European long-term care programs: lessons for community living assistance services and supports?

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.