The number of people receiving
long-term care (LTC) in OECD countries is rising, mainly due to population ageing and the
growing number of elderly dependent persons, as well as the development of new programmes
and services in several countries. In response to most people's preference to receive LTC
services at home, an important trend in many OECD countries over the past decade has been
the implementation of different types of programmes to support home-based care.
Although the receipt of long-term care
is not limited to elderly people, the vast majority of LTC recipients are over 65 years of
age. Most of them are also women, because of their higher life expectancy combined with a
higher prevalence of disabilities and functional limitations in old age.
On average across OECD countries,
about 12% of the population aged 65 and over were receiving some long-term care services
at home or in institutions in 2009 (Figure 8.4.1). The use of
long-term care services increases sharply with age, with people aged 80 and older being
more than six times more likely to receive long-term care than people aged 65-79 in many
The number of LTC recipients as a
share of the population 65 years and over was the highest in Austria in 2009, with almost
one-fourth of the senior population receiving long-term care benefits either in
institutions or at home. On the other hand, only about 1% of the senior population in
Poland and Portugal receive formal LTC services, with most of them receiving care in
institutions, although many more may receive informal care from family members at
Over the past decade, many OECD
countries have introduced programmes to promote the delivery of long-term care at home.
Several countries have expanded community-based services and home care coverage and
support (e.g. Canada, Ireland and Sweden). Some
countries have introduced financial support for users, for instance in the form of cash
benefits for LTC recipients at home in Austria and the Netherlands.
In most countries for which trend data
are available, the number of people receiving long-term care at home as a share of the
total number of LTC recipients has increased over the past ten years (Figure 8.4.2). The proportion of LTC recipients at home is the highest in
Japan and Norway. In both countries, the proportion has gone up over the past decade, so
that now more than three-quarters of LTC recipients receive care at home. The share of
home-based care recipients has also increased in Sweden, Luxembourg and Hungary. In
Hungary, LTC in institutions has been restricted by budgetary constraints and stricter
admission criteria. In Finland, there has been a significant reduction in the share of
home-based care recipients over the past decade. The number of people receiving LTC at
home has not declined, but it has grown at a much slower rate than the number of people
receiving care in institutions. This may be due to the fact that a larger number of people
have more severe conditions or that they live in remote areas where home-based care
options may be limited.
In the United States, only around half
of LTC recipients receive care at home. This may partly reflect a traditional bias towards
supporting institutional-based care. Financial support to promote home-based care has only
been implemented by certain states. Additional support may be needed in the United States
and in other countries to further encourage home-based care (Colombo et al., 2011).
Definition and comparability
LTC recipients are defined as
persons receiving long-term care by paid providers, including non-professionals
receiving cash payments under a social programme. They also include recipients of cash
benefits such as consumer-choice programmes, care allowances or other social benefits
which are granted with the primary goal of supporting people with long-term care
needs. Long-term care institutions refer to nursing and residential care facilities
which provide accommodation and long-term care as a package. Long-term care at home is
defined as people with functional restrictions who receive most of their care at home.
Home care also includes specially designed or adapted living arrangements.
Data for Japan underestimate the
number of recipients in institutions because many elderly people receive long-term
care in hospitals. In the Czech Republic, LTC recipients refer to recipients of the
care allowance (i.e. cash allowance paid to
eligible dependent persons). In Poland and Spain, the data underestimate the total
number of LTC recipients due to partial coverage of facilities or services. In
Australia, the data do not include recipients who access the Veterans' Home Care
Program and those who access services under the National Disability Agreement. With
regard to the age threshold, data for Austria, Belgium, France and Poland refer to
people aged over 60, while they refer to people over 62 in the Slovak Republic (this
is resulting in a slight under-estimation of the share in these countries, given that
a much smaller proportion of people aged 60-65 or 62-65 receive LTC compared with
older age groups). LTC recipients refer to people aged over 67 in Norway.