Long Term Care in USA and Germany

Long-term care is a term referring to personal assistance helping the elderly in poor health and adult living with disability to live a quality life. Additionally, it helps those living with acute or terminal illnesses be able to manage their lives with the needed relief and security (Gleckman, 2010). Personal assistance helps them when eating, bathing, cooking, and toileting. Personal assistance provides their services at home, nursing homes or group care like group homes and assisted living homes (World Health Organization, 2000).

Long Term Care in the USA

In the U.S., the greatest challenge of long-term care is its cost. Long-term care is generally expensive (Gleckman, 2010). It makes family members cater for a major proportion of long-term care and the minor by aides. As a result, the formal care per individual attending a nursing facility for skilled personnel care has to meet an averaging cost of $75000 in a year. Those requesting skilled personnel to attend them at homes pay approximately $20 per hour of service. In general, the U.S. spends $230 billion in long-term care per year (Burwell, Sredl, & Eiken, 2008)..

The U.S. citizens receive long-term care through Medicaid, which in most cases pays for forty percent, aides like private health insurance pays benefits for less than ten percent, and the individual has to pay the remaining fifty percent. Additionally, Medicaid provides long-term care for those who meet its stern assets and earnings tests (American Association of Homes and Services for the Aging, 2006).

The existing Medicaid system favors the poor by offering comprehensive covers for them. However, for the middle class, it becomes problematic. Consequently, to be eligible for its coverage, people need to impoverish themselves. For instance, in a large number of states, unmarried individuals have to “spend down” several financial assets of value $2000 to be covered, or else they must be under harsh income restrictions (Gleckman, 2010).

Although the U.S. is making limited consumer-directed care through Medicaid, it makes most of the payments through licensed providers under high regulations like home care agencies and nursing homes. In doing so, the U.S. fails to provide requirements for long-term care at home or in a community setting. This has limited benefits directed by Medicaid to home care assistance. This has led to the long waiting list at home-based care. It has also ignored the consumer preference whereby most of the elderly prefer remaining at home and receiving their care there than being taken to nursing facilities. However, this forces them to relocate to a nursing home to receive Medicaid care (American Academy of Actuaries, 2010).

Burwell et al. (2008) state that simultaneously, the rate of cost accumulation from long-term care to elderly and disabled is increasing the government expenditure on health substantially. For instance, Medicaid spends more than $100 billion, which is more than one-third of the U.S. budget on a population of elderly. This is relatively lower than the expected proportion when the 77 million baby Boomer age reaches their old age.

Lastly, the consumers may decide to buy insurance covers to hedge the need for long-term care from private insurance. However, the cost of the policies is quite high, policies are quite complex, and consumers do not want to confront disability during old age, making its prospect difficult. Furthermore, the presence of Medicaid restrains against purchasing private insurance and this has resulted in a lower number of covered individuals (Gleckman, 2010).

Germany Long Term Care

Germany has a long-term care system running separately but parallel to its health insurance policy. The whole program is a central government based with the individual state in charge of providing infrastructures for long-term care. The central government ensures the benefits from the system are uniform across the country and does not consider any variation based on regions (Gleckman, 2010).

The central government started the current mandatory universal long-term care insurance system in 1995. Initially, it received funding through a 1.7 percent payroll tax divided among employers and workers. In 2005, there was an added 0.25 percent premium to those without children since they would need much higher insurance benefits at their old age in the absence of children to provide for the informal care (Gleckman, 2010).

In 2008, the essential premiums increased by 1.95 percent with continued adding of premiums for those without children. Moreover, there was an increase of benefits indexes that remained unchanged in 2005. Annually until 2012, the government will raise premiums in other benefits like in-kind assistance and service for the disabled population. Thereafter, reviewing of policy benefits would be after three. Before 2008, the system had built strong cash balances despite its intended purpose being a pay-as-you-go system. However, it is in 2008 government noted how the ratio of benefit levels had fallen due to giving out benefits that were not inflation-indexed. Hence, it raised the contribution and benefits (Arntz, Sacchetto, Spermann, Steffes & Widmaier, 2007).

The German long-term care system covers about 70 million people. This amounts to 2.4 percent of the population with two-thirds opting to receive home-based care. However, recently, the population of those needing nursing facilities has increased and at the same time, higher-income earners are choosing to buy individual covers from private insurance other than receiving government covers under the long-term care scheme. However, the scheme covers all workers. Overall, it has increased the expenditures at institutions from 42 percent to 48 (Gleckman, 2010).

The scheme has benefits to the disabled and elderly who must need care at the time of application. Patients receive the first assessment by the regional medical board staff and from the benefits; their families may obtain services in three ways. They may decide on receiving cash, which they can decide to pay a professional caregiver, pay a family member to give care or modernize their home in a way the disabled can easily access it. Moreover, they may opt for the in-kind service and the agency receives direct payment from the insurance program to provide care. Lastly, they can choose to combine the two modes receiving benefits (Arntz et al., 2007). Other benefits from the scheme are the provision of educational materials about long-term care, training grounds to family members on how to give long-term care provides the needed equipment, and respite care (Gleckman, 2010).

According to Gleckman (2010), contrary to the U.S., Germanys public stand to benefit through the long-term care offers especially to the weak elderly community through social policies, retirement benefits, and overall health care. The insurance policy is compulsory to purchase on citizens through their payrolls in the form of tax, and some pay premiums. Later, the benefits from the insurance policy include cash to paying for services. Additionally, it gives some payments to be the income source for the eligible citizens.

In conclusion, U.S. long-term care can learn from the Germans. Germany has managed to incorporate its long-term care into existing social insurance policies. For instance, Germany has reduced the number of long-term care by testing public assistance especially for patients at home. It has also provided flexible care to families and costs little to the countries per capita. Hence, the scheme is more viable despite long-term costs appearing to trouble it (Gibson & Redfoot, 2007).


American Academy of Actuaries (2010). Letter from Alfred A. Bingham, vice president, to Speaker of the House Nancy Pelosi and U.S. Senate Majority Leader Harry Reid. Web.

American Association of Homes and Services for the Aging (2006). Financing Long-Term Care: A Framework for America. Washington, D.C.: National Press Club.

Arntz, M., Sacchetto, R., Spermann, A., Steffes, S., & Widmaier, S. (2007). The German Long-Term Care Insurance: Structure and Reform Options. Web.

Burwell, B., Sredl.K., & Eiken, S. (2008). Medicaid Long-Term Care Expenditures in FY 2007. Web.

Gibson, M., & Redffot, R. (2007). Comparing Long-Term Care in Germany and the United States: What Can We Learn from Each Other? Web.

Gleckman, H. (2010). Long-term care Financing Reform: Lessons from the U.S. and Abroad. Web.

World Health Organization (2000). Home-based Long-term Care (Report No. 898). Geneva, Switzerland: World Health Organization. Web.

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