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Journal of Aging and Health
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Public and Private Responsibilities

Home-and Community-Based Services in the United Kingdom and Germany

Joshua M. Wiener, PhD

Alison Evans Cuellar

The Urban Institute, Washington, DC

In the late 1980s, the United States, the United Kingdom, and Germany had roughly the same system of financing and delivering long-term care. In contrast to the United States, the United Kingdom and Germany enacted radical reform. The United Kingdom converted an open-ended, means-tested national entitlement for institutional care to a block grant to local governments, whereas Germany enacted a nationally uniform, non-means-tested social insurance program. This article analyzes the postreform experience of the United Kingdom and Germany with respect to issues of financing, assessment and case management, and the availability of home-and community-based services. Policy implications for the United States are developed.

Journal of Aging and Health, Vol. 11, No. 3, 417-444 (1999)
DOI: 10.1177/089826439901100308
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