Cylus, J., Wharton, G., Carrino, L., Ilinca, S., Huber, M., Barber, S.L. (eds.) (2025) The Care Dividend: Why and How Countries Should Invest in Long-Term Care. Cambridge University Press.
The increase in demand for long-term care raises questions about the capacity of governments to provide access to needed care, how these services will be properly resourced and who should receive these benefits. This book provides a roadmap for investing in long-term care systems. It argues for increased public investment in high-quality, universally accessible long-term care and explains why these systems benefit everyone: households, health systems, economies, and societies. Bringing together a team of academics and policy experts from around the world, this book explains why and how governments can, and should, take action.
Ricardo Rodrigues, Cassandra Simmons and Kai Leichsenring have contributed a chapter on the impact of long-term care on the financial situation of families in Europe. The chapter shows that individuals and families in Europe make large contributions towards long-term care, in terms of out-of-pocket payments, depletion of savings, and time spent caregiving, and that these contributions substantially increase the risk of poverty for both care users and caregivers. Focusing on Europe, a wide cross-country variation in out-of-pocket spending for home care services can be observed. Even within a context of relatively established longterm care systems such as in Europe, one out of four care users report catastrophic payments in some settings, and the heaviest burden is concentrated among households with the lowest incomes. The contribution also highlights the financial situation of informal caregivers, many of whom are already below the poverty line before the onset of caregiving, and the long-lasting impact that caregiving can have on their incomes. Such effects are larger in countries with lower public coverage for long-term care, but they are still relevant even in countries with more generous long-term care systems. This points to the existing failures by European governments to implement effective policies to address longstanding inequities besetting long-term care systems. That this is the case even in European countries with relatively strong long-term care systems underlines a near-universal need for more investments to bridge the gap in social protection that is even wider in other countries and regions.
