Help Wanted?

Providing and Paying for Long-Term Care

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This book examines the challenges countries are facing with regard to providing and paying for long-term care. With populations ageing and the need for long-term care growing rapidly, this book looks at such issues as: future demographic trends, policies to support family carers, long-term care workers, financing arrangements, long-term care insurance, and getting better value for money in long-term care. 


“WHO recognizes that long-term care represents a major challenge for all countries in the world, with important implications for economic development and for the health and well-being of older people. This well-documented book provides a comparative analysis of the common challenges and diverse solutions OECD countries are adopting to respond to the growing demand for long-term care services, and particularly its implications for financing and labour markets.  It provides much needed evidence to guide policy makers and individuals.”

-Dr John Beard, Director, Department of Ageing and Life Course,

World Health Organization


“This carefully researched book offers invaluable data and insights into the organization and financing of long-term care in OECD countries.  The book is an indispensable resource for anyone interested in international long-term care”.

-Dr. Joshua M. Wiener, Distinguished Fellow and Program Director

of RTI’s Aging, Disability, and Long-Term Care Program, United States

English Also available in: French

Long-term Care

Growing Sector, Multifaceted Systems

Long-term care (LTC) is a growing, but relatively small sector in the economy. People older than 65 years of age, especially those aged over 80 years, have the highest probability of receiving LTC services, while women are the main recipients of services. LTC is a labour intensive sector, which is mostly publicly funded. On average, LTC expenditure accounts for 1.5% of GDP across the OECD. Most care is provided by family carers. The LTC workforce (mostly women working part-time in a majority of countries) is about 1.3% of the total OECD workforce. Over the last ten years, new long-term care programmes have been implemented in a number of countries, including cash-for-care programmes in European countries and the United States, aiming at providing consumers with more choice and control over LTC services. Due to the variety in target groups, governance, provision and workforce, LTC services are often fragmented. The connection with health systems is sometimes poor. The size, benefits, target groups, use, provision, governance and financing of long-term care differ markedly across countries. This chapter provides an overview of the sector in OECD countries. It begins by defining long-term care. In the following sections, it offers a snapshot of who uses, provides, and pays for long-term care services. Another section describes available services, with a focus on cash-for-care programmes, while the final section offers a short overview of recent policy developments in the sector.

English Also available in: French

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