Who will pay bills in ageing society?

CEE countries face shortages of quality long-term care services in both the institutional care and the home-based care settings.

Many applicants for long-term care are on the waiting list do the reason, that one’s right to receive institutional services depends on the discretion of the local authorities, who must restrict admission due to limited vacancies.

“Social hospitalization” cause of a shortage of institutional care where the elderly in need of care are hospitalized for non-medical reasons.

Insufficient supply of long-term care is correlated with low public expenditure on long-term care. The share of the public long-term care expenditure in terms of GDP in the CEE countries is generally less than a half the OECD average. It is 0.7 percent in the Czech Republic, 0.74 percent in Poland. As opposed to 1.7 percent in the OECD countries. Absence of integrated long-term care systems makes provision of long-term care fragmented.

Coordination between health care and social services and between the central and local governments is a lack of effective. The provision of long-term care becomes primary responsibility of family members and relatives, do the low utilization of formal long-term care services in CEE countries

Lack of adequate support mechanisms for home-based care CEE countries ( home visit services, day care, or short stays in community-based long-term care facilities). Without enhancing formal support for home-based care, it is difficult to effectively alleviate the care burden currently imposed on family members.

The budget allocated for improving the service infrastructure and human resources is limited accordingly. Securing the necessary resources to ensure adequate benefits is a common challenge facing all social protection systems. Financing of long-term care benefits is particularly vulnerable to the country’s unstable fiscal conditions.

Since long-term care benefits the relies largely on the State and local government budgets. In some CEE countries care allowance in the first degree was cut by 60 percent as part of the emergency austerity measures of 2011. Cash benefits may not achieve their intended objective different survey results reveal. Cash benefits have the advantage of giving beneficiaries the freedom to choose the services according to their priority. Cash benefits in the form of care allowances play a major role in long-term care in countries like the Czech Republic.

However, different survey results show, that a large portion of the allowance is used for purposes other than the direct acquisition of care services. When the supply of formal long-term care services is insufficient, cash benefits may not achieve their intended objective and could lead to the confinement of family members in home care.

The amount of allowance is given to family carers  (even if the care allowance is given), is not enough to fully compensate the lost opportunity costs. Ineffective targeting of the cash benefits may also make them vulnerable to cuts in times of fiscal pressure. Reliance on informal family care (including financial support) can be partially ascribed to traditional norms, but it is a legal obligation in some CEE countries.

There are limited options for incentivizing the recipients of the care allowance to spend it on formal care services while assuring their freedom of choice (cash benefits replace with service vouchers).

Source: ilo.org