Towards the Development of a

1. 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

3. Outline • Definitions, method, data, systems • Population and disability • Care - utilisation and projected utilisation • Model performance • North-South comparisons • Policy questions

4. 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

5. 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

6. Model projection methodology Pure population scenario omits second step

7. Data sources

8. Systems of care

9. 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

10. Demographic change Source: Morgenroth (2009)

11. 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

12. Disability, RoI 2002-2006 Source: Census 2002 and 2006

13. 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

14. Utilisation of care in all settings - proportions

15. Utilisation of care in all settings - numbers

16. Utilisation of care in all settings – 2006 NDS

17. Utilisation projections, RoI & NI NB: Definitions of categories differ in RoI and NI

18. Who will care? Republic

19. 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

20. Ageing North & South Increase in numbers of people aged 65 and over

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

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

23. 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.

24. 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?