Social Protection FLoors and Long-term care for older persons · Long-term care for older persons as part of Social Protection Floors: ... Georgia, 30 October 2015 . Outline Social

Long-term care for older persons as part of Social Protection Floors:

An ILO perspective

by

Xenia Scheil-Adlung Health Policy Coordinator

Social Protection Department International Labour Organization

Georgian Association of Social Workers, Tbilisi, Georgia, 30 October 2015

Outline

Social Protection

Floors and LTC

What are the deficits in LTC coverage and

access?

How to provide resilient LTC protection?


Universal access to

preventive and curative

health care services

Basic income security at poverty

level for children to access education,

health, housing

Basic income security for all in

working age;

Social assistance for the poor and

unemployed

Basic income security

at poverty level for those in old age

securing access to needed services

How is LTC covered in Social Protection Floors?

ILO Recommendation 202:

LONG-TERM CARE: Range of services and cash benefits

addressing reduced functional physical and/or cognitive capacities of older persons

Components of National Social Protection Floors guaranteeing access to services and income support


How are LTC benefits delivered?

Formal health and LTC workers

LTC benefit packages for older persons include

• LTC benefits in kind

For care recipients: • Basic medical Services • Assistance with daily

activities (getting dressed, preparing meals, etc.)

For informal LTC workers: • Paid or unpaid leave for

informal carers • Social protection for

informal workers • LTC benefits in cash

• Financial support for formal / informal LTC services

• Financial support for enabling environments

Private homes

Communities

Institutions

Informal LTC workers

Provided to older persons in

Delivered through


Which principles and criteria of SPFs apply to LTC?

Social Protection Floors

Guarantees to access nationally defined, at least essential health care and basic income security

In-kind and in-cash component

Key principles

for benefit coverage and access

Based on legislation

Universal

Equitable

Solidarity in financing

Criteria

for benefits

Affordable

Available;

Quality

Financial protection


Social Protection

Floors and LTC


access?



Global deficits in LTC coverage for older persons aged 65+ based on national legislation, 2015

in % of total population

Source: ILO estimates 2015, World Bank, 2015 (population data in 2013)

• 48% ( 300 million people) of the global older population lives in countries without any right to LTC (red) • 46.3 % of the global population lives in countries with means tests forcing people to become poor before becoming eligible for LTC (orange) • 5.6% of the global older persons live in countries with rights-based universal LTC coverage (green)

Coverage Deficit:

0 %

Coverage deficit: 100%

Coverage deficit:

Very High (Means tested)

5.6 %

46.3 % 48%

Percentage of global population 65+ by LTC coverage deficits


Availability and quality of services

1.5

8.2

2.3

1.6

Africa Asia and the Pacific Europe Americas

Global gap

of LTC

workers

(FTE)

13.6 million

Source: ILO estimates, 2015; OECD, 2014

- Globally we find a critical workforce shortage of 13.6 million LTC workers - The related reliance on mostly unpaid informal workers is unacceptable - Wage levels of LTC workers are globally very low; of informal workers very low to zero


Number of informal and formal LTC workers available

per 100 persons aged 65+ Europe Informal* Formal** Poland: 23.9 3.0 Russia: - 0.7 Finland: - 6.5 Norway 87.2 17.1 Slovakia 8.6 1.1 Sweden 12.8 9.6 _____________________________ World Chile - 0 China - 1.1 South Africa - 0.4 USA 123 6.4 _________________________________ Minimum - 4.2 (estimated) _____________________________________

*head count **Full-time equivalent

Global LTC workforce shortages

Impact of workforce shortages on access to LTC


0

10

20

30

40

50

60

70

80

90

100

Global Africa Americas Asia andthe

Pacific

Europe

50.1

92.3

14.7

64.6

29.7

49.4

0

73.5

22.9

56.6

0 0

27.7

90.4

73.5

83.7

0 0 0

10

20

30

40

50

60

70

80

90

100

Global access deficits due to workforce shortages in % of population not covered

European access deficits due to workforce shortages

in % of population not covered

LTC is hardly accessible due to major gaps in the availability of quality services

Financial protection and quality of LTC services

Public expenditure on LTC per person 65 years and over in selected countries

in PPP dollars, 2013

0 0 0

450.2

0

3336.6

0 0 0

2206.4

0

133.0

99.4 186.3

994.1

7945.0

818.1

2639.6

3838.7

505.1

5221.7

280.0

1629.8

2297.1

1826.0

614.2

395.7

5436.3

1481.6 1442.1

1120.4

5622.4

6088.8

8406.1

633.5

136.8 361.7

0

1111.3

891.9

1573.7

3727.0

0

1899.1

0

2000

4000

6000

8000

10000

Pu

bli

c L

TC

exp

en

dit

ure

pe

r p

ers

on

s 6

5+

, in

PP

P$ in

2013


Affordability of LTC services

Share of population 65+ experiencing OOP for LTC (home and institutional care) selected countries, 2015


65.6

56.3

83.4 80.2

66.0

73.7 75.3

49.9

70.0

86.5

48.2

65.7 66.9

54.1

15.3

0

20

40

60

80

100

In p

erc

en

tag

e o

f th

e p

op

ula

tio

n 6

5 y

ears

an

d

ov

er

• OOP occur in globally all countries • Insufficient public funding results in often intolerable high private expenditure

Social Protection

Floors and LTC


access?



Addressing the issues – 1

Establish and implement LTC as a right in its own

• Develop and implement inclusive legislation for older persons that are often vulnerable

• Develop LTC schemes based on needs rather than means separately from other social protection schemes and systems

• Ensure in kind and cash benefits

Make quality LTC equally available

• Increase number of skilled LTC workers with decent working conditions

• Balance the formal and informal LTC workforce and provide support and compensation to informal workers

• Develop infrastructure

Guarantee affordability and financial protection

• Adjust scope of benefits and eligibility rules to ensure effective access

• Minimize out-of-pocket payments (OOP)

Develop fiscal space and matching health and LTC

• Provide sufficient public funding

• Improve interface and coordinate national health and LTC schemes

Removing leading causes of deficits within LTC and health schemes and systems


Consider living conditions of older persons

• Poverty

• Age and gender discrimination

• Exclusion from participatory processes

Reallocate fiscal resources • Set up enabling macroeconomic frameworks

Address the socio-economic determinants of deficits

• Based on social protection floors policies: coordinate health, social, economic, labour market and developmental policies

Achieve economic growth

• Raise household income of older persons

• Create health worker jobs to achieve higher productivity, formalization of informal labour markets

• Ensure the political/electoral support of older citizens

Removing leading causes of deficits beyond LTC schemes and systems in a coherent multi-sectoral policy framework and creating returns of investment


Addressing the issues – 2

Conclusions

• SPFs are guarantees that ensure effective access to necessary goods and services to all in need over their entire life. They include LTC for older persons but…

• LTC is generally overlooked and wide coverage and access deficits exist all over the world, even if some countries perform better than others.

• To ensure resilient LTC worldwide, inclusive legislation need to be implemented, specific schemes developed and fairly financed, workforce and infrastructure shortages addressed in a coherent policy framework as outlined in ILO Recommendation 202 on National Social Protection Floors.


Thank you !

[email protected]

P4H Meeting, 3-4 Februrary 2015, Bangkok, Thailand


Documents

Social Protection FLoors and Long-term care for older persons · Long-term care for older persons as part of Social Protection Floors: ... Georgia, 30 October 2015 . Outline Social