Long-term Care Benefits Research Articles

Financial sustainability and automatic balance mechanisms for NDC pension systems with disability benefits

AbstractThe need for Long term care (LTC) service continues to rise due to the increasing number of elderly in the world, which stresses the healthcare systems. As most of the LTC recipients are over age 65, several authors studied retirement products combining a lifetime annuity with a long-term care benefit (typical examples are Enhanced Pension and Life Care Annuity). The development of an integrated strategy may help to address the issue of the cost of care for pensioners affected by disability. In this paper, we contribute to the debate on the introduction of LTC benefits into a notional defined contribution (NDC) pension system by using a multivariate stochastic model to represent the future evolution of transition probabilities and economic variables, which allows investigation of the financial sustainability of the system in a stochastic environment. The presence of LTC adds new risk elements, such as the uncertainty related to disability rates and mortality rates of the disabled, which may jeopardize the financial equilibrium of the integrated system. To restore the system’s equilibrium, we apply two types of automatic balance mechanisms (ABM), one based on the solvency ratio, and the other on the liquidity ratio. Both act on the indexation of pensions and the notional rate.

Geographic variation in inpatient medical expenditure among older adults aged 75 years and above in Japan: a three-level multilevel analysis of nationwide data.

In Japan, a country at the forefront of population ageing, significant geographic variation has been observed in inpatient medical expenditures for older adults aged 75 and above (IMEP75), both at the small- and large-area levels. However, our understanding of how different levels of administrative (geographic) units contribute to the overall geographic disparities remains incomplete. Thus, this study aimed to assess the degree to which geographic variation in IMEP75 can be attributed to municipality-, secondary medical area (SMA)-, and prefecture-level characteristics, and identify key factors associated with IMEP75. Using nationwide aggregate health insurance claims data of municipalities for the period of April 2018 to March 2019, we conducted a multilevel linear regression analysis with three levels: municipalities, SMA, and prefectures. The contribution of municipality-, SMA-, and prefecture-level correlates to the overall geographic variation in IMEP75 was evaluated using the proportional change in variance across six constructed models. The effects of individual factors on IMEP75 in the multilevel models were assessed by estimating beta coefficients with their 95% confidence intervals. We analysed data of 1,888 municipalities, 344 SMAs, and 47 prefectures. The availability of healthcare resources at the SMA-level and broader regions to which prefectures belonged together explained 57.3% of the overall geographic variance in IMEP75, whereas the effects of factors influencing healthcare demands at the municipality-level were relatively minor, contributing an additional explanatory power of 2.5%. Factors related to long-term and end-of-life care needs and provision such as the proportion of older adults certified as needing long-term care, long-term care benefit expenditure per recipient, and the availability of hospital beds for psychiatric and chronic care and end-of-life care support at home were associated with IMEP75. To ameliorate the geographic variation in IMEP75 in Japan, the reallocation of healthcare resources across SMAs should be considered, and drivers of broader regional disparities need to be further explored. Moreover, healthcare systems for older adults must integrate an infrastructure of efficient long-term care and end-of-life care delivery outside hospitals to alleviate the burden on inpatient care.

Models for Long-Term Care Policy: What the U.S. Can Learn from Other Countries

The need to provide Long-Term Care (LTC) for growing elderly populations is a public policy issue in all industrialized countries. Unlike other OECD countries, the U.S. lacks a foundation for universal LTC benefits. Much can be learned by examining other industrialized countries. LTC systems. In this paper, we will examine how other countries' provide LTC services for their glowing elderly populations, finance the costs of LTC services, determine eligibility for services, and encourage and support informal caregivers.

Long-Term Survival Prediction Model for Elderly Community Members Using a Deep Learning Method.

In an aging society, maintaining healthy aging, preventing death, and enabling a continuation of economic activities are crucial. This study sought to develop a model for predicting survival times among community-dwelling older individuals using a deep learning method, and to identify the level of influence of various risk factors on the survival period, so that older individuals can manage their own health. This study used the Korean National Health Insurance Service claims data. We observed community-dwelling older people, aged 66 years, for 11 years and developed a survival time prediction model. Of the 189,697 individuals enrolled at baseline, 180,235 (95.0%) survived from 2009 to 2019, while 9462 (5.0%) died. Using deep-learning-based models (C statistics = 0.7011), we identified various factors impacting survival: Charlson's comorbidity index; the frailty index; long-term care benefit grade; disability grade; income level; a combination of diabetes mellitus, hypertension, and dyslipidemia; sex; smoking status; and alcohol consumption habits. In particular, Charlson's comorbidity index (SHAP value: 0.0445) and frailty index (SHAP value: 0.0443) were strong predictors of survival time. Prediction models may help researchers to identify potentially modifiable risk factors that may affect survival.

