Welfare Reform on the Web (November 2006): Care of the elderly - Overseas

Choice and long-term care in OECD countries: care outcomes, employment and fiscal sustainability

J. Lundsgaard

European Societies, vol.8, 2006, p.361-383

This article categorises and analyses the various arrangements that allow older home care users more choice in OECD countries. Some states are experimenting with personal budgets which allow users to employ care assistants; others are giving older people the option of receiving cash to partly finance their long-term care; still others are trying out income support payments to informal caregivers. The paper goes on to review some country-specific outcomes in terms of care quality and to discuss some implications for employment and fiscal sustainability.

Constructing the care consumer: free choice of home care for the elderly in Denmark

T. Rostgaard

European Societies, vol.8, 2006, p.443-463

This analysis is focused on care of the elderly in Denmark as a case of consumerism in social care, but presents three generally applicable arguments about consumerism in social policy:

• That the introduction of consumerism leads to people being required to take more responsibility for their own welfare.
• That designing one’s own care package entails risk; autonomy means freedom to make bad choices
• That the consumerist approach to social policy implies that the imperative is to secure the right to choose, rather than aspiring to equality of outcome or equality of opportunity to choose.

Design limitations of long-term care insurance schemes: a comparative study of the situation in Spain

J. Costa-Font and M. Font-Vilalta

International Social Security Review, vol.59, Oct-Dec. 2006, p.91-110

This study examines arrangements for funding long-term care for frail older people in Spain and compares it with the situation elsewhere in Europe and in other developed countries such as the United States. In Spain, the family still largely provides informal long term care for the elderly, with some means tested public provision by local authorities. The authors argue that there is scope for the development of complementary private insurance schemes and the encouragement of saving to cover costs of future long term care.