Nfld. & Labrador·In Depth

The Liberals will 'explore' public long-term care insurance. So what exactly is it?

Concept is one of the "innovative approaches to long-term care" being considered for review by the Liberals, in the province with the oldest population in Canada.

Mandatory system proved popular in Japan, with premium payments resulting in bigger benefits

Liberal Leader Andrew Furey outlines his party's long-term care platform in Corner Brook on Jan. 18. (Colleen Connors/CBC)

It garnered just a fleeting mention in the early days of the Liberal election campaign — a reference to public long-term care insurance that merited one line in a press release, and one sentence in the party's platform.

The Liberals have downplayed the significance of the reference, declining interview requests initially sent 10 days ago.

A campaign official did indicate that the system in Japan is what caught their attention here.

But given the fact it is in the party's platform, CBC News decided to have a deeper look at the idea, even though it is something that may just be explored at some point in the future, with no commitment to enact it.

In Japan, the institution of public long-term care insurance marked a sweeping change to how the nation takes care of its elderly.

Meanwhile, back in Canada, another province almost launched its own version of public long-term care insurance about eight years ago, but those efforts were scuttled when an election shifted the reins of power.

Even closer to home, the care of the elderly is a particularly urgent issue in Newfoundland and Labrador.

"One in every five Newfoundlanders and Labradorians is over the age of 65, and they are the people who have worked hard their whole lives to provide for and take care of us — their families," Liberal Leader Andrew Furey said in a press release Jan. 18.

"Seniors deserve our utmost respect and attention. Our government will explore innovative approaches to long-term care, such as public long-term care insurance, to make sure all Newfoundlanders and Labradorians have the necessary support — no matter what."

Popular system in Japan 'very generous'

The program in Japan, which launched in 2000, is "very generous" compared with other European jurisdictions with similar initiatives, like Germany, according to John Creighton Campbell, an emeritus professor of political science at the University of Michigan. 

He has extensively studied social policy in Japan, and the country's long-term care insurance system.

Here are the broad strokes of how the system in Japan works.

Japan launched public long-term care insurance in 2000. The benefits begin for everyone over the age of 65. (Toru Hanai/Reuters)

First of all, there is a cost.

The program is funded half by taxes, and half by premiums paid by those aged 40 and above.

The benefits begin for everyone over the age of 65.

The process starts with a visit to an applicant's house for an assessment.

According to Campbell, about 95 per cent of applicants make it through this process, and are sorted into various categories of need.

"It's compulsory, so you have to pay the premiums," Campbell told CBC News in an interview from California, where he now lives. 

"When people become eligible for the benefits it's been very popular. They've mostly applied, and gotten the benefits."

They are provided with institutional care or home- and community-based services.

Campbell said there are an array of benefits available, from help in the home and adult day care, to the rental of wheelchairs and home repairs, to respite care.

"Taking care of older people who need it is an expensive proposition. And so to really make a big difference, the way they did in Japan and Germany, you can't get away with just a small program," Campbell said.

"If you really want to deal with the problem, you're going to have to be prepared to spend money."

Election loss saw Quebec plan abandoned

Quebec recently came close to enacting its own vision of public long-term care insurance.

Réjean Hébert was health minister in the province from 2012 to 2014, and introduced what was called "autonomy insurance."

But the Pauline Marois PQ government lost power before it came into effect, and the program was shelved.

"I almost succeeded," Hébert told CBC News in a recent interview.

"It would have taken six more months. But I think it's feasible to try to implement such a new funding mechanism." 

Hébert has continued to promote the public long term care insurance idea.

Former Quebec health minister Réjean Hébert is pictured in a 2014 file photo. (File Photo: Radio-Canada)

He is currently a professor in the school of public health of the Université de Montréal, and has worked for decades on care for the elderly with functional decline. Hébert has also been the scientific director of the Institute of Aging of the Canadian Institute of Health Research.

Last year, he wrote in Policy Options, published by Institute for Research on Public Policy, that "we must abandon the current institution-based funding model for long-term care" and governments should instead "put in place financing based on seniors' long-term care needs."

In an interview, Hébert said provinces should change the funding system for supporting home care, to allow people to stay at home as long as possible. 

"Nobody wants to go to a nursing home if it's not absolutely necessary," he said.

Hébert called that particularly important in the time of COVID-19.

"Living in institutions and living in collective housing is not as safe as living in your own home," he said.

The Quebec program would have been funded by income tax revenues, and made economic sense, he noted.

"It needs an investment, but, you know, this investment is going to be much, much lower than the cost of the status quo," Hébert said. 

Hébert said he is "very pleased" the idea has at least been raised in Newfoundland and Labrador.

He says any province considering this should look at the experience of continental Europe and in Japan — and what was being considered in Quebec.

"I think it was a very good project based on the experience of other countries," he said.

"But my message is let's do it, because it's really important for improving the services and [making] it affordable for the next generations."

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