텍스트 마이닝 기법을 활용한 노인장기요양기관 부당청구 판례 분석 연구

The increasing number of unfair claims in long-term care facilities has emerged as a risk factor for threatening the finances of the Korean national health insurance and increasing medical expenses, considering the imminent danger to super-aged society, since the implementation of the Long-term Care Insurance Act for the Elderly. Therefore, we aim to provide alternatives for unfair claim prevention and recidivism. The court's precedents and text-mining analysis were used to identify issues and factors in unfair claims to meet our research goals. Ninety-one cases (i.e., eighty-five elderly care facilities and six elderly care communal homes) were collected from January 1, 2013, to December 31, 2020. Our results revealed that fourty-four were fined, seventy-two received probation, and eighteen were sentenced to imprisonment, of the first verdicts by trial courts for senior medical welfare facilities. Among the defendants (n = 146), ninety-nine were top managers; thirteen were care workers; and five were social workers. The indictments consisted of seven violations, and of three most representative contents were violations of the Long-Term Care Insurance Act for the Elderly, of the Act on the Aggravated Punishment of Specific Economic Crimes (fraud), fraud, violations of the Elderly Welfare Act, business embezzlement and forgery of private documents. In the first trial, TF-IDF analysis indicated four keywords, 'regulations and announcements,' 'working hours,' 'additions,' 'competition,' and mandatory personnel, such as physical therapists, social workers, and nursing assistants. In the second trial, 'field investigation,' 'sanitation,' and 'resident' were the main words. Topic Modeling of the first trial showed that 'nursing care workers & sanitation center,' 'nursing care staff assignment standards,' 'social worker & physical therapist,' 'notifications and laws,' 'working hours & exploitation,' 'defendants & victim.' In the second trial, 'accused & supreme unjust (heavy),' 'placement criteria & deception (acts),' 'long-term care benefit & breach of working hours,' 'victim's claim & crime of fraud,' 'false service,' 'staff assignment standards & deceiving (acting),' and 'defendant's working rules & field investigation.' Thus, we explored causes and issues with unfair claims. Finally, we proposed several preventative solutions: ①. change in the perception of operators and works of long-term care institutions, ②. transparent management, ③. a thorough understanding of relevant regulations, such as laws and public announcements, and prevention of errors in interpretation, and lastly ④. active countermeasures focused on improving unfair claims instead of punishment.

Effects of a Dementia Special Care Unit on the Changes in Physical Function, Cognitive Function, and Problematic Behaviors among Nursing Home Residents.

This study compared changes in physical function, cognitive function, and problematic behaviors among nursing home residents with dementia between the dementia specialized care and general units. To assess the effects of a dementia specialized care unit (D-SCU), this study applied the difference-in-differences method. While the D-SCU was introduced in July 2016, the service was provided in January 2017. We defined the pre-intervention period as July 2015 to December 2016 and the post-intervention period as January 2017 to September 2018. We matched long-term care (LTC) insurance beneficiaries using the propensity score matching method to minimize selection bias. After this matching, two new groups were obtained, each with 284 beneficiaries. To characterize the actual effects of the D-SCU on physical function, cognitive function, and problematic behaviors among dementia beneficiaries, we conducted a multiple regression analysis that controlled for demographics, LTC need, and LTC benefit utilization. The physical function score significantly increased according to the time effect, and the interaction term between time and the use of D-SCU was significant. Therefore, the activities of daily living (ADL) score of the control group increased by 5.01 points more than that in the group of beneficiaries using the D-SCU (p<0.001). However, the interaction term had no significant effect on cognitive function or problematic behavior. These results revealed the partial effect of the D-SCU on LTC insurance. Further research is required that considers the variables of service providers.

