European long-term care programs: lessons for community living assistance services and supports?

To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010.

Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands.

Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers.

Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence.

Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers.

Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design.