The International Social Security Review has released a new special double issue focusing on long-term care for the elderly. This complements a number of recent activities by the International Social Security Association (ISSA) to advance the long-term care agenda.
The special issue entitled “The human right to long-term care for the elderly: Extending the role of social security programmes” (Vol. 75, No. 3–4) includes a set of important articles that take a close look at the challenge of how to sustainably extend affordable and adequate access to quality medical and social care for the world’s growing elderly population.
At the heart of the special issue lie complex questions concerning the formal roles that social security systems can and should play. Currently, few countries provide social insurance coverage to elders to address the medical and social care risks associated with the contingency of long-term care (LTC). Often, tax-financed provision may be a source of support for older people in need, while private LTC provision is an option for those with the financial means.
A key challenge is that there is no international social security standard, or “benchmark”, to help guide the development and expansion of social security coverage for LTC. Consideration should thus be given to revising and extending the international social security standards, to expressly include long-term medical and social care for the elderly.
In support of such a benchmark, the human rights argument is clear.
The United Nations Universal Declaration of Human Rights of 1948, Article 22, is unequivocal: “Everyone, as a member of society, has the right to social security”. Providing continuity to this keystone assertion, the United Nations Sustainable Development Goal target 1.3 commits to progressively realize the human right to social security.
Time is of the essence. Demographic trends presented by the unprecedented scale and pace of global population ageing demand immediate coordinated policy responses. National initiatives would be aided by being foregrounded and accompanied by international political impetus for action. Indeed, the United Nations Decade of Healthy Ageing (2021–2030) provides this.
Extending the role of social security programmes
The practical pursuit of “social security for all” is guided by the international social security standards, most prominent amongst which are those of the International Labour Organization (ILO).
As a team of authors from the International Labour Office and International Social Security Association remind, to develop effective and sustainable LTC programmes there is no one-size-fits-all solution for all countries. And not to be forgotten are the important remaining coverage gaps in many countries, such as for pensions and health care. Regardless, as the international evidence from this special issue spotlights, it is possible to develop country-owned LTC solutions rooted in a rights-based approach.
To do so, countries should seek to prioritize and incorporate a number of elements. To be prioritized are solutions that offer universality of coverage, solidarity in financing, broad risk pooling, gender equality in care provision, and non-discrimination. Of necessity is strong coordination between health, social and employment policies. LTC systems must also meet the needs of those who provide care, both formally and informally. Notably, formalizing and providing social security coverage to informal carers can encourage higher levels of employment and decent work in this growing sector. Also required is a strengthening of the legal basis surrounding how services are provided and regulated.
On this basis, a core aim is to enable a continuum of care. In this manner, the realization of the right to LTC becomes possible, and does so without creating financial hardship and while supporting individual well-being.
What roles for social security administrations?
The special issue maps out a number of steps for social security policy deciders and administrators to consider.
At the national level, the sustainable and equitable financing as well as the appropriate regulation of quality LTC care are essential. Also required are responses to the labour market challenges of ensuring a professional care workforce, decent work and social protection for all carers.
As regards the mandated roles of social security administrations in delivering LTC programmes, policy deciders must consider and decide upon the relative respective roles of public, private and mutual-based provision and their regulation, of programme coordination at the national, sub-national and community levels, of the use of strategies of ageing in place and residential care, of the appropriate use of digital technologies and communication tools in programme administration and the tailored person-centric delivery of services and care, and the continuing caregiving role of the family and community, often with a heavily gendered distribution of roles.
To conclude, as the above interconnected steps, roles and design choices underline, the complexity of meeting this global LTC policy challenge should not be underestimated.
ISSA activities on long-term care
With population ageing a global phenomenon, ensuring national systems of long-term care for the elderly is increasingly important. During the 2020–2022 triennium, the ISSA has actively engaged with its member organizations to raise knowledge, share good practices and advance the long-term care agenda. Among other things, it has organized a series of webinars on long-term care, and produced both the analysis Long-term care in ageing societies: Issues and strategies, and the technical report Long-term care: Global efforts and international attention from the health perspective. The working paper Long-term care in the context of population ageing: A rights-based approach to universal coverage was recently published jointly by the ISSA and the ILO. The Technical Commission on Medical Care and Sickness Insurance – TC Health – has played a key role in these efforts, and it will continue to follow up on this agenda in the 2023–2025 triennium.
Finally, these issues were addressed at the session Adapting social security to the needs of ageing populations of the World Social Security Forum 2022.