Developing evidence for decision-making and monitoring progress

54 Long term-care protection for older persons the rights guaranteed in legislation or in international conventions and recommendations such as ILO R202. In the area of LTC, it is important to develop universal rights to LTC through inclusive legislation providing coverage and access to needed LTC services and benefits in cash. Such legislation should specify the range of services and benefits, eligibility rules, levels of benefits and others. Further, these rights should open access to complaint and appeal procedures.  Economic empowerment: Income is a key foundation of empowerment for older persons. It acts as an enabler for older persons to bring about change for themselves. Economic strengthening of older persons advances independence through the use and control of expenditure and increases the choices that can be made for example regarding the purchase of services and decisions on quality levels. Thus, adequate income should be available to all. Besides sufficient public funds to cover LTC expenditure, at ages 65+ such income often needs to be provided through old-age pension schemes or other social protection benefits in kind or in-cash as outlined in R202.  Physical empowerment through universal access to fully funded LTC services: A prerequisite for empowerment is physical and mental wellbeing. However, in many countries throughout the world such services are poorly funded. As a result, access to needed services is hampered. In addition, where financial protection from OOP is lacking, the required private expenditure acts as a barrier to access. Thus, at least essential LTC services of adequate quality need to be guaranteed. This requires sufficient public support and appropriate numbers of LTC workers, particularly in rural areas where the greatest deficits have been observed, including in social protection in health Scheil-Adlung, 2015.  Administrative empowerment: Access to LTC and health services involves the knowledge of rights, availability and quality of benefits and the understanding of administrative processes necessary to claim them. However, many older persons are not in a position to navigate the extremely complex schemes and systems. Against this background, it is recommended to improve health and LTC literacy and reduce complexity and administrative procedures. Further, it should be considered to develop the capacities and understanding of older persons with regard to rights, services and administrative procedures through providing training and information sessions. Finally, it is necessary to better match health and LTC schemes and systems, for example by using efficient models of care management and integrated care approaches. This also includes better coordination of professionals, paraprofessionals, informal family workers and institutions such as social insurance funds.  Empowerment through enabling environments and infrastructure : Empowering persons aged 65+ requires enabling environments for example concerning housing, transport, accessing services and institutional care. Thus, policies strengthening the impact of older persons in need of LTC should facilitate and financially support the development of related settings. Within institutions providing LTC, specific attention needs to be paid to reducing negative experiences of older persons, for example related to an oppressive or paternalistic Long term-care protection for older persons 55 nature of service delivery. Possible actions include raising standards of care and staffing and introducing regular monitoring.  Empowerment through evidence: Regular evaluation of the needs, coverage and access to LTC services as well as the socio-economic situation of persons aged 65+ in need of LTC should be undertaken. In this context a particular focus should be set on the cost and poverty impacts of taking up LTC services, quality aspects as well as the overall efficiency and effectiveness of schemes and systems. This will allow policy makers to take priority action where needed.  Empowerment through voice and participation: Voice and participation are instrumental for empowerment. The ability to advocate and emphasise needs and preferences through formal or informal channels is key in democracies and often a prerequisite for change. However, currently the level of involvement of older persons in decision-making processes is very low. Particularly underrepresented are persons in need of LTC living in middle and low-income countries. In these countries only very few self-help groups or NGOs are active in the area of advocacy. Against this background, it is important to significantly increase the level of representation and participation of older persons at all levels of decision and policy making. This includes for example LTC institutions, local and national governments, political parties, mass media and networks that impact on policy decisions and provide access to information. In this context it should be understood that voices of persons aged 65+ needing LTC are not necessarily homogenous and include various groups – marginalized, excluded, crowded out or in. As a result, voices of several representatives might have to be considered for adequate decision making of policy makers, service providers or others that exercise influence over LTC users.