By NextBestFitCovering long-term care can pull unpaid family care into the paid system
If home care becomes covered, families who now provide care for free may switch to paid aides, raising costs far above today's spending (the 'woodwork effect').
Evidence
- Japan's long-term care insurance saw demand grow faster than expected after launch in 2000.
Who's affected
Who is hurt
- Taxpayers and public budgets: Replacing unpaid family care with paid aides increases public costs.
Who gains while it lasts
- Family caregivers and affected families: Covered home care relieves unpaid caregiving.
- Hospitals, clinics, and care organizations: Home-care agencies gain paid care work previously done by families.
Under your mix of paths
Paths that create or worsen it
Paths that fix or soften it
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Root causes
- Large hidden demand met today by unpaid family care
Open questions
- How should eligibility for long-term care be assessed and capped?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Universal long-term care insuranceLong-term care requires spending down to povertyChosen
Covering home and nursing care through public insurance is expensive, and demand grows.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
An independent assessor rates need levels; benefits are tiered with set hours.
- +Covering long-term care can pull unpaid family care into the paid system
- −Long-term care requires spending down to poverty
- −Adds paperwork, coordination, or complexity
Families can take a smaller cash benefit to provide care themselves.
- +Covering long-term care can pull unpaid family care into the paid system
- −Makes performance and quality hard to oversee
- −Leaves unequal burdens on family caregivers