L AZARILLO DE T ORMES ( PERDIDA )

Long term care is administrated to people who have reached a stage in life in which they are dependent on others for social, personal and medical needs.

On prior ground, long term care can be provided by three institutions: the family, the market and the State. Historically family has been the main provider. Then progressively, the State, particularly in

118 _{1) Department of Health: www.dh.gov.uk ; 2) Nolan, M. et al. (2004).} 119 _{Department of Health: www.dh.gov.uk}

Nordic countries, intervened either by expanding its health care systems or by introducing specific programs.

Recent developments focus on a new type of insurance: dependency at old age. In this framework, the carer tends to become an ordinary worker with rights and obligations (work contract).

Belgium

The Flemish Care Insurance provides compensations for non-medical costs for dependent people. When the person is living at home, compensations are provided for family care. People who live at home and are in need of serious care, after obtaining one of the special certificates can get benefits of € 90 for home care per month.

Some local authorities give extra compensations to people caring for a family member at home. The compensations are only awarded if the income of the main carer does not exceed a certain limit and amounts to € 2,47 per day, with a maximum of € 619,73 per year.

Denmark

In accordance with the Consolidation Act on Social Services, persons attached to the labour market who wish to take care of a close relative with substantially and permanently impaired physically or mental function or a serious chronic disease or other illness of long duration at home shall be engaged by the municipal authority under certain conditions. The total employment period cannot exceed 6 months. The family carer becomes official carer, thus family carer benefits do not exist in usual form. In accordance with this same legislation, persons caring for a close relative wishing to die at home will under certain conditions be eligible for a constant care allowance (1,5 times sick benefit). This is independent of the financial standing of the carer or the family.120

Germany

Germany introduced in 1995 a mandatory social insurance scheme for long term care121_{. Care facilities} include home-care and institutional services. People can choose between cash benefits, in kind benefits or a combination of both. The definition of long term care in Germany is somewhat narrower compared to others countries. However, the program continues to maintain broad popular and political support.

Concerning long-term care insurance, benefits may be taken in cash or in services. The recipient has full control over its disbursement. Recipients of payments can mix informal care and formal services, with the later being provided by a range of agencies. Cash benefits which can be forwarded to informal carers by the caree are lower than the value of professional services.

Around 580,000 of all such family carers are entitled to contributions towards their old age pension and insurance cover in the statutory accident insurance. In order to be eligible for these entitlements the carer must not draw his or her own pension, must care for his or her elder for more than 14 hours a week and cannot be in regular paid employment for more than 30 hours a week. The allowance is partly taxable. Further, respite care, short term car are also available to relieve home carers.

Times of long term care provision are considered for old age pension benefit contribution. Protection without contribution is also provided by the accident insurance. Germany’s Long-Term Care

Insurance System provides for pension credits for each week the benefit is received. Additionally, the pension credits are independent from the employment relationship. If the person is working, the credits are added to the rights generated by his wage. If the carer is working part-time, his/her pension contributions are supplemented in order to achieve the level of a representative worker122_.

The cash benefit option was intended to encourage and support informal care. The Long-Term Care Insurance has acted as an incentive to increase the capacity of care provided informally; the number of informal care-givers per care-dependent person has increased significantly.

Spain

The Carer’s Allowance is a means-tested benefit for carers with very low, or no, income, who live with someone needing full-time care and attention; the latter must be in receipt of one of a number of disability benefits. Allowance is also dependency-level tested. The monthly level of payment was 220 EUR in 2004. Autonomous government provides the allowance.

France

Beneficiaries of the personal autonomy allowance, who live at home, may purchase the services offered by specialist organizations. Beneficiaries may also choose to employ or pay one or several people in their home, in the context of a common law employment contract. It should be noted that the personal autonomy allowance cannot be used to pay for the employment of a beneficiary’s spouse, common-law husband or wife, or long-term partner.

Netherlands

In the Netherlands, persons assessed and eligible for non-institutional care, can ask for care in cash (“personal budget for care”, PGB) or care offered in kind. Under “the personal budget for care” people may obtain cash instead of services. They must use the money to buy services, but they are free to hire whomever they want. A detailed description is presented in the next part.

A study of the outcome of the Personal Budget scheme in the Netherlands found that while care quality is roughly the same as when persons needing care are referred administratively to a designated agency, persons receiving care through a personal budget feel less dependent because they have more control over when care is provided and notably by whom.”123

Austria

Austria is unique in providing a “full cash” strategy, i.e. providing an allowance that may be used to purchase formal home care services, pay informal caregivers, or for any purpose. There are no “in- kind” benefits”124_{. It is important to note that it covers psychological problems. The Austrian Long-} term Care allowance is financed from the general budget.

