Long-Term Care Around the Globe

Most advanced industrial countries have chosen to provide more generous public funding for home care than for nursing homes and other forms of residential eldercare. The United States is unusual, however, in taking a more dichotomous approach toward financing home care services that are perceived to be skilled nursing, rehabilitation therapy, and home health-aide services, as opposed to home and community-based services delivered by unskilled personnel. The former are covered generously, whereas coverage for the latter is strictly means-tested and is often limited to individuals considered to be at imminent risk of permanent placement in nursing homes if the services are not provided. Analyses of data from the 1994 National Long-Term Care Survey found that Medicare home health services are used disproportionately by the chronically disabled elderly.

An international opinion poll across five English-speaking countries (Donelan et al., 2000) found that significantly greater percentages of U.S. and New Zealand elders who used home care reported that the government paid for it. Numerous other surveys of older Americans conducted during the 1990s indicate that Americans are greatly confused about the extent to which Medicare's home health and skilled nursing facility benefits provide them with coverage for long-term care.