Long Term Care: U.S. vs. Them

By Michelle Seitzer / Posted on 10 March 2010

doctor discussing with patientWhenever I’m depressed about the state of the long term care (LTC) system in America, my mind wanders to other countries. What’s it like in Uganda, France, or Kazakhstan? Is it better, worse, or about the same? Apparently, Howard Gleckman heard my cry. A senior research associate for the Urban Institute (and author of “Caring for our Parents”), he tackled this topic (in response to a Washington Post piece) in a recent column for Kaiser Health News.

Starting with a nutshell history, Gleckman states that, even just 20 years ago, most developed countries approached LTC in much the same way that our current Medicaid system operates. If you’re poor enough or sick enough, you’ll get the care you need. But if you are a person of modest means, well give us a ring when you’re broke or too sick to manage on your own. Not really a great system, and certainly not financially sustainable.

Purchasing private long term care insurance has yet to turn the system around for the US, despite a strong government push towards this solution. Even today, only 7 million Americans have a policy.

European countries built on their existing national health systems to integrate a social insurance approach to paying for long term care, rather than the welfare bent so familiar to American citizens. But countries like Germany and the Netherlands have been forced to reduce benefits in response to rapidly increasing costs so I guess the grass isn’t necessarily greener there.

In Japan, the creation of a national long term care insurance system – funded by taxes and premiums based on income – successfully covers 90% of the cost of care for their 65+ citizens. Despite this achievement, Japan is also struggling to keep up with the rising costs of LTC like their European friends mentioned above.

So who’s got it right? The Washington Post seemed to think England had done a bang-up job, but Gleckman disagrees, stating, they “may face the biggest mess of all.” Entrenched in a failing welfare model and in need of reform (sound like any place we know?), the United Kingdom has struggled for more than a decade to improve its LTC system.

I’m afraid, Mr. Gleckman, that I’m just as depressed as I was before I found your article. It seems that long term care is and will be the elephant in the room for years to come, both here and abroad. The global population is aging as rapidly as the costs for care are exploding. Nothing, especially health care, is getting cheaper, and seniors aren’t getting any younger. Maybe no one has it right yet (has anyone checked that island where good health and longevity seems to be the norm?), but someone needs to figure it out soon.

SFL followers, what are your ideas for improving the massively flawed LTC system? Any thoughts on how we got in this mess in the first place?

-Michelle Seitzer

There are 4 Comments about this post

  1. Dale Carter says,

    After all I’ve read and heard about this huge challenge, it feels like it really is up to the individual to ask the right questions, and make the right decisions and choices (without a crystal ball :-) It does seem to be a global issue.
    My mother is totally covered in her CCRC. But, I doubt my husband and I will be able to afford that when we reach her age.


    on 10 March 2010 / 9:33 PM

  2. Exactly, Dale! I think that’s an excellent point. I do wonder what long term care will look like in ten, twenty, or even fifty years, not just in terms of affordability but availability.

    Thanks for reading and commenting!


    on 13 March 2010 / 2:47 PM

  3. Mimi S. says,

    Nice article. Care of our seniors is in trouble around the globe. What does this say about our culture?
    Years ago, I was given the opportunity to purchase a long term nursing home policy. I declined because of two reasons. First, the premiums were so high I could not afford them without going into savings. Doing so for a fixed monthly expense did not seem a good idea. Second, reading the fine print disclosed that all that money would have given me a maximum of two years nursing home care. Granted, this is the average stay in such a facility, but insurance is supposed to provide for the unexpected, not the average.


    on 16 March 2010 / 2:49 PM

  4. Thanks for your comment, Mimi – and thanks for checking out my work here!


    on 17 March 2010 / 7:52 PM


Do you have something to say?