanni Lamura* “Long-term care in Europe – discussing trends and relevant issues” Conference held under the project “Mainstreaming Ageing: Indicators to Monitor Implementation” Budapest, February 2010 *: INRCA (Italian National Research Centre on Ageing) Centre for socio-economic research and elder care Ancona, Italy,

Policy implications derived from the stylised facts I As a relative newcomer, LTC gets limited public resources… …yet, despite policy discourse and public preferences, most resources go to institutional care; It is care at home that is key to provide care to most; Expenditure on LTC is not purely age-driven: Policy choices; Quality; Availability of informal care. Reduced LTC services in some countries… too low to be sustainable.

Level and composition of debt as % of GDP (2009)

Policy implications derived from the stylised facts I As a relative newcomer, LTC gets limited public resources… …yet, despite policy discourse and public preferences, most resources go to institutional care; It is care at home that is key to provide care to most; Expenditure on LTC is not purely age-driven: Policy choices; Quality; Availability of informal care. Reduced LTC services in some countries… too low to be sustainable.

1.Standard care-mix: AU-BE-CZ-FI-DE- FR-IT-UK 2.Public-Nordic: DK-NL-SE 3.Family based: ES-IE-GR-PT 4.Transition: HU-PL-SI-SL 5.Baltic: LT-LV LTC country clusters/regimes

Health related needs: 1. % of over 80 year old Social & economic needs: 2. % older people at risk of poverty (income level) DEMAND OF LTC match? PROVISION OF LTC Formal care Informal care (family, voluntary, friends etc.) Public 6. elder care expen- diture (% of GDP per capita) Private 7. % out-of-pocket payments for health care 3. female employment rate % extended households (3+ adults) 5. % informal carers of older people 8. % over 65 receiving home care 9. % over 65 in residential care Possible LTC indicators

1.Standard care-mix: AU-BE-CZ-FI-DE- FR-IT-UK 2.Public-Nordic: DK-NL-SE 3.Family based: ES-IE-GR-PT 4.Transition: HU-PL-SI-SL 5.Baltic: LT-LV LTC country clusters/regimes

Share of older people receiving home care and residential care Nordic Family-based Transition Baltic Standard-mix

Over 65 year old people in residential care (in %)

Over 65 year old people receiving home care (in %)

Policy implications derived from the stylised facts I As a relative newcomer, LTC gets limited public resources… …yet, despite policy discourse and public preferences, most resources go to institutional care; It is care at home that is key to provide care to most; Expenditure on LTC is not purely age-driven: Policy choices; Quality; Availability of informal care. Reduced LTC services in some countries… too low to be sustainable.

Elder care expenditure (as % of per capita GDP)

13 Over 80 year old population (% on total)

Source: EUROBAROMETER („If, in the future, working adults would have to look after their elderly parents more than nowadays, would you say that this would be rather a good thing or rather a bad thing?“, Alber & Köhler 2004) Citizens thinking that „working adults should look after their elderly parents* (%)

Households with three or more adults (in %)

Policy implications derived from the stylised facts II Funding mix: users/families still shoulder a great deal of the financial costs of (institutional) care; Solutions to guarantee fiscal sustainability… must be sustainable themselves; Anticipating change… issues to look at: Coordination of health and social care; Quality of care; “Consumer choice”; Alzheimer and other dementias; Changes in informal care; Workforce and migrant carers.

Private health care expenditure (out of pocket payments as % of total expenditure)

Income level (GDP per capita as % of EU-average)

Policy implications derived from the stylised facts II Funding mix: users/families still shoulder a great deal of the financial costs of (institutional) care; Solutions to guarantee fiscal sustainability… must be sustainable themselves; Anticipating change… issues to look at: Coordination of health and social care; Quality of care; “Consumer choice”; Alzheimer and other dementias; Changes in informal care; Workforce and migrant carers.

Restrictions reported by employed carers (in %) N = 4427; only carers <= 65 years

Restrictions reported by not employed carers (in %) N = 2093; only carers <= 65 years

22 Use of support services for carers, by country (in%)

Policy implications derived from the stylised facts II Funding mix: users/families still shoulder a great deal of the financial costs of (institutional) care; Solutions to guarantee fiscal sustainability… must be sustainable themselves; Anticipating change… issues to look at: Coordination of health and social care; Quality of care; “Consumer choice”; Alzheimer and other dementias; Changes in informal care; Workforce and migrant carers.

In which areas do older people need more help? (in %)

Do nursing homes offer insufficient standards of care? Source: Special Eurobarometer 2007

Households employing privately paid home care workers (in %)

Families’ motivations to employ migrant workers % Source: Spano 2006

Thank you!