Investigation of User Complaints and Improvement Requests for Medical Electric Toilet Bed

의료용 전동 변기 침대는 침대 상판에 변기를 내장하여 와상 환자의 용변처리에 도움을 주는 제품이다. 2021 년부터 장기 요양 급여 품목으로 지정되어 와상 환자의 가정에 보급되었다. 본 연구에서는 변기 침대 사용자들에게 불만 혹은 개선 요청 사항이 있는지 여부를 묻는 문자를 보낸 후 응답자와의 인터뷰를 통하여 사용시의 불만및 개선 요구사항을 파악한 후, 항목별로 분석하였다. 총 131명의 불만 혹은 개선점 신고 요청자 중 6명의 사용자가 인터뷰에 응하여 불만 및 개선 요구사항을 제시하였다. 인터뷰에 응한 6명이 모두 15개의 불만 및 개선 요구사항을 제공하였으며, 유사한 불만들을 통합하여 재분류한 결과로 모두 10개 항목이 남았다. 불만 항목 중 욕창 발생이 3건으로 가장 많았으며 설문요청을 보냈던 변기침대 사용자 131명 중 2.1%로 계산되었다. 이 비율은 이전의 유사한 환자 그룹을 대상으로 했던 연구들에서 보고되었던 약 10-20% 비율에 비하여는 매우 낮은 비율이다. 이 결과는 변기 침대가 와상 환자의 용변 처리에 효율적이고 위생적임을 의미한다. 변기침대의 구성 요소 중 불만 및 개선 요구사항이 가장 많은 부분은 변좌 및 변기 덮개 관련이었다. 이 부분에 관한 불만은 변좌 주위의 틈으로 오염된 세정수가 스며드는 문제, 그리고 변좌와변기 덮개가 조립될 때 너무 빡빡하여 시간이 걸린다는 것이었다. 따라서 향후 연구의 중점은 변좌 및 변기 덮개의 개선을 위한 연구에 집중되어야 할 것으로 사료된다. 6명의 불만 및 개선을 요구한 사용자 중 4명은 개선 요구사항은 있지만 변기침대의 사용은 전반적으로 만족스럽다고 응답 하였으며, 나머지 2명은 변기 침대를 이용한용변 처리가 어려워 전반적으로 불만족하다고 응답하였다. 따라서 변기 침대의 사용자 불만율은 약 1.5 %인 것으로 추정된다. 변기 침대는 와상 환자의 배뇨 및 배변 처리에 도움이 되는 대중적인 위생용품이 될 것으로 기대된다Medical electric toilet bed is incorporated with a toilet in the bed frame that helps urination and defecation of bed-ridden patients. It has been designated as a long-term care benefit item and distributed to the homes of bedridden patients since 2021. In this study, after ending out a text message asking if the user has either a complaint or improvement requirement, the toilet bed users’ complaints and improvement requirements were identified through interviews with the respondents, and then analyzed. Out of a total of 131 users, 6 users responded to the interview and presented with complaints and improvement requests. The six interviewees provided total of 15 complaints and improvement requests, and after consolidating and reclassifying similar complaints, a total of 10 items of complaints and improvement requirements remained. Among the complaint items, the occurrence of pressure ulcer was the most with 3 cases, and it was calculated as 2.1 % of the 131 toilet bed users who were sent with the survey request. This rate is significantly lower when compared with the approximately 10-20% rate reported in previous studies with similar patient groups. This result indicates that the toilet bed is efficient and hygienic for toileting assistance of bed-ridden patients. Among the components of the toilet bed, the most complaints and requests for improvement were related to the toilet seat and the toilet cover. The complaints in this area included the problem of seepage of contaminated water through the gaps around the toilet seat, and the problem that it took time because the toilet cover and the toilet seat were too tight to assemble.

Caregiving subsidies and spousal early retirement intentions

AbstractBalancing caregiving duties and employment can be both financially and emotionally burdensome, especially when care is provided to a spouse at home. Caregiving subsidies can play a role in helping caregivers to cope with such duties. This paper demonstrates how providing financial respite for caregivers can influence individuals' decisions to retire early. We investigate the impact of a reform that extended long-term care (LTC) benefits (in the form of subsidies and supports) on the intention of a caregiving spouse to retire early in Spain. We subsequently examine the effect of austerity spending cuts reducing such publicly funded benefits, and we compare the estimates to the effects of an early retirement reform among private sector workers around the same time. Our preferred estimates suggest evidence of a 10pp reduction in early retirement intentions after the extension of LTC benefits even though the effect is heterogeneous by type of benefit. Consistently, austerity spending cuts in benefits are found to weaken retirement intentions. Even more importantly, our estimates suggest that cuts in caregiving subsidies exert a much stronger effect on early retirement intentions than actual early retirement reforms.

