coverING THE cost OF LoNG-term cAre
As the world’s
to age, many
countries are being
forced to grapple
with making long-term care affordable.
Is it possible?
By Doug Andrews
N MOS T OF THE WORLD’S developed countries, the
population is aging. Yet while multiple surveys indicate
that people are concerned about the potential costs of
long-term care and believe its cost should be shared by
the individual and the government, few national social
insurance programs cover the nonfinancial personal assistance and
chronic health care support that long-term care involves.
While only a subset (though, perhaps, a significant subset) of the
elderly will require long-term care, the costs can be financially devastating. Insurance is an ideal means for covering this risk. But to
guarantee success, government must play a part as well.
Defining the Problem
Unfortunately, there’s no common definition of what exactly constitutes long-term care. And there are considerable differences from
country to country as to which long-term care services are eligible
As a starting point in any definition of long-term care, however, we
can point to activities of daily living, referred to as ADLs. Although
different names may be used to describe them, the standard six ADLs
are bathing, dressing, eating, getting in or out of bed, walking across a
room, and using the toilet. Disability normally is defined in terms of
a minimum number of ADLs a person is unable to perform without
assistance. But the number varies. Some policymakers consider adults
with at least one ADL restriction to be severely disabled, while others reserve that distinction for individuals who report difficulty with
three or more ADLs. To qualify for benefits in the German social insurance system, an individual must need help with at least two ADLs.
Another measure is instrumental activities of daily living, referred to as IADLs. IADLs include a wide range of tasks, including
shopping, preparing hot meals, using the telephone, taking medications, and managing money, as well as functional limitations such
as difficulty in bending, reaching, and stooping.
Scotland’s 2002 legislation implementing free personal care at
the point of delivery defines personal care as including help with
personal hygiene, continence management, assistance with eating and mobility, counseling and support services, assistance with