© Ollivier Girard / CIFOR
More than half of the global population aged 65 and above, representing 300 million people, is excluded from urgently needed long-term care (LTC), says the International Labour Organization (ILO).
The new ILO study LTC protection for older persons: A review of coverage deficits in 46 countries which covers 80 per cent of the world population aged 65 and over finds extreme deficits in social protection for older persons in need of long-term care due to a lack of 13.6 million LTC workers worldwide.
In Africa, which lacks 1.5 million LTC workers, more than 90 per cent of older persons do not receive long-term care services when in need. The most important deficit in absolute numbers is observed in Asia and the Pacific where there is a shortage of 8.2 million LTC workers meaning 65 per cent of the older population is excluded from access to long-term care. Filling these gaps would result in a great number of jobs created.
Deficits in legal LTC coverage towards universal coverage based on national legislation, 2015 (total population, percentages)
Source: ILO estimates 2015, World Bank, 2015 (population data in 2013)
“We face these shortfalls despite the fact that the bulk of care – up to 80 per cent of LTC work – is provided by unpaid female family members of older persons. Their numbers exceed by far the numbers of formal LTC workers in all countries,” explains Xenia Scheil-Adlung, ILO Health Policy Coordinator and author of the study.
Closing the gap
According to the ILO expert, the situation is aggravated by a complete lack of LTC coverage in most social protection schemes. Only 5.6 per cent of the global population lives in countries that provide universal LTC coverage.
While more than 48 per cent of the world’s population is not protected by national LTC legislation, another 46.3 per cent are, to a large extent, excluded from LTC coverage due to narrow regulations that limit benefits only to the poorest. The latter forces many persons aged 65 and over to pay out of their pockets for LTC services.
Global estimates of coverage deficits in LTC: Proportion of the world’s population not protected by legislation, 2015
Source: ILO estimates 2015, OECD 2011, World Bank, 2015 (population data in 2013)
“This deplorable situation is reflected in the very low public LTC expenditure, which amounts to less than 1 per cent of GDP on average globally. The lowest public expenditure is found in Africa, where the majority of countries spend 0 per cent of GDP on LTC,” says Scheil-Adlung.
The most “generous” countries can be found in Europe but on average spend only 2 per cent or less of their GDP on LTC. As a result, the older population living in developed and developing countries has to pay up to 100 per cent of LTC out of their own pocket.
“The neglect of vital needs of older persons and the exploitation of unpaid female family members is the result of many years of underinvestment in LTC protection. Closing the gaps and providing universal LTC coverage would respect the rights and dignity of both older persons and their caregivers and create millions of jobs,” says Isabel Ortiz, Director of the ILO’s Social Protection Department.
Age and gender discrimination
The disregard of LTC needs points to age and gender discrimination – often referred to as “ageism”. This is reflected in the systematic unequal treatment of older persons needing LTC services compared to younger persons with similar health-care needs, the ignorance of older persons’ rights, the large absence of LTC workers and public underfunding.
Today’s ageism is also visible in the irrational fear expressed in the prevailing public opinion that LTC is not affordable rather than seeing the benefits of investing in LTC in terms of job creation and improved welfare of the population.
While frequently age discrimination is not considered a serious concern, it has the same social and economic impacts as other forms of discrimination and is experienced by LTC recipients in the form of impoverishment, exclusion and sometimes even abuse and violence in LTC environments.
The study suggests making LTC a top priority on the policy agendas of all countries by:
guaranteeing universal LTC protection based on the core principles of national social protection floors as outlined in ILO Recommendation 202
financing through national social insurance schemes or taxes and reducing out-of-pocket payments to a minimum;
increasing the LTC workforce to make quality services available to all in need, generating much needed jobs.