1. Identifying policy options: International lessons for long-term care policy Linda Pickard Personal Social Services Research Unit (PSSRU) London School of Economics & Political Science

2. International lessons for long-term care policy Scenarios identified for modelling so far variants around current means-tested system reforms to treatment of assets, savings, income policies arising from long-term care debate free personal care, limited liability model, partnership arrangement Policies may also be drawn directly from experience in other countries eg entitlement to formal care

3. Issues in long-term care policy & systems in other countries Some key issues in long-term care policy in UK (outside Scotland) have been identified as equity in access to resources (Royal Commission on Long Term Care (1999), Wanless (2006) formal : informal care balance in context of rising ‘old age dependency ratio’ tension between unpaid care and paid employment for succeeding generation (Wanless 2006) Examples of long-term care systems that address both issues: Denmark, Japan

4. Example One: Denmark Responsibility for social welfare of older people lies primarily with the state publicly-funded formal services for older people emphasis on home & community-based services funded by taxation domestic, personal, nursing, rehabilitation services largely free to user Succeeding generation not expected to provide unpaid care high levels of labour market participation by mid-life women (especially full-time employment) Potential scenarios: variants around free personal care

5. Example Two: Japan Long Term Care Insurance system (2000) entitlement to formal care for disabled aged 65+ emphasis on domiciliary care funded by taxation, social insurance and co- payments user pays 10% co-payment on cost of services Aims to reduce reliance on family care givers, especially succeeding generation no incentives to provide informal care (no cash payments) ‘marketisation of elder care’ Potential scenarios: entitlement to formal care

6. Conclusions Potential options for policy suggested by these countries Long-term care systems in these countries are characterised by universality universality not necessarily way forward in UK addresses issues around equity of access to resources Changing system of long-term care for older people may change balance between formal and informal care may address tensions between unpaid care and paid employment for succeeding generation Contact details: L.M.Pickard@lse.ac.uk