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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

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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 19th 2013


Outline
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
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
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
Model projection methodology

Pure population scenario omits second step




Demographics republic
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
Demographic change

Source: Morgenroth (2009)


But with less disability
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 2006
Disability, RoI 2002-2006

Source: Census 2002 and 2006


Utilisation patterns republic
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 projections roi ni
Utilisation projections, RoI & NI

NB: Definitions of categories differ in RoI and NI



How well does model perform republic
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
Ageing North & South

Increase in numbers of people aged 65 and over


Residential ltc north south
Residential LTC North & South

Percentage of people aged 65 & over in residential long-term care


Home care north south
Home care North & South

Percentage of people aged 65 & over receiving formal home care


Unmetneed, North and South

South

ADL difficulty and no help

North

‘No help’ pie slice on same basis, for other pie slices definitions differ & North-South not comparable.


Policy questions
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?


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