European models of long-term care in the home and community.

In the 1980s, faced with a rapidly increasing elderly population and soaring costs of health and long-term care services, many European governments began to reexamine fiscal policies that often encouraged institutionalization of frail and dependent elders. A number of these countries have now turned to new models of home and community-based care. This report describes home care policies that serve the needs of frail elders in Sweden, Denmark, the Netherlands, and Great Britain, with special attention to experimental projects that have tested varying approaches for providing high quality, low-cost care in the home and in the community. The central governments in these countries have developed long-term care systems that improve quality of care, ensure more efficient delivery of services, and control or lower costs. They have (1) discouraged the building of additional nursing homes and instead supported the development and expansion of a range of housing alternatives; (2) shifted greater responsibility to local governments for delivering long-term care services, bringing those services closer to those who need them; (3) developed care management techniques that enable care providers to better target appropriate services to each elderly client; and (4) provided incentives for different types of care providers to coordinate their work, resulting in improved service delivery and greater client satisfaction.