The 10-year multimorbidity trajectory and mortality risk in older people with long-term care needs

BackgroundThis study aimed to identify trajectories of multimorbidity in older adults prior to receiving long-term care benefits and to demonstrate their value in predicting mortality. MethodsThis study included 1,004,924 Korean beneficiaries who completed the National Long-Term Care Insurance (NLTCI) eligibility assessment between 2010 and 2016. Multimorbidity was defined as the coexistence of 2 or more out of 23 chronic diseases related to disability in the 10 years before transitioning to long-term care. Mortality was defined as all-cause deaths after the date of the NLTCI needs assessment. Latent class growth modeling was performed to identify groups that exhibited similar trajectory patterns over time. Sex, age, and long-term care grade were used as covariates. Cox proportional hazards models were used to analyze the mortality rates by trajectories. ResultsThree patterns emerged in the multimorbidity trajectory in the 10 years prior to entering the long-term care system: consistently low morbidity (“consistently low”), an abrupt increase in morbidity in less than one year (“catastrophic”), and an increment in morbidity over a longer period (“progressive”). In multiple Cox regression adjusting for covariates, the hazard ratios (95% confidence interval) of 1-year mortality for the catastrophic and progressive groups were 1.38 (1.36−1.39) and 1.43 (1.41−1.45), respectively, compared to the consistently low group. ConclusionsThis study identified distinct trajectories of multimorbidity in older people accessing the long-term care system and demonstrated their prognostic value for the survival of those with long-term care needs. Treatment and management strategies targeting individuals with a high-risk trajectory are warranted.

Effects of long-term care benefits on healthcare utilization in Catalonia

This paper estimates effects of long-term care (LTC) benefits on utilization of primary and secondary healthcare in Catalonia (Spain). Identification comes from plausibly exogenous variation in the leniency of LTC needs assessment. We estimate that receiving LTC benefits worth 365 euros per month, on average, reduces the probability of avoidable hospital admissions by 66%, and has no significant effect on planned hospitalisations nor on hospitalisation for any reason. Receiving LTC benefits is estimated to reduce unscheduled primary care visits by 44% and has no significant effect on scheduled visits. These findings have important policy implications suggesting that allocating resources to LTC may not only increase the welfare of LTC beneficiaries but also reduce avoidable and unscheduled utilisation of healthcare.

REVERSE MORTGAGE AND FINANCIAL SUSTAINABILITY

This paper analyzes the effects that contracting a reverse mortgage has on the finances of families of a country or group whose members who aged 65 or older are the sole owners of the 100% of the property, regardless of the receipt of a retirement pension. For this purpose, an economic-financial model based on the life cycle model is defined, which considers a double source of randomness: mortality and dependence of family members. Long-term effects are measured using probabilistic, temporal and monetary indicators. For each country, the model must be adapted according to the legal framework for retirement and long-term care benefits and for the actuarial mortality and long-term care tables. As an illustration, this model was applied on Spanish families using data from the Spanish Survey of Household Finances 2017. The results obtained indicate that a family in Spain that meets the conditions for contracting a reverse mortgage sees, on average, an increase in its initial income and a decrease in both its probability of having liquidity problems in the future and the value of this lack of liquidity. It is also concluded that family composition influences the magnitude of these positive effects.

Valuation of variable long-term care and limited hospitalization coverage benefits and two investment funds

Valuation of variable long-term care and limited hospitalization coverage benefits and two investment funds

Old age or dependence: Which social insurance?

AbstractIn recent decades, there has been an increase in life expectancy and a rapid increase of the very senior dependency ratio in developed countries. In this context, we examine the optimal levels of public pensions and public long‐term care (LTC) insurance. According to the most reasonable estimates of correlations among individual incomes, risks of mortality and dependency, we show that it is always desirable for a utilitarian social planner to have a balanced budget increase in LTC benefits at the expense of public pension benefits, until the cost of LTC is fully covered. This is true with or without liquidity constraints. For a Rawlsian planner, the balance between the two schemes depends on a comparison of the ratio of the survival probability to the dependence risk of the poor with its population average.

