Inclusion and strengthening of social services as part of the agenda on ageing Rosemary Lane, Focal Point on Ageing United Nations Department of Economic and Social Affairs, New York

Social inclusion - why is this important in the context of provision of care? Social inclusion - why is this important in the context of provision of care? Selected models of care service provision at home and funding sources – pros and cons Selected models of care service provision at home and funding sources – pros and cons Some issue for Member States to think about moving forward Some issue for Member States to think about moving forward

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

What is the relationship between provision of care and social inclusion? Type, quality and level of care are directly linked to enhancement of quality of life and participation/links to the community/family and friends. Type, quality and level of care are directly linked to enhancement of quality of life and participation/links to the community/family and friends. Social isolation and exclusion – risk factors - specificity to older persons – being over 80 years old, living alone, no children, poor physical heath, residential care, unable to access benefits/services Social isolation and exclusion – risk factors - specificity to older persons – being over 80 years old, living alone, no children, poor physical heath, residential care, unable to access benefits/services

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

Germany Mandatory long-term care insurance system to cover old persons and persons with disabilities since Managed by central government with individual states responsible for provision of infrastructure. Benefits uniform across country. May participate or pay for private insurance. Mandatory long-term care insurance system to cover old persons and persons with disabilities since Managed by central government with individual states responsible for provision of infrastructure. Benefits uniform across country. May participate or pay for private insurance. Financed by payroll tax divided between employers and employees (now 1.95% since 2008 as costs had risen, also with additional premium for childless) Financed by payroll tax divided between employers and employees (now 1.95% since 2008 as costs had risen, also with additional premium for childless) Recipients may opt for benefits either in cash to pay for benefits (including paying for family member care giving), in-kind service from agency under contract with insurance programme. Also covers institutional care but not room/ board. Recipients may opt for benefits either in cash to pay for benefits (including paying for family member care giving), in-kind service from agency under contract with insurance programme. Also covers institutional care but not room/ board.

Netherlands Established universal social insurance for long- term care in Administered by private insurance company who manage but do not accept financial risk. Covers more than care for older persons. Established universal social insurance for long- term care in Administered by private insurance company who manage but do not accept financial risk. Covers more than care for older persons. Financed through income and payroll tax that is income related – pay as you go system. General revenues cover shortfalls. Financed through income and payroll tax that is income related – pay as you go system. General revenues cover shortfalls. Benefits through in-kind services and cash payments. Co payments required. Benefits through in-kind services and cash payments. Co payments required. Due to escalating costs in 1990s Government capped budgets that created long waiting lists for some services. Due to escalating costs in 1990s Government capped budgets that created long waiting lists for some services.

Japan Created social insurance programme in Covers long-term care of older persons only. Created social insurance programme in Covers long-term care of older persons only. Financed through both contributions (payroll tax 0.9% employee/employer) and small monthly premiums for retirees) plus general taxes. Pay as you go system. Financed through both contributions (payroll tax 0.9% employee/employer) and small monthly premiums for retirees) plus general taxes. Pay as you go system. Covers institutional and home care but no cash benefits. Institutional care provided by non- profits. Covers institutional and home care but no cash benefits. Institutional care provided by non- profits. Government has raised fees and reduced benefits and lowered payments to providers Government has raised fees and reduced benefits and lowered payments to providers

United Kingdom Long-term care provided on means-tested basis. Tax based funding from central gov., local gov. and co payments. Long-term care provided on means-tested basis. Tax based funding from central gov., local gov. and co payments. Social care provided on means-tested basis by local authorities. Broad geographic disparities. Social care provided on means-tested basis by local authorities. Broad geographic disparities. Skilled nursing in home provided under NHS at no cost. Skilled nursing in home provided under NHS at no cost. Cash benefit for intensive care by members of low-income families. Cash benefit for intensive care by members of low-income families. Cuts through more strict eligibility requirements have recently been made by local governments due to budgetary cuts from Central Government. Cuts through more strict eligibility requirements have recently been made by local governments due to budgetary cuts from Central Government.

A word about some developing countries experience Often first reaction was to build old age homes Often first reaction was to build old age homes Many service systems ad hoc and run by civil society, religious organizations. Many service systems ad hoc and run by civil society, religious organizations. Some civil society organizations contracted by Government for services (eg. Egypt) but generally for low income people. Some civil society organizations contracted by Government for services (eg. Egypt) but generally for low income people.

A number use volunteers to run schemes, some with basic government funding. Progress in establishment of day centers Progress in establishment of day centers Legal requirements for families to provide support Legal requirements for families to provide support

Issues and lessons learned Encouragement by governments (including tax breaks) to purchase private long-term care insurance have not been successful (see US) Encouragement by governments (including tax breaks) to purchase private long-term care insurance have not been successful (see US) Strict income-based restrictions to access benefits/services cause huge problems for large segment of population (eg. UK) Strict income-based restrictions to access benefits/services cause huge problems for large segment of population (eg. UK) Different countries/cultures have different views on shared responsibility approaches to funding Different countries/cultures have different views on shared responsibility approaches to funding Inability to access services – leads to social exclusion/isolation, poverty Inability to access services – leads to social exclusion/isolation, poverty Impact on family and economy due to lack of services or support to care Impact on family and economy due to lack of services or support to care

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