A comparative analysis of both formal and informal long-term care in ten of the world’s wealthiest countries.

Nations throughout the world are in the midst of an enormous demographic transition, with life expectancy increasing and fertility falling, leading to a rapidly aging population and critical implications for long-term care around the world. This volume documents and compares long-term care programs in ten wealthy countries.

Analyses of survey data and government statistics show that the costs of long-term care are beyond the financial means of a large fraction of the elderly population in most countries, particularly the oldest and most disabled. As a result, public systems bear most of the cost of formal long-term care, such as care in an institution or paid home care. Most countries spend more on nursing homes than on home care, but this relationship varies widely as does the mix of care needs and resources used to define eligibility for public funding. At the same time, most care is provided informally through family or unpaid caregivers. The costs of informal care, including the foregone earnings of caregivers, are estimated to account for at least one-third of all long-term care spending in every country. Thus, any estimate of the social costs of long-term care must account for the implicit costs of informal care.