The effect of family support, knowledge, and socioeconomic status in controlling diabetes and its complications on the patient

Background: About 422 million people with diabetes worldwide live in low- and middle-income countries, and the disease directly causes 1.5 million fatalities yearly. Objectives: to assess the impact of patients’ knowledge and family factors in controlling (DM) and its complications. Methods: a cross-sectional study was done on 137 DM patients. The Diabetes Care Profile (DCP) developed by the Michigan diabetes research and training center was used to measure the social and psychological factors of DM. Results: 79.6% of the participants were checking their blood sugar and 39.5% were keeping a record of blood sugar test results. Of them, 23.4% had good DM education and 54.7% and 3.6% had fair and good DM understanding respectively. Almost 50% had good social support, 43.8 had good DM control and 56.2% had a good attitude toward DM. Of them, 47.4% had good diet adherence, 46% had long-term care benefit and only 27.7% had good monitoring and understanding management practice. Participants who had good DM understanding had a significantly higher percentage of those who were checking their blood sugar. A significant positive correlation was found between the Control Problems Scale and both the support scale and the Diabetes Attitude Scale (DAS-3). A significant positive correlation was found between the support scale and the health status scale and the Diabetes Attitude Scale (DAS-3). Conclusion: a relation between family support, knowledge, and socioeconomic status was found to have an effect on diabetes control and complications. Keywords: support, knowledge, socioeconomic, controlling, diabetes, Saudi Arabia

Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data

Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3)higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Health Care Insurance Adequacy for Children and Youth With Special Health Care Needs.

US children and youth rely on insurance to access health care.1 Families living in or near poverty may qualify for public coverage with income thresholds for eligibility varying from 138% to 325% of the federal poverty level (FPL) across states.2 Other families may have commercial insurance through an employer or direct purchase.3 Families lacking insurance pay out-of-pocket for health care. The adequacy of insurance varies across insurance types,4 with some providing better coverage and access to care than others.5,6 Households with children and youth with special health care needs (CYSHCN) with low-to-middle income (ie, 200% to 399% of FPL) may be particularly sensitive to insurance variations, yet little is known about family perceptions of insurance adequacy.1,3 We compared these perceptions across insurance types for CYSHCN living in low-to-middle income families.We performed a retrospective analysis of 4321 responses of parents of CYSHCN aged 0 to 18 years in the 2016–2017 National Survey of Children’s Health, with family income that was 200% to 399% of FPL, representing 6 056 833 CYSHCN nationally. National Survey of Children’s Health uses the well-established and extensively used CYSCHN screener questions.7 CYSHCN with above-average use of health services, medications, and functional limitations were stratified as having greater health care needs.8 Family perceptions of benefits, coverage, referrals, and other health service aspects were compared across insurance types by using logistic regression, adjusting for age, race and ethnicity, and level of health care needs. For benefit adequacy, we included only families who reported the child had a specific need. The Boston Children’s Hospital Institutional Review Board waived review because the study did not meet criteria for human subjects research.Health insurance among CYSHCN in low-to-middle-income families included employer-sponsored (56%), public (22%), combination of public and commercial (9%), and direct-purchase commercial (3%); 6% had other types, including Tricare; 3% were uninsured; and 1% were missing. Thirteen percent of CYSHCN had greater health care needs. In general, family perceptions of insurance adequacy were highest for use of public insurance (Fig 1). The adjusted percentages of families perceiving that their child’s health insurance always offered benefits or covered services that met the child’s needs were 64% for public only, 56% for public-commercial combination, 51% for employer-sponsored, and 28% for direct purchase (P &lt; .001). The adjusted percentages of families perceiving that their child’s insurance always allowed him or her to see the health care providers that he or she needs were 74% for public only, 68% for public-commercial combination, 70% for employer-private, and 48% for direct purchase. Perceptions of insurance correlated with health care needs. For example, a big problem to get specialist care was reported more often by families of CYSHCN with greater versus lesser medical needs covered by direct purchase (23% vs 5%, P = .02).The current study reveals new findings about insurance adequacy for CYSHCN from low-to-middle-income families. Family-perceived adequacy of their children’s health insurance varied substantially. Some families may have had inaccurate knowledge of the exact coverage offered by their insurance. In general, public coverage was viewed as most adequate. Families of CYSHCN with greater health care needs reported more problems with their children’s insurance, especially with direct purchase. Affordable, direct-purchase plans may have offered less coverage of needed health services for CYSHCN. Public coverage may indeed have better benefits than commercial for CYSHCN. In 1965, when Medicare and Medicaid were established, Medicare lacked long-term care benefits, in part because of concerns that good long-term benefits would cost too much. Medicaid served more as a safety net for low-income people, including many elderly people who enrolled also in Medicaid, which had more comprehensive long-term benefits, and CYSHCN insured by Medicaid can also use these benefits. Early and periodic screening, diagnostic, and treatment benefits were added to ensure availability of health services and treatments for disabling conditions affecting growth and development.This study highlights the importance of public coverage for CYSHCN, especially children living near poverty. Future investigation is needed to assess (1) how many CYSHCN living near poverty and covered by commercial insurance, especially direct purchase, meet income eligibility for enrollment in their state’s public coverage program; (2) how commercial insurers could match public coverage benefits and services; and (3) approaches to improve the adequacy of all insurance types. These efforts will strengthen US health care coverage for CYSHCN and their health care needs.We acknowledge Matt Hall, PhD, and Adams Bellows, BS, for their contributions to this work.

