has a long history of working with trauma. Long-term care (LTC) is a key policy priority for governments internationally. Most countries are faced with demographic and/or socioeconomic changes that are resulting in a significant growth in the need for LTC services. The impact of this higher demand on LTC systems is compounded by long-run increases in service unit costs and by reductions in the availability of unpaid care, which still provides the lion's share of the support for people with LTC needs. In addition, the rising political voice of key LTC consumer groups and the mounting pressure on public service budgets mean that LTC is likely to remain at the forefront of the political agenda across OECD nations for the foreseeable future.

Since the 1990s, LTC policies have undergone significant transformations across many countries. In some instances, these changes have been the outcome of major explicit policy goals. In others, new systems have come about through the accumulation of incremental changes. As a result, LTC policy reforms in the last decades across OECD countries offer a rich body of experience that should inform the design of future strategies for improving equity and efficiency in LTC. The main purpose of this book is precisely that: to analyse the range of solutions adopted internationally about how to organise, regulate and fund LTC services in the face of the growing needs of our ageing societies.

Scope of the book

It is important to clarify the boundaries of the analysis in this book given the national variability in the range of services and care needs associated with the LTC system. In this book, we adopt a definition used recently by the OECD, namely, ‘care for people needing support in many facets of living over a prolonged period of time … typically … help with so-called activities of daily living (ADL), such as bathing, dressing, and getting in and out of bed, which are often performed by family, friends and lower-skilled caregivers or nurses’ (Colombo et al, 2011, p 39). Whereas many LTC-related policies are introduced without reference to the dependent person's age, there are important differences in the need-related characteristics of care recipients in different age groups, for instance, in terms of their income and wealth, employment status, informal support and health profiles.