Inclusion and strengthening of Inclusion and strengthening of social services as part of the social services as part of the

agenda on ageingagenda on ageing

Rosemary Lane, Focal Point on AgeingRosemary Lane, Focal Point on Ageing

United Nations Department of Economic United Nations Department of Economic and Social Affairs, New Yorkand Social Affairs, New York

Social inclusion - why is this important in Social inclusion - why is this important in the context of provision of care?the context of provision of care?

Selected models of care service provision Selected models of care service provision at home and funding sources – pros and at home and funding sources – pros and conscons

Some issue for Member States to think Some issue for Member States to think about moving forwardabout moving forward

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The provision of social services, including The provision of social services, including care, is as much to do with the care, is as much to do with the maintenance of social relationships and maintenance of social relationships and engagement in the community (social engagement in the community (social inclusion) as it is with the provision of inclusion) as it is with the provision of servicesservices

What is the relationship between What is the relationship between provision of care and social inclusion?provision of care and social inclusion?

Type, quality and level of care are directly Type, quality and level of care are directly linked to enhancement of quality of life linked to enhancement of quality of life and participation/links to the and participation/links to the community/family and friends.community/family and friends.

Social isolation and exclusion – risk factors Social isolation and exclusion – risk factors - specificity to older persons – being over - specificity to older persons – being over 80 years old, living alone, no children, 80 years old, living alone, no children, poor physical heath, residential care, poor physical heath, residential care, unable to access benefits/servicesunable to access benefits/services

Social care – ie. Help to remain in one’s Social care – ie. Help to remain in one’s home – assistance with activities of home – assistance with activities of everyday living (housework, laundry, food everyday living (housework, laundry, food preparation/delivery, personal care); minor preparation/delivery, personal care); minor medical care. Provided by public/private medical care. Provided by public/private services or family/friendsservices or family/friends

Provision of medical services at homeProvision of medical services at home

GermanyGermany

Mandatory long-term care insurance system to cover old Mandatory long-term care insurance system to cover old persons and persons with disabilities since 1995. Managed by persons and persons with disabilities since 1995. Managed by central government with individual states responsible for central government with individual states responsible for provision of infrastructure. Benefits uniform across country. provision of infrastructure. Benefits uniform across country. May participate or pay for private insurance.May participate or pay for private insurance.

Financed by payroll tax divided between employers and Financed by payroll tax divided between employers and employees (now 1.95% since 2008 as costs had risen, also with employees (now 1.95% since 2008 as costs had risen, also with additional premium for childless)additional premium for childless)

Recipients may opt for benefits either in cash to pay for Recipients may opt for benefits either in cash to pay for benefits (including paying for family member care giving), in-benefits (including paying for family member care giving), in-kind service from agency under contract with insurance kind service from agency under contract with insurance programme. Also covers institutional care but not room/ board.programme. Also covers institutional care but not room/ board.

NetherlandsNetherlands

Established universal social insurance for long-term Established universal social insurance for long-term care in 1968. Administered by private insurance care in 1968. Administered by private insurance company who manage but do not accept financial company who manage but do not accept financial risk. Covers more than care for older persons.risk. Covers more than care for older persons.

Financed through income and payroll tax that is Financed through income and payroll tax that is income related – pay as you go system. General income related – pay as you go system. General revenues cover shortfalls.revenues cover shortfalls.

Benefits through in-kind services and cash Benefits through in-kind services and cash payments. Co payments required.payments. Co payments required.

Due to escalating costs in 1990s Government Due to escalating costs in 1990s Government capped budgets that created long waiting lists for capped budgets that created long waiting lists for some services. some services.

JapanJapan

Created social insurance programme in 2000. Created social insurance programme in 2000. Covers long-term care of older persons only.Covers long-term care of older persons only.

Financed through both contributions (payroll tax Financed through both contributions (payroll tax 0.9% employee/employer) and small monthly 0.9% employee/employer) and small monthly premiums for retirees) plus general taxes. Pay as premiums for retirees) plus general taxes. Pay as you go system.you go system.

Covers institutional and home care but no cash Covers institutional and home care but no cash benefits. Institutional care provided by non-benefits. Institutional care provided by non-profits.profits.

Government has raised fees and reduced benefits Government has raised fees and reduced benefits and lowered payments to providersand lowered payments to providers

United KingdomUnited Kingdom

Long-term care provided on means-tested basis. Long-term care provided on means-tested basis. Tax based funding from central gov., local gov. and Tax based funding from central gov., local gov. and co payments. co payments.

Social care provided on means-tested basis by Social care provided on means-tested basis by local authorities. Broad geographic disparities.local authorities. Broad geographic disparities.

Skilled nursing in home provided under NHS at no Skilled nursing in home provided under NHS at no cost.cost.

Cash benefit for intensive care by members of low-Cash benefit for intensive care by members of low-income families.income families.

Cuts through more strict eligibility requirements Cuts through more strict eligibility requirements have recently been made by local governments have recently been made by local governments due to budgetary cuts from Central Government.due to budgetary cuts from Central Government.

A word about some developing A word about some developing countries experiencecountries experience

Often first reaction was to build old age homesOften first reaction was to build old age homes

Many service systems ad hoc and run by civil Many service systems ad hoc and run by civil society, religious organizations.society, religious organizations.

Some civil society organizations contracted by Some civil society organizations contracted by Government for services (eg. Egypt) but generally Government for services (eg. Egypt) but generally for low income people.for low income people.

A number use volunteers to run schemes, A number use volunteers to run schemes, some with basic government funding. some with basic government funding.

Progress in establishment of day centersProgress in establishment of day centers

Legal requirements for families to provide Legal requirements for families to provide supportsupport

Issues and lessons learnedIssues and lessons learned

Encouragement by governments (including tax Encouragement by governments (including tax breaks) to purchase private long-term care breaks) to purchase private long-term care insurance have not been successful (see US)insurance have not been successful (see US)

Strict income-based restrictions to access Strict income-based restrictions to access benefits/services cause huge problems for large benefits/services cause huge problems for large segment of population (eg. UK)segment of population (eg. UK)

Different countries/cultures have different views on Different countries/cultures have different views on shared responsibility approaches to fundingshared responsibility approaches to funding

Inability to access services – leads to social Inability to access services – leads to social exclusion/isolation, poverty exclusion/isolation, poverty

Impact on family and economy due to lack of Impact on family and economy due to lack of services or support to careservices or support to care

THANK YOU!THANK YOU!