Organizing Eldercare The Danish Case in a Comparative Perspective

1. Organizing Eldercare The Danish Case in a Comparative Perspective Morten Balle Hansen, Professor, PhD Department of Political Science, Aalborg University Denmark mbh@dps.aau.dk

2. Outline • Introduction • Some Global Trends • Global variation in organizing eldercare • The Danish (Nordic) Case • Key facts Danish Long Term Care • Discussion: Advantages and disadvantages Danish system

3. Some Global Trends • From a purely demographical point of view, since the 1970s, the need for elder service on a global scale has grown and will continue to grow over the next decades • The percentage of the world’s population which is 60 years old or older has increased from 8 % in 1970 to 10% in 2000 and is expected to reach 15 % in 2025 and 22 % in 2050 (Mirkin & Weinberger 2001, 37-38) • Claim: How a society choose to organizeitseldercareincreasinglydeterminesitssuccess in the global economy

4. Global variations in Organizing Eldercare IFamily and state • Traditionally the family has taking care of the elderly • In all countries the family and informal social networks continues to play a significant role • In many countries however – and increasingly in the past decades – the state has taken over a lot of this responsibility – especially in the Northern part of Europe • This is also shown in judicial terms: • In the Nordic countries and the Netherlands the state is legally responsible for taking care of the elderly • In the southern part of Europe the family (defined in various ways) is legally responsible • The change tends to covary with women participation rates in the labor market

5. Global variations in Organizing Eldercare II • Financing eldercare: Who pays? • Taxes (Denmark) • Taxes and user payment: (Other Nordic countries, Austria, etc.) • Insurance (public) and user payment: (Netherlands, Germany, etc.) • Either taxes (low income groups) or private insurance (high income groups) and user payment: (France, USA, etc.) • Family or non-profit (e.g. church) charity organizations

6. Global variations in Organizing Eldercare III • Organizing eldercare: Who controls and organizes the eldercare? • Public: Municipalities (Denmark, other Nordic countries, UK) • Public: Local health boards (Ireland) • Public: representatives for AWBZ (Netherlands) • Public: other kinds of public sector organizing • Public and private: (Belgium and France) • Non-profit organizations or family: (Greece)

7. Global variations in Organizing Eldercare IV • Supply: Who are the primary suppliers of eldercare? • Public municipalities and some private and/or Non-profit providers: (Denmark, other Nordic countries, UK) • Non-profit providers and some private companies: (Netherlands, Germany, Italy, etc.)

8. Summing up on global (European) variations as related to Denmark • Financing eldercare: Who pays? • Denmark is unique in the sense that almost all costs are financed by tax payers • Organizing eldercare: Who controls and organizes the eldercare? • Denmark, other Nordic countries and UK relies heavily on local government administration to organize and control • Supply: Who are the primary suppliers of eldercare? • Denmark, other Nordic countries and UK relies on local government supply, but increasingly private providers as well

9. The Danish Long-Term Care System • The Danish long-term care (LTC) system for the elderly and people with disability, including home-help services, is a universal system. • The Danish Central government is responsible for determining the overall principles underpinning the long-term care system. • Local authorities are responsible for the delivery of LTC services, make and implement LTC policy and decide how LTC resources are allocated

10. Key facts Danish Long Term Care • Approx. 16.1% of the Danish population is aged over 65 (OECD average 15%) while 4.1% of the population is aged over 80 (OECD average 4%) • Denmark spent 2 % of its GDP on health related long term care in 2007, of which 1,8% was publicly funded. • Denmark spent 1,2% GDP on home long-term care and 0,8% on institutional long-term care in 2007 • In 2007 there where 9.5 formal long-term care workers per 1000 population over the age of 65, above the average OECD of 6.1 workers • In 2008, there were 14.5 long-term care beds per 1,000 population aged 65 years old and over, substantially lower than OECD-average of 44.5 beds (OECD Health Data, 2010)

11. Benefits and Eligibility Criteria • The Danish LTC system provides comprehensive coverage for a wide-range of social services, including home adaptation, assistive devices and home help • One of the main aims of the social services for elderly and disabled people is to ensure that they can manage in their own homes. • In cases where elderly or disabled people cannot manage on their own, they can move to residential care homes and sheltered homes • Eligibility is based on a needs’ assessment performed by the local authority • Eligible individuals may receive a cash benefit in order to employ necessary assistance • In order to qualify for this allowance, an individual must meet a given level of need

12. Discussion of the Danish system I • Advantages: • Sons and daughters of elderly people are able to work full time far away from their parents knowing that there is a reasonably well functioning system to take care of them • The municipalities has continuously taken professionally good care of improving the LTC system – both in terms of efficiency – delivering value for money – and in terms of quality – improving the quality of eldercare • Equality: All elderly, no matter of previous income in work life, are given a relatively high quality of eldercare • Public debate: Since we are all dependent of this system, public debate tend to focus on how a decent level a eldercare quality looks like

13. Discussion of the Danish system II • Disadvantages: • The Danish Long Term Care system is very expensive and imply a high administrative burden on taxpayers – Denmark has for many years been in top 2-3 in terms of incom tax level • The paternalistic features of the system, defining one societal acceptable standard of eldercare for all elderly, could be seen as too collectivistic and against a more individual approach to life as elder citizens • Since the elderly has increasing electoral power, the system may tend to enhance too much money spend on the elderly compared to other groups in society