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European Long-Term Care Programs: Lessons for Community Living Assistance Services and Supports?

Keywords: Cash for care; long-term care; aging; disability; health care financing.

Objective: To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010.

Data Sources: Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands.

Study Design: Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers.

Data Collection/Extraction Methods: Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence.

Principal Findings: Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers.

Conclusions: Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design.

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