Longterm Care in Denmark vs the United States

Stephanie’s father-in-law, a Danish citizen, is currently moving into assisted living just outside of Copenhagen. His flat is only $1,000 per month, and the home help and rehabilitation he’ll receive is totally free of charge. We wondered about the differences between the U.S. and Denmark’s longterm care system, so we invited a special guest to join this episode: Jon Kvist, a professor at Roskilde University and expert on Danish social welfare systems. We talk about how the Danish longterm care system works and contrast it to what is covered under Medicare and Medicaid here in the United States.

Show Notes

Depending on the state, anywhere from 40% to 60% (or more) of coronavirus deaths in the United States are taking place in long-term care facilities such as nursing homes [note: Ben incorrectly said 50 to 60% on the podcast]. This is due, in part, to our terrible system of long-term care (at least as bad as our medical care system!).

Stephanie’s father-in-law is being transitioned to an assisted living facility. Fortunately, he’s Danish, where long-term care is covered as a right – just like healthcare. His only expense will be roughly $1,000 per month for rent of his new apartment.

We introduce a special guest to the program: Jon Kvist, a professor at Roskilde University, and an expert on the long-term care system in Denmark.

First things first: What is long-term care (or LTC)? “Long-term care generally refers to non-medical care (ie, custodial care) for patients who need assistance with basic daily activities such as dressing, bathing and using the bathroom. Long-term care may be provided at home or in facilities that include nursing homes and assisted living.”

Who gets access to long-term care? Here in the United States, almost no one. Medicare – our public healthcare program for seniors and some people with disabilities – incredibly does not cover long-term care! Most people have to get LTC through Medicaid – which means making yourself poor.

Professor Kvist tells us that Denmark has a universal system for long-term care. If you can demonstrate a need for long-term care, it will be covered largely for free – so it is purely needs-based. LTC in Denmark is run at the local level, so it varies somewhat by “municipality” – although the richer municipalities redistribute their funds to the poorer municipalities.

By European standards, the Danish government spends a lot on LTC – almost 3% of their total economic spending. But as Professor Kvist points out, if you don’t cover LTC publicly, a lot of care will be paid for privately OR provided informally by family members – particularly women are forced into this role.

American couples are supposed to save over $240,000 for long-term care and medical costs alone if they want to retire by age 65. How much does the average Dane have to save for retirement? “Close to $0” says Professor Kvist. When you retire in Denmark, you will be taken care of, with the understanding that you will pay into the system when you are healthy and working.

The good news for Americans? Ben is only $240,000 short of his retirement savings goals! Ben asks about Danish refugee status for Americans who can’t afford to get older in the U.S. – and Professor Kvist says that we’re welcome!

Another problematic feature of the American long-term care system is what’s called “institutional bias“: in many states, Medicaid is required to cover institutional LTC (meaning LTC at nursing homes, or assisted living facilities), but does not cover LTC provided in people’s own homes, which is cheaper, provides a better quality of life, and doesn’t create a public health nightmare during pandemics! What about in Denmark? Both institutional and home-based care are covered equally, and starting in 1987, Denmark has made a major push to de-institutionalize LTC, with the slogan that people should be allowed to stay in their own home as long as possible. In the past few years, Denmark has made a new push to focus on rehabilitation for people within their own homes, so that they will not need LTC, but can learn to care for themselves – granting them greater autonomy. As a result of de-institutionalization, Denmark is far less vulnerable to coronavirus outbreaks.

This is one factor in why Denmark has been impacted by coronavirus so much less than a state like Massachusetts, which have a similar population. As of this recording, about 560 people have died from COVID-19 in Denmark, compared to almost 6,000 deaths in Massachusetts alone.

How did the long-term care system come about in Denmark? It turns out Denmark enacted universal LTC coverage at the same time they created their universal healthcare system, after WWII. This would be similar to the Medicare for All bills in Congress here in the U.S.

We close by asking how Professor Kvist got into research on long-term care? Both of his parents became very ill and needed long-term care support when he was still too young to care for them himself, and it left an impression on him about the importance of taking care of one another as a society.

Happy Ascension Day everyone! (Apparently this is a major holiday in Denmark!)

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  1. Cheryl on May 25, 2020 at 5:37 pm

    Good info and perspective ! Looks like the Danes are way ahead of us.

  2. Leslie M Moore on May 25, 2020 at 6:01 pm

    Thanks so much for this podcast. My heart goes towards the elderly, especially those with dementia. I think I might be the only nurse to raise a flock of egg laying ducks in a locked memory care unit. It was a lot of work and even though the owner of the facility did not appreciate what I was trying to do, it was a great source of liveliness and engagement for the men and the women and the visitors. I have recently been working in adult day health. These are programs that participants come to each day. Our participants enjoy each other’s company and the program activities. This helps the caregivers, spouses and relatives. It is also great for folks who live all alone. The intention is to support people in their places so they don’t have to go into a facility, and to save the government money thereby. Our programs are currently destined to be defunded and closed down due to State Budget Hell which I understand. I hope adult day health care will be reborn when Medicare for All comes into being.

  3. Barb Ryan RN on May 26, 2020 at 5:43 pm

    This is so timely! I am a Nurse and on the Healthcare for All – Marin chapter planning team in CA. We are approaching one of our Democratic Assemblyman who is up for re-election in November. He is a middle of the road candidate at best and not fully supportive of HCA in a SINGLE PAYER system. Our strategy is to discuss the affects the Covid 19 pandemic has had on Californians and his constituents. This podcast today was helpful in pointing out some poignant arguments as to how IMPROVED HCA in a Single Payer system would help the vulnerable elderly in the US!!

  4. Ann Charland on May 27, 2020 at 1:30 pm

    Yes, we must do better in the US! Medicare for all is just the start.