Towards the Development of a Predictive Model of Long-Term Care Demand For Northern Ireland and the...
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Transcript of Towards the Development of a Predictive Model of Long-Term Care Demand For Northern Ireland and the...
Towards the Development of a Predictive Model of Long-Term Care Demand For Northern Ireland and the Republic of Ireland
Dr Maev-Ann Wren, Economic and Social Research InstituteApril 19th 2013
Outline Definitions, method, data, systems
Population and disability
Care - utilisation and projected utilisation
Model performance
North-South comparisons
Policy questions
What is long-term care? Residential care:
Residential care homes & nursing care homesSheltered housing? Intermediate care facilities?
Hospitals for older people? Delayed discharge from acute hospitals?
Home/community care:
Home helps & personal care assistantsMeals on wheels? Day centres?
Informal care:
Spouse, partner, adult child, adult child’s partner, sibling, friend/neighbour
Methodology Population + disability -> need
2 projection scenarios:
pure population increase vs declining disability
2006 utilisation -> 2007-2021 projected utilisation
Cell-based macro-simulation – adapts PSSRU methodology
Not prediction of balance between care settings
Individual-level data required
Model projection methodology
Number of people in projection year
Disability Rate in projection year
Utilisation Rate in 2006 base year
X X =
Number of users in projection year
By single year of age and gender to 100+
By age cohort By genderBy disability definition By care type:
ResidentialFormal home careInformal home careCombinations of care
By single year of age and gender orBy age cohort
Pure population scenario omits second step
Data sourcesDemographics RoI: Census, Morgenroth
NI: NISRA, GAD
Need/disability RoI: Census, NDS
NI: NISALD, CHS
Care/nursing homes
RoI: DoH/INHO/HSE
NI: DHSSPS/BSA/RQIA
Domiciliary RoI: NDS/HSE/TILDA
NI: NISALD
Unmet RoI: NDS
NI: NISALD
Systems of careAssessment NI Care management for residential +
nursing homes + domiciliary care
RoI Residential care needs assessment only
Entitlement NI Residential: nursing care free; personal + hotel costs means-tested, family home incl.Domiciliary: means-test for home helps, free aged 75+
RoI Residential: means-tested co-payment, family home % incl. after death; Domiciliary: no legal entitlement, patchy provision, erratic co-payments; 11% people aged 75+ with ADL paid
Demographics - Republic
Aged 65+: 11% in 2006 to 15%+ in 2021 468,000 to 792,000 – nearly 70% increase
Outward migration potential carers
Rising female labour force participation
Convergence in male and female life expectancies
Late to population ageing; care infrastructure under-developed
Demographic change
0
50,000
100,000
150,000
200,000
250,000
Numbers aged 74-84 157,000 248,000
Numbers aged 85+ 48,000 106,000
2006 2021
Source: Morgenroth (2009)
But with less disability? Longer periods, deferred disability; shorter periods,
divergent trends
Studies using ADL measures show decline
Evidence of declining disability for older people in RoI & NI
Preferred scenario assumes cohort effect converges to long-run trend of declining disability
Prevalence ADL difficulty aged 65+ reduces by 7-8% RoI and NI
Rate reduces, numbers with ADL difficulty up
Disability, RoI 2002-2006Percentage at each age with reported disability
0%10%20%30%40%50%60%70%80%
70 y
ears
72 y
ears
74 y
ears
76 y
ears
78 y
ears
80 y
ears
82 y
ears
84 y
ears
86 y
ears
88 y
ears
90 ye
ars a
nd o
ver
Alldisabilities2002
Alldisabilities2006
Source: Census 2002 and 2006
Utilisation patterns, Republic Alternative estimates
Of people aged 65+ in 2006 base year:
4.4% to 4.8% in residential LTC 8.9% to 10.5% receive formal home help 8.8% have ADL difficulty and receive intense all-day
or daily informal care; 28% receive some informal care
Gender differences and unmet need
Utilisation of care in all settings - proportions
0%
5%
10%
15%
20%
25%
2006 2021
With severe disability
With ADL difficulty
In residential LTC (low)
In residential LTC (high)
Receiving home help (low)
Receiving home help (high)
All day/daily informal care
Utilisation of care in all settings - numbers
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
2006 2021
With severe disability
With ADL difficulty
In residential LTC (low)
In residential LTC (high)
Receiving home help (low)
Receiving home help (high)
All day/daily informal care
Utilisation of care in all settings – 2006 NDS
Men aged 65-74
13.2%
58.6%
3.1%
10.9%
0.0%14.2%
Women aged 65-74
11.2%
46.7%
20.9%
15.4%
5.5%
0.3%
Men aged 75 and over
36.7%
0.5%
24.9%
1.0%
25.3%
11.6%
Women aged 75 and over
26.9%2.5%
30.3%
32.3%
7.8% 0.1%
Communal establishment
Informal help only
Both informal and formal help
Formal help only
No help
Only PHN/ other
Utilisation projections, RoI & NI
Annual average increase
2006 2021
Residential
RoI 967 22,491 36,993
NI 285 9,585 13,858
Home RoI 1,866 49,179 77,164
NI 280 11,315 15,512
Informal RoI 1,565 41,018 64,500
NI 734 42,821 53,827
NB: Definitions of categories differ in RoI and NI
Who will care? Republic2006 2021
Nos give all day/daily care to cohabiting family aged 65+ with ADL difficulty
32,017 50,470
Intense cohabiting caregivers as % population aged 65+
6.8% 6.4%
Nos give all day/daily care to non-cohabiting family aged 65+ with ADL difficulty
15,717 24,681
Intense non-cohabiting caregivers as % women aged 35-54
2.8% 3.2%
Intense non-cohabiting caregivers as % women aged 35-54 not in labour force
10.8%
How well does model perform? Republic
Residential care: Projection: extra 550-756 places p.a. 2006-2011 Private nursing homes: 590 residents p.a. 2006-early 2010 Count public bed numbers changed but evidence increase to
2009 Within projection range to 2009/2010
Formal home care: Projection: extra 1,050-1,240 recipients p.a. 2006-2011; Public home help recipients: 415 p.a. 2006-Sept 2011 Home care package recipients: 957 p.a. Overlap & private unknown, close to/within projection
Unlikely to have met unmet care need, reduced public provision
Ageing North & South
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
2006-2011 2011-2016 2016-2021
RoINI
Increase in numbers of people aged 65 and over
Residential LTC North & South
Percentage of people aged 65 & over in residential long-term care
3.6%
3.8%
4.0%
4.2%
4.4%
4.6%
4.8%
2006 2021
RoI: low
RoI: high
RoI: excl ltd stay
NI: publiclyfunded care
NI: incl elderlycare hospitalbeds
0%
2%
4%
6%
8%
10%
12%
2006 2021
RoI: low HSE
RoI: high incl.privatepayment
NI: publicstatutoryprovider, ADLrecipient
Home care North & SouthPercentage of people aged 65 & over receiving formal home care
Men aged 65-74Women aged 65-74
Women aged 75-84Men aged 75-84
Men aged 85+Women aged 85+
Men aged 65-74
Women aged 65-74
Men aged 75 and over
Women aged 75 and over
Unmet need, North and South ADL
difficulty and no help
North
South
‘No help’ pie slice on same basis, for other pie slices definitions differ & North-South not comparable.
Policy questions How and where to meet need?
How to design our systems: availability, entitlement?
Does NI system of care management provide a safety net?
Does NI free home help for over-75s achieve better outcomes?
How to fund care?
Is disability the best measure of need?
How improve our modelling?