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  • Author or Editor: Raphael Wittenberg x
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This chapter considers the drivers of demand for care and support for older people and trends in those drivers. It concentrates on trends in disability and in household composition and unpaid care. The chapter sets the scene for discussions in later chapters. Understanding the drivers of demand is crucial in the context of concerns about the future affordability of care for older people. Demand for formal care depends on a range of factors including: needs in terms of disability, prices of services, incomes, availability of unpaid care, the funding system for public programmes and personal preferences. There is ongoing debate about whether as life expectancy rises the period of life with disability will rise, fall or remain broadly constant. Different countries have experienced different trends and may continue to experience different trends in the future. The future trend in availability of unpaid care is also a crucial influence on future demand for formal care.

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Successes and failures

Since the early 1990s, long-term care policies have undergone significant transformations across OECD countries. In some countries these changes have responded to the introduction of major policy reforms while in others, significant transformations have come about through the accumulation of incremental policy changes.

The book brings together evidence from over 15 years of care reform to examine changes in long-term care systems occurring in OECD countries. It discusses and compares key changes in national policies and examines the main successes and failures of recent reforms. Finally, it suggests possible policy strategies for the future in the sector.

With contributions from a wide range of experts across EECD countries, this book is essential reading for academics, researchers and policy-makers in the field of long-term care policy.

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This concluding chapter reviews the findings of the rest book in order to map and discuss the most important challenges and dilemmas that long-term care policies are going to face internationally. The focus of policy has shifted from development of care services to meeting the challenges of increasing demand, rising expectations, constrained budgets and concerns about future supply of care. Policies must take account of the expected rise in the numbers of people needing care, rising expectations for high quality care and likely constraints on the supply of unpaid care and of resources for formal care. Promotion of improved quality, support for carers, a well-trained and motivated workforce, and better integration between health and social care will be essential. International comparisons are valuable in enabling countries to learn from successes and challenges in other similar countries.

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Long-term care (LTC) is a key policy priority for governments internationally. Most countries are faced with demographic and/or socio-economic changes that are resulting in a significant growth in the need for LTC services. The impact on LTC systems of higher demand is compounded by long-run increases in service unit costs, and by reductions in the availability of unpaid care, which still provides the lion share of the support for people with long-term care needs. In addition, the rising political voice of key LTC consumer groups and the mounting pressures on public service budgets mean that LTC is likely to remain for the foreseeable future at the forefront of the political agenda across OECD nations. Since the 90s, long-term care policies have undergone significant transformations across many countries. In some instances, these changes have been the outcome of major explicit policy goals. In others, new systems have come about through the accumulation of incremental changes. As a result, LTC policy reforms in the last decades across OECD countries offer a rich body of experience that should inform the design of strategies for improving equity and efficiency in the LTC systems of the future. The main purpose of this book is to analyse the range of solutions adopted internationally about how to organise, regulate and fund LTC services in the face of the growing needs of ageing societies.

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Long-term care (LTC) is a key policy priority for governments internationally. Most countries are faced with demographic and/or socio-economic changes that are resulting in a significant growth in the need for LTC services. The impact on LTC systems of higher demand is compounded by long-run increases in service unit costs, and by reductions in the availability of unpaid care, which still provides the lion share of the support for people with long-term care needs. In addition, the rising political voice of key LTC consumer groups and the mounting pressures on public service budgets mean that LTC is likely to remain for the foreseeable future at the forefront of the political agenda across OECD nations. Since the 90s, long-term care policies have undergone significant transformations across many countries. In some instances, these changes have been the outcome of major explicit policy goals. In others, new systems have come about through the accumulation of incremental changes. As a result, LTC policy reforms in the last decades across OECD countries offer a rich body of experience that should inform the design of strategies for improving equity and efficiency in the LTC systems of the future. The main purpose of this book is to analyse the range of solutions adopted internationally about how to organise, regulate and fund LTC services in the face of the growing needs of ageing societies.

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Long-term care (LTC) is a key policy priority for governments internationally. Most countries are faced with demographic and/or socio-economic changes that are resulting in a significant growth in the need for LTC services. The impact on LTC systems of higher demand is compounded by long-run increases in service unit costs, and by reductions in the availability of unpaid care, which still provides the lion share of the support for people with long-term care needs. In addition, the rising political voice of key LTC consumer groups and the mounting pressures on public service budgets mean that LTC is likely to remain for the foreseeable future at the forefront of the political agenda across OECD nations. Since the 90s, long-term care policies have undergone significant transformations across many countries. In some instances, these changes have been the outcome of major explicit policy goals. In others, new systems have come about through the accumulation of incremental changes. As a result, LTC policy reforms in the last decades across OECD countries offer a rich body of experience that should inform the design of strategies for improving equity and efficiency in the LTC systems of the future. The main purpose of this book is to analyse the range of solutions adopted internationally about how to organise, regulate and fund LTC services in the face of the growing needs of ageing societies.

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Long-term care (LTC) is a key policy priority for governments internationally. Most countries are faced with demographic and/or socio-economic changes that are resulting in a significant growth in the need for LTC services. The impact on LTC systems of higher demand is compounded by long-run increases in service unit costs, and by reductions in the availability of unpaid care, which still provides the lion share of the support for people with long-term care needs. In addition, the rising political voice of key LTC consumer groups and the mounting pressures on public service budgets mean that LTC is likely to remain for the foreseeable future at the forefront of the political agenda across OECD nations. Since the 90s, long-term care policies have undergone significant transformations across many countries. In some instances, these changes have been the outcome of major explicit policy goals. In others, new systems have come about through the accumulation of incremental changes. As a result, LTC policy reforms in the last decades across OECD countries offer a rich body of experience that should inform the design of strategies for improving equity and efficiency in the LTC systems of the future. The main purpose of this book is to analyse the range of solutions adopted internationally about how to organise, regulate and fund LTC services in the face of the growing needs of ageing societies.

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The personalisation of residential care services is based on three broad principles of valuing personal identity, empowering resident decision-making and fostering care relationships. We analysed 50 Care Quality Commission care home inspection reports to identify factors that the reports indicate facilitate or hinder the delivery of personalised residential care in England. Findings suggest that the provision of personalised services is affected by staff skills, attitudes and availability, as well as the quality of care home leadership. Future care policy should consider addressing external pressures facing the care home sector, including inadequate funding and too few staff, to mitigate barriers to delivering high-quality, personalised care.

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This article reports findings from the evaluation of the Direct Payments in Residential Care Trailblazers in England (2014–16). It focuses on the perspective of residential care providers on implementing direct payments, which aimed to improve the level of choice and control over care available to their residents. The article explores the views of providers, using interviews and survey responses of care home managers and owners. Concerns expressed by providers include issues that have arisen in domiciliary care but also issues specific to residential care, especially challenges in facilitating greater choice and control in settings that provide care collectively for substantial numbers of residents.

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This chapter presents some findings from the research project ‘Modelling Needs and Resources of Older People to 2030’ (MAP2030). The project developed a set of projection models to estimate future family circumstances, incomes, pensions, savings, disability and care needs of older people in England. These projections included public and private expenditure on pensions, disability benefits and care services under different scenarios for reform of pensions and long-term care funding under a range of alternative population futures. The chapter focuses on the projected future costs and impacts for the different income quintiles of the older population of proposed reforms to the system of funding adult social care, in particular the impact of a cap on individual liability to meet care costs.

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