Long-Term Care Is the Responsibility of the State, Society or Family (a View from the East and West)

The rapidly changing demographic and social situation, the aging of the population and the associated growing number of citizens in real need of long-term care, who remain outside the area of social support, poses new challenges to the state. The model of state provision for only poorest and most vulnerable and reliance on the local community as the organizer of social sphere and the family for the rest does not fully meet the new challenges. The article is devoted to the modern understanding of the aging process and the definition of long-term care as a new social risk; the analysis of various approaches to the formation of support system for people with disabilities in self-care on the example of a number of key states with high rates of aging and an average level of development, in which the supply of informal care is declining and the infrastructure of formal care is only being formed. Extended and multi-channel modern care system belongs to the category of expensive services, the cost of which usually significantly exceeds the median income of pensioners in the case of an average and especially high level of dependence. Additional constraints in the middle- developed countries include a relatively low level of accessibility of medical services, including a high proportion of patients’ personal expenses in the total health costs. The practice of the countries under consideration shows that the tasks for forming modern institutions, that could ensure increased in the effectiveness of public spending on material and social support for the elderly are being solved by creating a mixt care economy using budget funds insurance schemes and public funds, attracting government, non-profit and commercial agencies operating in this area. The forms and volume of the state support are determined by the size of the population groups under care.