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.

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Presentation transcript:

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 Institute April 19 th 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 homes Sheltered housing? Intermediate care facilities? Hospitals for older people? Delayed discharge from acute hospitals? Home/community care: Home helps & personal care assistants Meals 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 -> projected utilisation Cell-based macro-simulation – adapts PSSRU methodology Not prediction of balance between care settings Individual-level data required

Model projection methodology Pure population scenario omits second step

Data sources DemographicsRoI: Census, Morgenroth NI: NISRA, GAD Need/disabilityRoI: Census, NDS NI: NISALD, CHS Care/nursing homesRoI: DoH/INHO/HSE NI: DHSSPS/BSA/RQIA DomiciliaryRoI: NDS/HSE/TILDA NI: NISALD UnmetRoI: NDS NI: NISALD

Systems of care AssessmentNICare management for residential + nursing homes + domiciliary care RoIResidential care needs assessment only EntitlementNIResidential: nursing care free; personal + hotel costs means-tested, family home incl. Domiciliary: means-test for home helps, free aged 75+ RoIResidential: 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 ,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 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 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

Utilisation of care in all settings - numbers

Utilisation of care in all settings – 2006 NDS 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 ResidentialRoI96722,49136,993 NI2859,58513,858 HomeRoI1,86649,17977,164 NI28011,31515,512 InformalRoI1,56541,01864,500 NI73442,82153,827 NB: Definitions of categories differ in RoI and NI

Who will care? Republic Nos give all day/daily care to cohabiting family aged 65+ with ADL difficulty 32,01750,470 Intense cohabiting caregivers as % population aged %6.4% Nos give all day/daily care to non-cohabiting family aged 65+ with ADL difficulty 15,71724,681 Intense non-cohabiting caregivers as % women aged %3.2% Intense non-cohabiting caregivers as % women aged not in labour force 10.8%

How well does model perform? Republic Residential care: Projection: extra places p.a Private nursing homes: 590 residents p.a 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 ; Public home help recipients: 415 p.a 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 Increase in numbers of people aged 65 and over

Residential LTC North & South Percentage of people aged 65 & over in residential long-term care

Home care North & South Percentage of people aged 65 & over receiving formal home care

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?