By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.2
Make home- and community-based care an entitlement
Year 2 · UHA; state aging & disability agenciesDiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Long-term services at home stop depending on Medicaid's poverty rules and capped waivers. HCBS spending goes from $320.5B to $353.5B, home health from $169.4B to $204.5B, and nursing facilities from $219.9B to $225.7B. | ||
| Germany | Long-term care insurance (Pflegeversicherung, 1995): payroll contribution, benefits by care level, choice of cash or in-kind. | Universal LTC; cash option supports family caregivers; contribution rates have risen. | Paying family caregivers is popular; costs rise with aging. |
| Japan | Kaigo Hoken (2000): mandatory LTC insurance from age 40; services by assessed need level. | Rapid growth in home services; repeated benefit and copay adjustments. | Demand grows faster than expected (woodwork effect). |
| Canada | Provinces fund nursing homes with income-tested co-payments for room and board; home care varies. | Long waits for LTC beds in some provinces. | Room-and-board contributions keep LTC from becoming a housing program. |
Germany
- What they did
- Long-term care insurance (Pflegeversicherung, 1995): payroll contribution, benefits by care level, choice of cash or in-kind.
- What happened
- Universal LTC; cash option supports family caregivers; contribution rates have risen.
- Lesson for this plan
- Paying family caregivers is popular; costs rise with aging.
Japan
- What they did
- Kaigo Hoken (2000): mandatory LTC insurance from age 40; services by assessed need level.
- What happened
- Rapid growth in home services; repeated benefit and copay adjustments.
- Lesson for this plan
- Demand grows faster than expected (woodwork effect).
Canada
- What they did
- Provinces fund nursing homes with income-tested co-payments for room and board; home care varies.
- What happened
- Long waits for LTC beds in some provinces.
- Lesson for this plan
- Room-and-board contributions keep LTC from becoming a housing program.
More precedent
- Germany's Pflegeversicherung (1995): cash or in-kind benefits by need level; Japan's Kaigo Hoken (2000).