The Attendance Allowance is paid to dependent persons. It may be used to hire an attendant, including family members, or it may be saved. Attendance allowance is given to a person in a need of 50+ hours of care a month (assistance has to be suspected to be needed for at least six months) or who is on a wheelchair. It is paid from general taxation. There are 7 benefit levels relating to the number of hours of care needed, ranging from 145 € to 1532 € a month. Benefits are not means-tested.

122 _{The Gender Impact of Pension Reform, Department for Work and Pensions.} 123 _{Lundsgaard (2005)}

124 _{Federal Ministry for Social Security, Generations and Consumer Protection: The provision of care in Austria, Vienna}

Carers allowance is given to carers who care at least 1 year for Long term care allowance recipient (level 4+). It is not taxable. The level of payment is means-tested, and there are 4 benefit levels ranging from 117 to 183 EUR per month.

Poland

Under the Act on Family Benefits, parents of a child who needs long-term care are entitled to a family allowance and supplements to this allowance. Additionally, the child's mother, father or actual guardian is entitled to a nursing benefit due to resignation from employment or other gainful work in connection with the necessity to exercise child care, provided that the child does hold an official statement assessing disability and indicating the necessity of permanent or long-term care or assistance of a third person.

There is no allowance granted directly to the carer for the provision of long term care to dependent people.

Slovenia

A person entitled to institutional care has also the right to choose a family assistant instead. A family assistant is awarded to a disabled person who requires help with performing all of the basic human needs by the locally competent Centre for Social Work. A family assistant is paid by the local municipalities.

Finland

Home Care Allowance125 _{is paid to carers who practice care at home for persons with lowered} capacity, sickness, disability or other similar problems. Home care allowance is granted on the basis of a contract between the municipality and the carer. Attached to this contract is a care plan which specifies which services will be provided and by whom, this must be agreed by the municipality, the care recipient and the carer.

The Home Care Allowance can be granted in the form of money, services or both. The minimum care fee is Euro 224, 2 per month. The rate depends on the time and the extent of the assistance required. In some municipalities it is possible for the carers to receive a higher allowance from approximately Euro 850 up to Euro 1200 per month for giving care the persons who need the institutional care but are cared at home. The highest level is designed to be an alternative for institutional care.

The support for informal care is allocated to the carer when a close person is in need of care because of decreased functional ability, illness or handicap. The support for informal care is taxable. There is a wide network of support for informal care126_.

Carers supported by HCA are also insured for accidents and have a right to two days off a month. The impact of this policy is ambiguous as only 22.000 out of an estimated 320.000 carers receive Home care allowance (Pijl and Johannson 2003).

Sweden

125_{Association of Care Giving Relatives and Friends (Omaishoitajat ja Läheiset -Liitto ry; Närståendevårdare och}

If an older person needs more constant care and attention, a family member can be employed by the municipality as a paid kin care-giver127_{. It reflects concerns about the poor financial status of daughters} who had to stay at home to care for a parent and is used primarily by family members of working age. The salary paid to employed kin care-givers is based on the number of hours of help needed by the older person and is equivalent to the hourly rate of pay received by ‘regular’ home helps or the lowest rate paid to nursing assistants. The salary is paid by the municipality, is taxable and includes social insurance benefits, such as entitlements to sickness benefit and pension credits. Care receivers pay a home help service fee to the municipality exactly as they would if they were receiving conventional home care services.

In most municipalities, paid kin care-givers have worse terms and conditions than employed home helps and nursing assistants128; for example, they lack rights to time off and holidays, do not receive payments for unsocial working hours and have no job security. Despite this, the salary is widely appreciated by paid kin care-givers, as social recognition of their work as carers.

Despite the fact that the government has promoted financial support for carers, the number of relatives paid as care-givers has declined; by 2002, 2,021 people were paid as kin caregivers.

United Kingdom

The main form of benefit for caring is Carer’s Allowance (CA). Carer's allowance can be claimed by those who spend at least 35 hours a week caring for a person getting Attendance Allowance, or Disability Living Allowance (at the middle or highest rate for personal care), or Constant Attendance Allowance (at or above the normal maximum rate with an Industrial Injuries Disablement Benefit, or basic (full day) rate with a War Disablement Pension).

The Carer’s allowance can be paid to more than one person in a household, such as a couple caring for each other. Carers are entitled to claim Carer’s allowance if they are: aged 16 or over, earn less than 125 € a week and spending at least 35 hours a week caring for someone entitled to benefits. There are also benefits that can be claimed by carers who work, but the availability of them is means tested.