Abstract

Objectives: In a time of permanent austerity, long term care policies in Western Europe have tried to cope with growing demand for care through significant processes of institutional change and innovation. In this process, a significant trade-off has emerged between extension of coverage and adequate generosity of benefits. National governments have to find new balances between quantity and intensity of LTC benefits in order to save costs on the one hand, and meet the increasing need for care on the other. While path-breaking reforms are quite rare, a number of technical criteria and procedures related to eligibility and generosity have been introduced and re-adapted to tackle this complex issue. Interestingly, while research on LTC policies has extensively studied the institutional changes and reforms introduced in Western European countries in the last decades, a few research has so far considered how these apparently only “technical” criteria and procedures - such as eligibility criteria, need assessment procedures, and criteria for the distribution of benefits - have been established and modified in different national contexts.

This paper starts to fill this gap by focusing on the need assessment criteria used in cash-for-care LTC programs aimed at defining the eligibility and the amount of benefits given to users according to their different levels of disability. We will investigate how aspects such as the level of physical and/or mental dependency, income, family composition, or age, are differently combined together to define the extension of such programs and the allocation of benefits according to different degrees of need for care.

The analysis will compare six European countries (Austria, Germany, France, UK, Italy, Spain) which are paradigmatic examples of different care regimes as well as characterized by different configurations and relevance of cash-for-care programs.
Methods: The paper is based on an analysis of secondary data regarding cash-for-care programs in the mentioned European countries. Firstly, the study will focus on the combination of degrees of generosity (in terms of different amounts of benefits) and coverage (in terms of population receiving benefits for each benefit levels) of LTC programs for the six countries considered. Trends and over time changes will be only a potential point of discussion. Then, institutional information and technical details about eligibility rules and need assessment procedures will be provided and discussed. The focus will be on the following aspects: the different and multiple criteria used for need assessment (e.g. mobility, ADL, cognitive aspects and physical care); the levels of disability required in order to be entitled to benefits; how the different assessment criteria are mainly weighted and to what extent they count for the differential definition of the amount of benefits.

Results and conclusions: As results, the paper aims to describe how the different degree of coverage and generosity of cash-for-care programs is crucially shaped by eligibility criteria and needs assessment procedures. This analysis is also relevant for identifying more clearly the different types of “ideas” and operational definition of need for care that stand behind the functioning of these programs in a comparative perspective.