<P> In Germany, funding for long - term care is covered through a mandatory insurance scheme (or Pflegeversicherung), with contributions divided equally between the insured and their employers . The scheme covers the care needs of people who as a consequence of illness or disability are unable to live independently for a period of at least six months . Most beneficiaries stay at home (69%). The country's LTC fund may also make pension contributions if an informal caregiver works more than 14 hours per week . </P> <P> In Canada, facility - based long - term care is not publicly insured under the Canada Health Act in the same way as hospital and physician services . Funding for LTC facilities is governed by the provinces and territories, which varies across the country in terms of the range of services offered and the cost coverage . In Canada, from April 1, 2013 to March 31, 2014, there were 1,519 long - term care facilities housing 149,488 residents . </P> <P> Long - term care is typically funded using a combination of sources including but not limited to family members, Medicaid, long - term care insurance and Medicare . One of these includes out - of - pocket spending, which often becomes exhausted once an individual requires more medical attention throughout the aging process and might need in - home care or be admitted into a nursing home . For many people, out - of - pocket spending for long - term care is a transitional state before eventually needing Medicaid coverage . Personal savings can be difficult to manage and budget and often deplete rapidly . In addition to personal savings, individuals can also rely on an Individual retirement account, Roth IRA, Pension, Severance package or the funds of family members . These are essentially retirement packages that become available to the individual once certain requirements have been met . </P> <P> In 2008, Medicaid and Medicare accounted for approximately 71% of national long - term care spending in the United States . Out - of - pocket spending accounted for 18% of national long - term care spending, private long - term care insurance accounted for 7%, and other organizations and agencies accounted for the remaining expenses . Moreover, 67% of all nursing home residents used Medicaid as their primary source of payment . </P>

Who uses long-term care services and why do they use them