The home-based postdoctoral mother in the neoliberal university

For centuries, women have practiced home-based work. What happens when this strategy enters the academy? What happens when a postdoctoral fellowship becomes home-based work? Using autoethnography, I examine the home-based postdoc as one option sought by gendered subjects with care obligations and limited mobility for accruing academic capital. Through telecommuting and occasional visits, aspiring academic mothers gain valuable experience at prestigious institutions without incurring the immediate social and financial costs of uprooting their families. Yet women’s home-based academic work cannot provide the long-term professional and care benefits of on-campus presence. To probe the challenges and strategies of a home-based postdoctoral mother, I study three tensions: im/mobility, spaces of re/production and care. This ploy for decoupling geographic from social mobility and reconciling family care with career progression speaks to gendered labour relations and the work-life balance myth. The home-based postdoc, with its inherent compromises, is thus a perennial site of critique of the neoliberal academic institution.

장기요양 재가급여 수급자의 급여이용 유형별 영향 요인

장기요양 재가급여 수급자의 급여이용 유형별 영향 요인

Components of Elderly Long-term Care System in Iran and Selected Countries: A Comparative Study

Context: With the increasing number of the elderly suffering from chronic diseases and disabilities, elderly long-term care (LTC) has been the subject of attention by health and welfare policymakers. This study aimed to compare the components of LTC for the elderly in Iran and selected countries. Methods: This comparative study was conducted in 2020. The search was conducted in three databases (PubMed, Scopus, and Web of Science), two search engines (Google Scholar and Google), and the websites of WHO and the Ministry of Health and Welfare of the selected countries from 2000 to 2020 to find relevant documents on the subject. The selection of countries was based on three criteria: the type of health system, having the highest percentage of the elderly population, and the development status. Finally, Germany, France, Sweden, Japan, South Korea, Turkey, Thailand, and Iran were included in the study. The findings were organized using a common LTC framework. Results: In this study, the common framework of LTC systems, including beneficiaries, benefits packages, providers, and financing, was used. The study results showed that developed countries had formal LTC systems with specific mechanisms, but each country had differences in the implementation of different components of this system. On the other hand, in most developing countries, sporadic measures were taken in this field. Conclusions: In general, developed countries have adopted different LTC system approaches in the organization, financing, type of services, and generosity of benefits. In choosing the appropriate LTC model in developing countries, factors such as the health system, resource constraints, social, and cultural status should be considered.

Socio-Economic Predictors of Hiring Live-In Migrant Care Workers to Support Community Dwelling Older Adults with Long-Term Care Needs: Recent Evidence from a Central Italian Region

To meet the rising demand for home care, many families in Italy hire live-in migrant care workers (MCWs). However, the reliance on MCWs to provide long-term care (LTC) and a lack of alternative formal care services raises concerns around equality in access to care. This study aimed to determine the socio-economic predictors of hiring live-in MCWs among older adults with LTC needs in Italy, the objective care burden placed on MCWs, and the financial barriers that people in need of care and informal caregivers face when hiring MCWs, analysing data from a cross-sectional questionnaire with 366 older adults with LTC needs and their primary family caregivers living in the Marche region. Binary logistic regression was used to calculate the predictors of hiring a live-in MCW. Having a primary caregiver that had a high school education or above significantly increased the odds of hiring a live-in MCW (Odds Ratio (OR) = 3.880), as did receiving a social pension (OR = 2.258). Over half (57.5 percent) of the people in need of care had difficulties in affording the costs of hiring an MCW in the past year. To increase the sustainability of the Italian MCW market and reduce socio-economic barriers to accessing care, the Italian Government should increase funding for LTC benefits and add means testing and restrictions on the use of cash-for-care allowances.