Long Term Care Policies for Older Populations in New EU Member States and Croatia: Challenges and Opportunities
Summary
The new EU member states and Croatia are facing a rapidly aging population. One of the consequences of these demographic changes is the expected increase in demand among the older population for long-term care (LTC). The future demand for LTC services will be driven by two factors: first, the size of the older population (+65), especially the very old (+75) and second, the percentage of older people dependent or severely dependent, and therefore requiring help with Activities of Daily Living (ADL).
All four case study countries are facing the double challenge of an increasingly older and more dependent society. The question facing the case study countries, and many others around the world, is how the marked increase of the elderly population will impact future demand for LTC services. For case study countries it is clear that the aging and increasingly dependent population will boost demand for LTC services at the same time the tax base and supply of healthy people to provide them steadily shrinks.
Bulgaria’s LTC and social service system for the elderly has grown significantly in the past few years thanks to recent reforms aimed at deinstitutionalization and providing more community and home-based services. Yet the country’s National Report on Strategies for Social Protection and Social Inclusion 2008-2010 states “there is no long-term approach for establishing an adequate system for LTC” to match demographic forecasts.
The demographic trend in Croatia resembles the recent trends throughout other European countries. In Croatia, the population aged 65 and over now makes up more than 17 percent of the population. The focus of this chapter is on the role of social welfare institutions in the provision of LTC since they are undergoing changes in terms of their ownership, as well as the scope and diversity of services provided. The most detailed account is presented on the LTC for the elderly as the principal recipient of LTC in Croatia.
This chapter explores some of these issues by looking at the demographic transition in Latvia and draw some conclusions on the long-term impact of aging on the dependent population. The section also explores current public expenditures on LTC in Latvia, and discusses important potential efficiency gains in the health sector by shifting services to the LTC sector. The main finding is that Latvia has to prepare for the demographic changes ahead by adjusting its health and social policy towards more community-based LTC services and by strengthening the linkages and the coordination between the health and the social sector.
This chapter finds that Poland faces a considerable fiscal challenge if it wants to provide appropriate LTC services for its aging population. If Poland continues its current pattern of strong annual expenditure growth, combined with a pronounced increase in the number of expected beneficiaries, public expenditures on LTC will quickly become fiscally unsustainable. It is therefore critical for the Polish government to think about ways i) to finance future LTC expenditures through means other than a pay-as-you-go mechanism, like for example, through private savings; (ii) to control demand for formal LTC services and channel demand into the right types of LTC services, like outpatient care; and (iii) to control costs of in-kind benefits and reform the cash benefit.
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