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Across OECD countries, populations are ageing. The average share of people aged 65 and over is projected to continue rising in the coming decades, from 17.3% in 2019 to 26.7% by 2050, with the share of those 80 and above more than doubling over the same period. As a result, demand for long-term care (LTC)—meaning assistance with everyday activities—is also gradually increasing. Rather than going into nursing homes, many people in need of LTC wish to remain at home for as long as possible, but policies have not always resulted in a significant move away from facility-based LTC.
In more than half of OECD countries, population ageing has been outpacing the growth of LTC supply and the workforce has stagnated or declined.
The COVID-19 pandemic has highlighted the urgency to address structural shortcomings in long-term care, in terms of governance, funding and the workforce. Many countries in the OECD lack coherent LTC systems: they are sometimes spread out across health and social sectors, with overlaps and gaps in access and coverage. This fragmentation makes it more difficult for users to get support, as they attempt to navigate such complex systems. Older people also often have limited financial resources to meet the costs of long-term care privately, and there is a risk that their needs are left unmet without sufficient public provision.
At the same time, users also pay a significant share of the cost out of their own pockets in many countries, and there are rising expectations to have high-quality, affordable and widely available LTC services. Yet in more than half of OECD countries, population ageing has been outpacing the growth of LTC supply and the workforce has stagnated or declined. This shortage in both formal and informal carers is putting pressure on governments to deliver in the years to come.
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Improving governance for integrated care is vital to bring about more effective, efficient and equitable long-term care. In many countries, responsibilities for LTC are often divided among a range of different actors such as municipalities, regional governments, central government, insurance funds and third-sector providers. Harmonising LTC governance as well as cash benefits and services, by having a single point of access, would create more coherent systems. They would also be better prepared to cope with external shocks, such as COVID-19, and resilient enough to withstand population ageing.
A new OECD report focusing on Lithuania shows that the country could benefit from a new legislative framework, with one main legal act on long-term care that consolidates access to rights and conditions. It discusses the importance of clarifying both the responsibilities of different stakeholders and the broad types of benefits and services available, and aims to ensure a single point of user access. An essential component of integrated care is a harmonised needs assessment, which groups users’ needs on a scale, as is the case in Germany and Japan. This can guarantee that people with comparable needs have comparable rights and services, as well as encourage choice according to people’s preferences.
A funding reform is also pivotal to help deliver integrated care and avoid cost-shifting across different sectors of delivery, as well as to help to sustain the financing of LTC services in the face of future challenges. As with many countries planning reforms, Lithuania could consider three possible options, which are not mutually exclusive:
- create a dedicated budget that pools current funding, following the example of France
- introduce a long-term care insurance policy, following the example of Germany and Japan
- ensure a broad-base for taxation as in Scandinavian countries
Similarly, encouraging preventative and rehabilitation services to delay long-term care needs, as is the case in Denmark, is an important part of a strategy to promote healthy ageing and contain costs.
Policy changes in governance, funding and the workforce can help address current shortcomings and improve the quality of life for older people in their final years.
Efforts to attract and retain formal caregivers should be considered together with policies to support informal or family carers. Addressing future labour shortages requires widening recruitment efforts, such as training people who are not currently in work, students and those in sectors with decreasing labour demand. Such measures have proved effective in Japan, and a few countries are also trying to attract foreign citizens by easing the migration process and providing them with an adequate set of LTC skills.
Alongside training, improving job retention in the sector requires addressing the poor quality of LTC jobs: improving wages, promoting a healthier work environment and improving organisation through self-managed teams are promising avenues being explored in the Netherlands, Australia and Japan. In addition, the position of care manager, as used in Denmark and Japan, could broaden career pathways. As for policies to support informal caregivers, Lithuania could consider training options as well as providing leave; currently, about two-thirds of OECD countries provide paid or unpaid leave to care for an older family member.
Demand for long-term care is on the rise. As more people live longer, complex health and care needs are becoming much more common, particularly among the oldest people. LTC systems need to move towards a model of care that is more tailored, people-centred and better integrated with the rest of health care. Policy changes in governance, funding and the workforce can help address current shortcomings and improve the quality of life for older people in their final years.