Conference on long-term care systems

How to balance quality and accessible care with sustainable public finances?

Representatives from Europe, the U.S. and Japan discussed this question at the ‘Evolution of Health Systems regarding the challenges of Long Term Care’ Conference on 18 September in Paris, organised by the International Association of Mutual Benefit Societies (AIM), the European Association of Paritarian Institutions (AEIP), Mutuelle Générale de l'Education Nationale (MGEN), and the Network Education and Solidarity. The European Social Network (ESN) was represented by one of its members, Jim Thomas from Skills for Care, UK, who highlighted two practices of workforce development in the social and health care sector.

Japan, the U.S. and Europe face similar problems in their long-term care systems: 1) a high number of stakeholders involved in the system; 2) the misconception that old age is a ‘burden’ on society; 3) a lack of a formal workforce; 4) a very high contribution from unpaid family carers.

Brian Buyinski from the U.S. Department of Labour explained that long-term care costs are not covered universally and only a few people (around 6%) have (private) long-term care insurance in the U.S. Most of the long-term care contribution is still provided by informal carers: “The value of work of unpaid family carers is estimated at 450 billion dollars per year.” Furthermore, 50% of people with long- term care needs are in institutional care, which is very expensive and draws concerns about the quality of care. However, a bigger emphasis has been put on assisted living facilities and the PACE programme, which provides integrated support under medical and social care.

Masahiko Iwamura from the University of Tokyo described the Japanese long-term care system: “In 2000 the Japanese government introduced a 'loss of autonomy insurance scheme', which started with 290 million people. In 2010, there were already 500 million people in the scheme. Since 2008 people over the age of 75 are asked to contribute financially towards the scheme and Japanese legislation has been promoting home care in the community. However, the Japanese system is still fragmented between health and social care.”

Christoph Schwierz from the European Commission explained that EU Member States face fiscal challenges and there remains the risk of an increase in the debt level if their long-term care systems do not change. He stressed the importance of prevention, health promotion and home-based care. However, there has been a decrease in spending on prevention and health promotion: “From an economic point of view it is not understandable why our systems are still focused on intervention and on institutional care.”

Francesca Colombo from the OECD also highlighted some measures that would support the financial sustainability of care systems:

• Flexible cost-sharing policies based on income and/or care needs


• A better pooling of financing across generations


• Broadening of financial sources beyond income from work (so people do not rely on labour)


• Automatic pre-funding schemes for workers


• Governmental incentives for service users to turn assets into cash

Good practices from across Europe and Japan

The second session of the conference focused on sharing good practices. ESN Member Skills for Care in the UK, represented by Jim Thomas, who reminded the delegates that there will be a significant workforce shortage in the social care sector in the coming years. Therefore, he stated: “we need to change the way our staff works. We need to invest in training in order to enable them to work together.”

He presented two case studies from England: Norfolk integrated commissioning where a team of professionals is working on integrating health and social services in a person-centred approach. “The staff in Norfolk stopped talking about social and health care needs and just talked about the needs of the people in Norfolk. This redesign of tasks and working not only saved money, but also improved care for users“, he explained.

The second example shows how an integrated health and social care team assesses a person's health and social care needs in Thurrock, to enable the service user to have faster access to services. Jim Thomas also stressed the importance of a cultural change in social work: “Don’t do a care assessment! Do a skills’ assessment! If we teach a service user to use his skills we not only save money, but also raise the self-esteem of people and carers.”

Other practices from Finland, France, Scotland, Japan and Germany included:

• Integration between acute hospital, primary care and social services in South Karelia, Finland. Local services work together at administrative level and provide integrated care. In remote areas, they provide mobile health care.


• A French company organises intervention systems after hospital stays, and prevention centres in France especially focus on social activities because of the positive impact on memory and health. In addition, a French telecommunication company helps professionals to connect, allows record sharing and drug prescription authorisation for patients.


• The National Telehealth and Telecare Delivery Plan for Scotland aims to provide Telehealth and Telecareto more service users. Within this programme, the portal ‘Shine, Flourish, Discover, Connect’was also developed, where older people can exchange skills, connect and find local information. 


• A German insurance company provides respitye holidays for carers. This has a significant positive impact on the health and wellbeing of family carers.

Investing in prevention

David McDaid from the London School of Economics said that although the results of prevention are very promising, there has not been an investment in prevention and rehabilitation. He underlined that preventative initiatives do not need to be expensive: “Group exercises and the interactions within the group have a profound impact on psychological wellbeing. Simple Tai Chi exercises can help to improve balance and prevent falls. Whereas the average cost of a hip fracture is 83,000 Euro per person and this person will probably end up in residential care.” Closing the conference, he added how much older people contribute economically (tax contribution, care expenses) and socially (volunteering, childcare, long-term care for a relative) to society: “In 2010, over 65s made an astonishing net contribution of £40 billion to the UK economy and the 65s’ net economic contribution will actually grow to £77 billion by 2030.”

In the field of ageing and care, ESN has been working with its members particularly on local initiatives on prevention, rehabilitation and health and social care coordination. A number of practice examples on local initiatives that promote prevention and rehabilitation can be found in our booklet of the last ESN Autumn Seminar.