World View: Helping hand
With an ever-ageing UK population, care of the elderly is in turmoil. Andrew Cole asks what lessons can be learned from other countries
Germany
Germany has had a ring-fenced fund for long-term care, paid through social insurance, since the mid-1990s. As with France, this was partly financed by the working population agreeing to forego a bank holiday. It means that if you have an assessed condition, you will be entitled to a particular level of care, regardless of where you live or what unpaid support is available. However, the gap is growing between care home fees and the benefits provided by the insurance scheme and individuals are expected to make up this shortfall.
Germany is also one of a growing number of countries to bring in direct payments – something the UK is also introducing – which give the individual the cash equivalent of the services they qualify for and then allows them to choose how to spend it. Cash payments have proved popular, helping to reduce costs and shift care from institutions into the community. But they have also led to some care staff being replaced by a ‘grey market’ of personal assistants, often the individual’s relatives or friends, who may be untrained and often poorly paid.
Up to 40% of residents in care homes now have to supplement their insurance benefits in order to pay for their care.
There are other strains in the system. Despite the changes, women in particular find it difficult to balance work and care-giving. As a result one in 10 has been forced to quit work in order to look after a relative. In addition there are surprisingly few community services for carers to turn to. Only 25% of family carers are supported by services such as daily home help, day care centres or facilities for short-term care.
And although cash payments remain popular they only work if a range of sources of care – both public and private – are available to choose from, backed up by the relevant information and advice. It seems this is not always the case since the numbers choosing to translate at least part of their benefit into services rather than cash almost tripled between 1995 and 2002, rising from 12% to 35%.
United States
Long-term care in the States remains means tested and underpinned by the belief that care is the responsibility of the individual, not the state. The US boasts much high-quality long-term care, but most is only accessible to the affluent or those who took out private insurance. If you are truly impoverished you may qualify for basic help through Medicaid.
A major review this year identified a recruitment crisis among direct care staff who ‘receive low wages and few benefits and have high physical and emotional demands placed on them’. Does that sound at all familiar?
Which system is working best?
Lizzie McLennan, senior policy officer at Help the Aged, says it is impossible at the moment to judge which system is working best. ‘France and Germany’s systems are quite well funded and people are clear about what money they get. They have been particularly successful in getting public support for an increase in public expenditure for elderly care and that’s something the UK could usefully learn from.’
But there is little evidence about the impact on people’s lives. ‘The system may well be in the black but the focus has to be on whether older people’s lives are improving. Do they feel the money is enough to pay for what they need? I’m afraid the jury is still out on that.’
Find out how France, Sweden and Japan are tackling this issue.
