Among industrialized countries, Canada and Sweden have well-developed (although imperfect) systems of long-term care. The USA is unique in that its long-term health care system does not protect the elderly against either chronic disability or impoverishment. The phenomenon of spending down to become eligible for government-paid long-term care is found only in the USA.
TABLE 106-3 lists the long-term care options available in various developed countries. Very few formal arrangements for long-term care exist in less developed countries. TABLE 106^ depicts variations among the rates of long-term institutionalization in several countries. The percentage of elderly needing institutional care varies from < 2% in Hungary to almost 11% in the Netherlands.
Use of nonmedical facilities (eg, a home for the aged or sheltered housing) also varies significantly. In European countries, commitment to provide nonmedical residential care and coordinated community services contrasts greatly to what is available in much of the USA. Despite cultural and other similarities between the USA and Canada, the two * Approximate date.
11981 census data indicate that 3% of the elderly were “usually resident” in communal establishments (mainly homes for the elderly but also hospitals, hostels, and hotels); another 1% was present in such places (usually hospitals), though not usually resident.
$ Excludes elderly in general hospitals.
N/A = not available.
Notes; For reasons of definition, coverage, and temporal reference, rates of institutional use may not be well suited to comparison across nations. Hence, differences between figures in this table should be taken as roughly indicative of different national propensities toward institutional use. Generally, a national use rate reflects the percentage of all elderly persons resident in institutional settings at a particular point in time.
From Suzman R, Kinsella KG, Myers GC: “Demography of older populations in developed countries,” in Oxford Textbook of Geriatric Medicine, edited by JG Evans and TF Williams. Oxford, Oxford University Press, 1992, p 10; used by permission of Oxford University Press.
countries differ greatly in how they care for the elderly. With respect to payment for long-term care, the average Canadian is far better off than his American counterpart because all Canadians are eligible for such care regardless of income.
Many governments are being pressured to provide more institutional care for the frail elderly. Projections of increases in this population and in the costs of institutionalized care have precipitated an intense debate over the ideal number of beds for such care.