title: European long-term care programs: lessons for community living assistance services and supports?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands.
  
  
  METHODS
  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.
  
  
  METHODS
  Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design.
authors.affiliation: Department of Gerontology, Gerontology Institute, University of Massachusetts Boston, Boston, MA 02125, USA. pamela.nadash@umb.edu
authors.forename: Pamela
authors.initials: P
authors.lastname: Nadash
authors.forename: Pamela
authors.initials: P
authors.lastname: Doty
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Mahoney
authors.forename: Matthias
authors.initials: M
authors.lastname: Von Schwanenflugel
mesh_terms: D001317:Austria; D003363:Cost Control; D004739:England; D005602:France; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D057187:Independent Living / Q000191:economics / Q000592:standards; D008134:Long-Term Care / Q000458:organization & administration / Q000592:standards; D009426:Netherlands; D011787:Quality of Health Care
references.citation: Milbank Q. 2010 Sep;88(3):286-309
references.pmid: 20860573
references.citation: Gerontologist. 2011 Apr;51(2):145-55
references.pmid: 21208997