Delivering long- term care: Lessons from the developed world

Abstract

Many countries have now experienced the demographic revolution of an aging population and responded to it. Lessons can be derived from the similarities and differences across these nations; some similarities are attributable to ef­ forts to import and adapt approaches developed elsewhere, while some differences reflect basic national ethics and beliefs about how general issues of human services should be handled. This overview will examine the provision of services for the dependent elderly by examining a series of themes that transcend national bound­ aries. Different countries have responded to these themes differently to create a mosaic of long-term care programs; nonetheless, each country must confront these issues, which in­ clude the current and expected relationship be­ tween aging and disability, the role of govern­ ment , a strategy of providing protection through pensions or services, the implications of a mar­ keting usa service paradigm for human services, the place of nursing homes and other institu­ tions (and conversely, the role of community care), the need for care givers (both formal and informal), the links between acute and chronic care, the need for rationing and for case man­ agement, and the use of regulation.