Social Protection for Dependent Elderly People: Perspectives from a Review of OECD Countries

There is growing concern about the future provision of care for frail elderly people. Many countries have planned to reform services or the financing of care, but have found that the implementation of these plans has coincided with economic slow-down and fiscal constraints. This has heightened the difficult choices that have to be made in relation to new services for care. All OECD countries are agreed in having as a main objective that elderly people should be able to stay for as long as possible in their own homes, and that they should be able to receive good residential care close to their own community ("ageing in place"). How successful have OECD countries been in pursuit of this goal? What barriers can be identified? Are services as effective as they could be? Most policy debates have been over-shadowed by the question of how to pay for the necessary services. OECD countries currently deploy a range of financing mechanisms for relevant health and social services, involving varying levels of financial burden on the client. To what extent are current financing mechanisms a barrier to effective care? What new mechanisms are in preparation or being implemented? Will it be possible to extent services for continuing care without having to trade off some existing welfare commitments? This paper is based upon the memorandum submitted by the OECD to the 6th Conference of European Ministers responsible for social security. The conference, on the subject of Dependency and Social Security, was convened by the Council of Europe at Lisbon on 29th-31st May 1995.