1. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 1 CSAIO6 Long Term Care The Situation in The Food And Agriculture Organization Of The United Nations (FAO), WFP and IFAD

2. The Provision of Long Term care for Staff and their dependants in FAO is defined by a general staff rule and the Provisions of the Manual Section on health protection and medical insurance plans STAFF REGULATION “The Director ‑ General shall establish a scheme of social security for the staff, including provisions or health protection, sick leave, and maternity leave...”

3. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 3 “The (FAO) Basic Medical Insurance Plan......... provides world ‑ wide insurance for expenses that are medically necessary, reasonable and customary for the treatment of sickness, accident or maternity.” BENEFITS: Expenses incurred by the staff member or family members for medical treatment prescribed by physicians and given by persons qualified to treat patients are reimbursed as shown below: Convalescence in sanatoria or institutional care for persons, including the aged, with permanent ailments, when prescribed by a physician;

4. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 4 Present Practice: The claims processor is continually attempting to narrow down coverage to clearly defined medical conditions Reimbursement of the costs of long term care for handicapped children of staff members; Reimbursement of the costs of long term care for the elderly but only when there is a specific medical condition (i.e. no coverage just because a person is frail or cannot look after themselves);

5. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 5 At the moment the Joint Advisory Committee on Medical Coverage (JAC/MC) is considering the definition of “Institutional Care”. What is being proposed by Van Breda is the following:

6. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 6 Present Definition: Convalescence in sanatoria, or institutional care for persons including the aged, with permanent ailments, when prescribed by a physician. Proposed Definition (by the Claims Processor – Van Breda): Institutional care for persons including the aged, suffering from permanent ailments, which require constant and primarily medical care. The care is to be prescribed by a physician and is to be provided in a specialized medical facility by staff carrying a recognized (para)medical degree. Care that is primarily custodial in nature, i.e. representing assistance with activities of daily living, is not reimbursable.

7. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 7 Irreversible mental diseases if treated with non-medical therapies will be reimbursed in the following way: Care made up of services and supplies that: a)are furnished mainly to train or assist in personal hygiene or other activities of daily living, rather than to provide medical treatment, or a)can adequately be provided by persons who do not have the technical skills of a covered healthcare professional.

8. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 8 What is going happen about long term care for the elderly (i.e. those too infirm to be able to look after themselves but not necessarily ill) ?? Particularly if they cannot obtain long term care provisions under their national social security system. Should long term care be: 1.Included in the present medical plan…? or 2.Do we need a separate long term care plan…? or 2.Do we need a long term care plan at all…?

9. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 9 Note however: Pensioners can only continue with after service medical coverage if they (and their families) have completed 10 years or more membership of the medical plan Pensioners can only continue with after service medical coverage if they are receiving a pension under the UN pension scheme

10. CSAIO6 - Long Term Care - Presentation by APS of FAO/WFP 10 Some Questions:  Should a long term care plan be compulsory??  If it is not then will another separate (new) plan be viable??  Should pensioners contribute to the costs of their care?  Should such a plan be system wide??  Would it not be more efficient to have only one medical plan instead of having the administrative costs of two separate ones??