Austria

In the period 2019-2050 the share of 65+ people in the Austrian population is expected to grow from 18.8% to 27.2% (compared to 20% to 28.5% for the EU-28). Over the same period, the share of 85+ is expected to more than double, from 2.5% to 5.8% (EU-28: 2.7% to 6.1%) while the old-age dependency ratio measured as the percentage of 65+ compared to the 15-64-year-old population will rise from 27.9% (EU-28: 30.5%) to 55.1% (EU-28: 55.3%).

Life expectancy for men and women at age 65 is projected to rise from 18.5/21.5 years (EU-28: 18.1/21.4) in 2017 to 22.4/25.6 years (EU-28: 22.4/25.6) in 2060. While life expectancy in Austria is higher than the EU-average, the healthy life expectancy at the age 65 is currently lower (AT: 7.5 years, EU-28: 10.2 years in 2017). This emphasises deficits in health promotion, prevention and rehabilitation, which unless corrected may lead to a higher burden and financial costs within the area of long-term care.

Under an assumption of no policy change the Ageing Report scenario suggests that public expenditure as share of GDP would almost double (1.6% to 3.0% compared to 1.8% to 3.6% for the EU-27). The impact of a progressive shift from the informal to the formal sector of care in Austria by 2070 would involve a projected increase in the share of GDP devoted to public expenditure on long-term care by 157% (128% on average for the EU27).

The Austrian system of long-term care is based on both cash benefits and publicly-organised (in-kind) long-term care services.

The cash benefit is called long-term care allowance (Pflegegeld). As of 2012, long-term care benefits have fallen under the sole competency of the federal level of power. Pflegegeld is granted without means testing (against income or assets) and according to seven different levels, corresponding to a categorisation of the health status of the person in need of care and the care needs. About 470,000 Austrians (5.3% of the population) are entitled to the LTC allowance that currently (as of 1 January 2021) amounts to €162,50 per month in level 1 (the lowest level, with about 131,000 beneficiaries) and reaches €1.745,10 in level 7 (about 10,000 beneficiaries). This cash benefit is intended to cater for ‘additional care-related expenses’ and buy formal care services from public or private providers or reimburse informal caregiving. In addition, the benefit aims to guarantee, an autonomous and need-oriented life for the care recipient, in accordance to the Convention on the rights of persons with disabilities. However, no control is exercised over the actual use of this long-term care allowance by the recipients, i.e. the people in need of care (and not informal carers).

As mentioned above, the long-term care allowance (Pflegegeld) is granted as a universal benefit according to a respective needs assessment. It is therefore up to the beneficiaries to choose how to use the money. For instance, they may access LTC services (home care or residential care), for which they will be charged an income-related out-of-pocket contribution. Means testing indeed applies and takes into account all kinds of personal income (including LTC cash benefits), but there is no recourse neither to own nor to family members’ assets. If services cannot be financed via personal income the regional governments cover the remaining costs of LTC services through their social assistance budgets and some mixed funding mechanisms comprising federal and regional resources (see below).

Municipalities increasingly seek to move away from traditional intramural institutional LTC to offer places in institutions of “alternative dwelling”, with the ambition of promoting more independent living for as long as possible. Beyond adapted housing policies to promote independent living, various rehabilitation and preventive measures are also put in place.

The quality of LTC at home and in institutions have been on the policy agenda for a long while. Over the past decade, several measures have been agreed and implemented to improve quality in both settings. Access is also a challenging question. The noticeably large variation in the coverage rates of in-kind LTC benefits and services seems to indicate that substantial deficits may exist in a number of federal provinces, but more evidence-based and comprehensive evaluations are required.

Long-term care cash benefits are financed through the general budget of the federal state. The public financing of in-kind long-term care benefits derives from the budgets of the federal provinces and municipalities, the tax balancing scheme (Finanzlastenausgleich), the so-called Long-term Care Funds (Pflegefond, 2/3 of which is financed by the federal state and 1/3 by the federal provinces), as well as the budget of the federal state. This means that public spending on long-term care (in its narrow sense, i.e. excluding the care provided by the health system) is entirely tax-financed in Austria.

Number of carers

According to SHARE/OECD data, the estimated number of informal carers in Austria amounts to more than 800.000 people (about 10% of the total population).

Identification of carers and assessment of their needs

The home visit programme, through which certified healthcare and nursing professionals visit the homes of recipients of long-term care benefits to inform and advise all those involved in the specific care situation, can reveal a great tool to identify and collect data about carers.

In 2016, about 73% of all main informal carers visited via the ‘home visit programme’ were women. In the working-age group (16-65), the share of female informal carers was even higher (about 78%), clearly indicating a very strong gender-specific imbalance in the provision of informal care in that age strand. Overall, around 59% of informal carers are aged under 65, with a minority of them being under the age of 46 (around 9% of female and 7% of male carers).

