I recently returned from a honeymoon—no gifts please!—spent in Europe.
Because I don’t know how to stop working, I made sure during my travels to ask folks about long-term care (LTC).
Although I consider myself quite familiar with the provider and funding infrastructure here in the U.S., I’ve only read a smattering of articles and studies of eldercare abroad.
From what I’ve learned, Americans are fascinated by the lure of retiring overseas. Forbes just published the 22nd Annual Global Retirement Index for 2013, where Ecuador was named the top spot for the fifth consecutive year.
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Meanwhile, life at home is comparatively miserable: According to a new study co-published by the National Research Council and Institute of Medicine (“Shorter Lives, Poorer Health”), Americans of all ages from birth to 75 die sooner and experience more illness than those in 16 other high-income countries, despite spending more on our health care.
One recent article from a national caregivers’ resource went so far as to suggest packing one’s bags and leaving the country just to avoid American nursing home care. Before renewing our passports, let’s take a closer look at how the other half lives.
The situation overseas depends, naturally, on what country you’re in. The New York Times ran a piece last year profiling the Hogeway complex, in The Netherlands.
Designed as a “humane and cost-effective” response to the burgeoning number of dementia patients, Hogeway’s innovation lies in reducing patients’ stress by surrounding them by familiar sights and sounds, and immersing them in cherished activities.
After all, said a spokeswoman, “A demented person doesn’t like to sit alone.”
Thus, Hogeway’s 240 staff members wear street clothes. Residents help with the laundry, and cooking—there’s a little supermarket on the premises. The government spotted $22 million of the $25.2 million pricetage for Hogeway, which now makes ends meet by renting out its theater, and opening its restaurant and café to the public.
According to further background on The Netherlands, the Dutch established universal long-term care insurance (LTCi) in 1968.
Today’s model consists of a pay-as-you-go system (i.e., annual revenues from taxes match claims) in which nearly every citizen over the age of 15 participates.
The average premium in 2008 was about €320 per month, which was ample for 600,000 to receive benefits. That’s 3.6 percent of the population, and the vast majority seniors.
A unique aspect of The Netherlands is that private insurance companies “manage” the LTCI program without bearing any financial risk.
Like any typical program of comprehensive “long-term services and supports” (LTSS), care is covered in the home (55 percent) or facility (45 percent), or beneficiaries can receive cash payments (75 percent of reimbursement).
A victim of its own popularity, the Dutch long-term care system has seen its costs skyrocket. The government has been forced to eliminate benefits, impose stricter needs assessments, and re-focus care on those most in need.
My travels took me to the beautiful Alsace region of France, which borders Germany.
Raising the topic of retirement with our sightseeing guide, I was told that government employees work 35 hours per week and are guaranteed 37 vacation days per year.
The minimum monthly salary is €$1,350.
The minimum retirement age used to be 60—at which point you would receive as a pension an amount equal to 60 percent of your last salary.
Ex-President Sarkozy raised the age to 62; now President Hollande has promised to lower it back down to 60.
Everyone from civil servants to farmers to private entrepreneurs is covered by the same social security system.