Long-term care of the elderly is accomplished quite differently outside the United States. In most of the industrialized West there is more government planning and financing, and more effort to keep people out of nursing homes.
In the third world there is less government planning and financing. Most elderly requiring assistance are cared for by family or friends.
Many industrialized nations have a more comprehensive plan for long-term care than the US does. Slightly fewer elderly are in nursing homes. Many more are in sheltered housing. Much of the cost is paid for by the government. But rising costs are a concern.
And in several Northern European nations between 14 and 16 percent of the citizens are over 65, compared with 12.1 percent in the US. In population ``they're right now where we're going to be in 2020,'' says Charlotte Nusberg, who coordinates the international activities of the American Association of Retired Persons.
Meanwhile, the situation is quite different in the third world. ``The vast majority of the elderly ... live with and are cared for by family members,'' Ms. Nusberg says. The few institutions for the aged are ``almost always for the destitute.''
As a matter of policy, she adds, when third-world nations consider the question of long-term care of the elderly, ``the emphasis almost always is on community-based services,'' if possible by the family.
Western Europe and Scandinavia generally accentuate community-based services, but with less reliance on family aid and more on government programs, such as home health care and the equivalent of America's Meals on Wheels program. Many nations assert that such programs have helped them keep nursing-home percentages below that of the US for citizens over 65.
Scandinavian countries and the Netherlands, Nusberg says, ``have put a great deal of emphasis on sheltered housing,'' where individual services are provided residents as required: It is an approach with which the US has done little.
Long-term care in and out of nursing homes receives particularly strong attention in the Netherlands. Yet resulting high costs - precisely what American conservatives worry about - are a serious concern. ``Because of the burgeoning costs,'' Nusberg says, other ``countries have hesitated to provide'' such complete long-term care benefits.