On average, people in Europe are living longer, and are in better health. Despite this, however, a significant degree of health inequality is emerging among different socioeconomic groups. Assessment-of-need procedures and eligibility rules define the target population in ‘need-of-care’, and represent a compulsory gateway for olderadults in order to receive home-care benefits, either in-kind or in-cash. In this context, the economic relevance of formal long-term care has been growing and the rates of care-dependent older people in need of long-term care are estimated to increase in the forthcoming decades. The authors of this volume compare micro-data from SHARE (the Survey of Health, Ageing and Retirement in Europe) and ELSA (the English Longitudinal Study of Ageing) across Austria, Belgium, the Czech Republic, France, Germany, Italy, Spain, and United Kingdom’s England and Wales, where eligibility rules are care-blind. They critically review long-term care regulations in Europe, offering a detailed taxonomy of the role and the characteristics of vulnerability-evaluations and eligibility criteria. This book is of interest to academics in health economics and social policy, managers in the health sector, policy makers and professionals interested in the design, implementation and evaluation of long-term care policies. It could also be used to support different courses in the fields of ageing, health economics and policy evaluation.

SHARE is an international survey designed to answer the societal challenges that face us due to rapid population ageing. How do we Europeans age? How will we do economically, socially and healthwise? How are these domains interrelated? The authors of this multidisciplinary book have taken a further big step towards answering these questions based on the recent SHARE data in order to support policies for an inclusive society.

Although economic literature has recently started to concentrate on the design, the scope and the regulations of main public programmes of Long-Term-Care in Europe, no analysis have, so far, compared different systems in terms of their degree of inclusiveness with respect to vulnerable elderly's health status. Focusing on several European countries, this paper investigate how LTC regulations assess vulnerability, as well as how they define a minimum level of objective-dependency that would entitle individuals to receive public benefits (in-kind or in-cash) for home-based care. Our contribution is threefold. We provide detailed information on assessment and eligibility frameworks for eleven LTC programmes in Europe. We show that substantial heterogeneities exist both at the extensive margin (the health-outcomes that are included in the vulnerability-assessment) and at the intensive margin (the minimum vulnerability threshold that defines benefit eligibility) of the assessment strategies. Building on this information, we compare LTC programmes in terms of their degree of inclusiveness, i.e., we investigate the extent to which each programme is able to cover a standard population of elderly individuals facing functional and cognitive limitations. The comparison is performed following both a directly- and an indirectly-adjusted strategy using SHARE data.

Long-term care is an increasingly important issue in many contemporary welfare states around the globe given ageing populations. This ground-breaking book provides detailed case studies of 11 EU-member states’ welfare regimes within Europe to show how welfare states organize, structures and deliver long-term care and whether there is a social investment perspective in the delivery of long-term care. This perspective is important because the effect of demographic transitions is often used as an argument for the existence of economic pressure on welfare states and a need for either direct retrenchment or attempts to reduce welfare state spending. The book’s chapters will look specifically into how different welfare states have focussed on long-term care in recent years and what type of changes have taken place with regard to ageing populations and ambitions to curb increases in public sector spending in this area. They describe the development in long-term care for the elderly after the financial crisis and also discuss the boundaries between state and civil society in the different welfare states' approaches to the delivery of care.

This book provides a comprehensive overview on the long-term care systems in 12 EU member states and Norway. Focusing on the legal background and its main principles, it includes a comparative analysis which highlights the principal dissimilarities between European long term care benefits, but at the same time also a variety of features in common. It also discusses the increasingly transnational dimension of long-term as a result of migrants returning to their country of origin in old age, and the still-unsolved legal problem of entitlement to long-term care benefits in another EU-member state.

A combination of demographic, social and macro-economic developments have put long-term care schemes in nearly all EU countries under severe pressures they were not intended to cope with. Adopting a cross-national comparative approach and combining existing literature with empirical findings, this exploratory study provides standardised information on the organisation and financing of long-term care for the elderly in the Union, and evaluates the respective merits of selected schemes - i.e. France, Germany and the UK - in meeting emerging pressures. It discusses the advantages and disadvantages of individual schemes using 'equity' and 'efficiency' criteria as an evaluation framework. Based on this evaluation, it offers reflections that may serve as a starting-point for policy strategies. In addition, it provides an analysis of the relationship between different long-term care arrangements and welfare state models.

An interdisciplinary investigation of key issues surrounding equity in long-term care. Examining equity choices in both finance and provision, the author applies an original framework for systematic comparative analysis to the long-term care policies within European welfare states.

In the context of an unprecedented aging process, the role of domiciliary care for older adults is becoming increasingly essential. In order to design effective and proactive policies of formal elderly-care, it is crucial to understand how vulnerable elderly individuals would adjust their informal long-term care utilization to changes in the formal-care provision. Although theoretical frameworks have been proposed, showing that a positive relationship could arise when the elderly exhibit an excess demand of care, empirical evidence is scant, due to the lack of credible instruments to account for the endogenous nature of formal-care decisions. We propose a novel instrument, an index that capture individuals' eligibility status to the LTC domiciliary programmes implemented in their own nation or region. That is, a dummy variable - being eligible or not - which is grounded on the LTC regulation context at national or regional level, but still has individual within region variation due to differences in health conditions and vulnerability assessment. We estimate an IV two-part model using a representative sample of the over 60 population for non-institutionalised individuals in Austria, Germany, France and Belgium. Our results, which are robust to a number of different specifications, point at the lack of crowding-out of the informal- by the formal-care, thus suggesting the existence of a substantial unmet demand of LTC among the elderly.

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.

Over the last two decades, many changes have happened to the social welfare policies of various industrial countries. Citizens have seen their pensions, unemployment benefits, and general healthcare policies shrink as “belt tightening” measures are enforced. But in contrast, long-term care has seen a general growth in public financing, an expansion of beneficiaries, and, more generally, an attempt to define larger social responsibilities and related social rights. The aim of this book is to describe and interpret the changes introduced in long-term care policies in Western Europe. The volume argues that recent reforms have brought about an increasing convergence in LTC policies. Most of the new programs have developed a new general approach to long-term care, based on a better integration of social care and health care. The book explores increasing public support given to family care work (in the past, the family would take care of the elderly or infirm) and increasing growth and recognition of a extended social care market (by which care has shifted from a moral obligation based on family reciprocity to a paid, professional activity). A new social care arrangement has therefore been developing in Western countries, based on a new mix of family obligations, market provision, and public support. In order to understand such changes, this analysis will take into account the social and economical impact of these reforms.