Access to respite care

If an informal carer, involved in the provision of care for at least a year, is unable to keep providing care as a result of illness, holidays or other important reasons, financial support can be provided (through the support fund for people with disabilities) in accordance with the Federal Long-Term Care Act in order to cover the costs arising from the need for substitute care by a professional.

Social inclusion of carers, access to education and employment

Overall, it is clear that informal care remains the main form of care provision in Austria, with an estimated 7% of those 50 and over providing informal care (Riedel & Kraus 2011), the majority of them women, and this, despite substantial expansion of institutional care services in the last two decades. Besides, the large variation in coverage rates of formal in-kind long-term care benefits and services suggests that substantial deficits in accessibility in a number of federal provinces, may be one of the drivers of the prevalence of informal care in the country. More comprehensive research on this would prove extremely valuable given the current lack of data-based evidence regarding the challenges faced by informal carers when trying to – or having to – combine professional and caregiving responsibilities.

However, the data collected through the Labour Force Survey (LFS) provides some useful insight into the issue. As mentioned above, many informal carers are in the 40-65 age bracket. Within this age group, 17.7% (men: 2.9%; women: 27%) of the unemployment population seeking employment report that their status is primarily caused by ‘family/caring responsibilities’ (data for 2016). Another 5.6% (women: 8.5%; men: N/A) report ‘looking after children or incapacitated adults’ as the main reason. These figures, while intriguing, have to be interpreted with caution, since they do not specifically address long-term care activities but may also cover other ‘family responsibilities’, etc.

As mentioned above, one of the main purposes of the Austrian LTC allowance is to support informal care and family carers. There has been a growing recognition of the role of informal carers, who are entitled to a number of benefits such as free health insurance and pension contributions (if they have not yet reached pension age and care for a person in care levels 3 to 7). Working-age informal carers who provide care to relatives already had the option to pay health and pension insurance voluntarily. Since August 2009, however, old-age pension contributions are paid by the federal Government and not by informal carers themselves. Other benefits available to informal carers include the extra allowance to pay for respite care.

Recognition and definition of carers

Based on the data collected by the Federal Ministry of Labour, Social Affairs and Consumer Protection, in 2016, 74% of all of persons receiving long-term care cash benefits were in home-based informal care provided by relatives or friends at home, and did not receive formal care services. In 2016, 32% were looked after by relatives or friends at home and at the same time benefited from formal outpatient (mobile) LTC services. Around 21% of persons receiving LTC cash benefits lived either in nursing homes or received inpatient care. About 5% of all cases LTC services were primarily performed by privately-hired carers at home (“24-hour care at home”), who are mainly female migrants from new EU Member States.

Over the past decade, an increasing number of measures have nevertheless been introduced to support informal carers. These include the 24-hour home care support; Social insurance for caregiving relatives, including pension and health insurance; Substitutionary care and a Paid Care-Leave.

Access to information and advice

The federal ministry for labour, social affairs and consumer protection organizes around 20.000 home visits per year to monitor the quality of informal long-term care. These visits are made by care professional (“qualified nurses”) who can take the opportunity to advice the informal carer and check the living situation of the person in need of care, including the effective use of the cash benefit to provide care.

Some additional scattered consulting and communication services (counselling, hotlines, online platforms, etc.) exist to support informal carers in the country.

Care leave

Since 2014, employees also have access to a paid care leave (Pflegekarenz) or part-time care leave (Pflegeteilzeit) to care for dependent relatives (not only older dependent people). The leave can be taken for up to three months, the amount of the compensation is income-related and at the level of unemployment benefit. Yet, take-up remains low, most likely because these two schemes are not supported by a legal entitlement vis-à-vis the employer – indeed, the jobholder and the employer have to reach an agreement, which can be difficult.

No evaluation of the cost-effectiveness of these measures is currently available, even though they seem to improve the possibility for informal carers to reduce the risks of unemployment (in the case of care leave) and burnout (in the case of the allowance for respite care).

• The 2018 Ageing Report, Economic and Budgetary Projections for the EU Member States (2016-2070), EC, 2018
• ESPN Thematic Report on Challenges in long-term care – Austria, EC, 2018
• CEQUA Country Report – A decade of piecemeal changes in Austria, R. Rodrigues et al., 2017
• ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Austria, 2016
• Joint Report on Health Care and Long-Term Care Systems and Fiscal Sustainability, EC, 2016
• Peer Review on financing of long-term care, Slovenia – Comments paper – Austria 2014
• Adequate social protection for long-term care needs in an ageing society, European Commission, 2014
• Nagl-Cupal, M., Kolland, F., Zartler, U., Mayer, H., Bittner, M., Koller, M., Parisot, V., Stöhr, D., Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz (Hg.) (2018) Angehörigenpflege in Österreich. Einsicht in die Situation pflegender Angehöriger und in die Entwicklung informeller Pflegenetzwerke. Universität Wien.