YuLin Zhen, Photography Editor
While the world is aging, infrastructures to support older adults are struggling to keep pace.
A new study led by researchers at the School of Public Health compared long-term care systems across countries and exposed a troubling reality: one in five dementia patients worldwide receive no care at all.
“We found an alarming message that both developed and developing countries face common care deficits for dementia care,” said Yuting Qian GRD ’27, co-lead author of the study and doctoral candidate in health policy and management at Yale.
The researchers examined both formal care, provided by professional healthcare workers, and informal care, typically delivered by family members. The study uncovered stark variations in how nations structure their care systems, with European countries generally providing better formal support than the United States or China.
Much of the difference lies in how care is financed and delivered. In Denmark and the Netherlands, centralized systems funded by both federal and municipal governments offer comprehensive, formal support. These models have proven more effective at meeting the medical needs of their aging populations.
In contrast, the United States lacks a cohesive national approach to long-term care. Most older adults rely on a patchwork of Medicare, Medicaid and private insurance, with Medicare only covering care for a limited time after hospital discharge — typically up to 100 days.
As a result, the majority of Americans must either pay out-of-pocket, rely on family caregivers or go without necessary care. The study found approximately 86 percent of American dementia patients lack access to formal care services.
“In America, older adults have only limited coverage of long-term care through Medicare and Medicaid, while select wealthy individuals can buy commercial insurance,” said Xi Chen, senior author of the study and associate professor of public health at YSPH. “That makes the American system one of the worst among developed countries.”
The situation appears even more dire in nations like China, where formal care infrastructure for dementia patients is virtually nonexistent, with 99 percent of patients receiving no formal care services.
Socioeconomic factors play a significant role in determining who receives care. Those with fewer financial resources face greater barriers to accessing professional services, creating a cascade of challenges for both patients and their families. For caregivers from lower socioeconomic backgrounds, providing care often means sacrificing income and employment, further straining already limited resources.
“Those who are less educated tend to lack access to formal care, which is important for those with dementia as they need highly skilled services,” said Zhuoer Lin, co-lead author and assistant professor of health policy and administration at the University of Illinois at Chicago School of Public Health. “If family members have to leave work because of caregiving responsibilities without financial support, a greater burden is placed on the family as a whole.”
Addressing these gaps will require significant policy changes. For the United States, Chen advocates for Medicare expansion to cover long-term care and more inclusive eligibility for Medicaid. Federal programs should also extend beyond short-term rehabilitation to address ongoing care needs.
The research also highlighted the potential of novel technologies to help address care deficits — though implementation challenges remain, particularly around patient preferences.
“Incorporating AI or robots in facilities like nursing homes could improve the care deficits,” said Qian. “But a majority of advanced technologies have been introduced in formal care settings, while most patients prefer aging at home in community settings.”
Regardless of new technologies, care systems across countries face sustainability challenges as populations age. Some European governments have begun shifting financial responsibility to local municipalities as costs rise, potentially threatening the centralized models that have proven most effective.
The research team aims to further their study by expanding their global dataset to include more developing nations. Through this ongoing work, they hope to identify sustainable solutions that can be adapted across more diverse healthcare systems and cultural contexts.
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