plan.be
P. Willemé and J. GeertsFederal Planning Bureau
Projecting future needs, use and supply of LTC in Europe
iHEA, Toronto, 10 – 13 July 2011
plan.be
• Simulating future number of formal and informal care users, informal and formal carers between 2010 and 2060
• For countries representative of different types of LTC systems in Europe
• Under different disability scenarios
• Using cross-nationally harmonized data
ANCIEN WP 6: Objectives
plan.be
• Care needs model: disability by age and gender (NIDI)
• Use of care models:-Institutionalisation model (home / residential care)-Home care model (No care, formal care, informal care, both)
• Supply of informal care model (London School of Economics and Political Science, LSE)-Probability of being informal caregiver
• Formal care labour supply
Components of the projection model
plan.be
2-stage model of care useProjected numbers of pers. 65+ Groups by age (A), gender (G), disability (D), other (O)
Persons residing at home Residential care users
Persons using no LTC
Users of formal
personal care only
Users of informal personal care only
Users of informal and
formal personal*care
Logit model residential care use
Multinomial model home care use
plan.be
• Logit models for the Netherlands and Spain of probability of use of residential care (samples: national survey data, 2007-2008)NL: “Elderly in institutions” (OII) + “Supplementary services use research” (AVO)SP: “Encuesta de Discapacidad, Autonomia personal y situaciones de dependencia
• Dependent variables:-Age groups-Gender-ADL limitations (0, 1-2, 3+)-Dementia-Informal care availability (proxy)-Income-Number of chronic diseases
Stage 1 data and model
plan.be
Stage 2 data and model
•Dependent variable:
Help with personal care: no care, informal care only, formal care only, formal and informal care
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
DE NL ES IT
informal only
formal only
informal and formal
•Sample (Share)Pooled wave1 and 2 data Respondents 65+ and over n (weighted sample):
The Netherlands 2,134 Germany 2,491 Spain 2,265 Italy 2,587
plan.be
Independent variables, selection based on literature review and WP3 model results• Age (5 year categories, 85+), gender, household composition (alone, with others), having children• ADL limitations (based on 5 ADL items), recoded: 0 limitation, 1 limitation, 2 limitations, 3 or more limitations; •IADL limitations (based on 7 IADL items), recoded: 0 limitation, 1 limitation, 2 limitations, 3 or more limitations) •Number of chronic conditions•Cognitive functioning (orientation, numeracy, recall and verbal fluency items, recoded into 5 categories)•Education (based on ISCED97 classification) recoded into low (ISCED97 0-1), medium (ISCED 97 2-4), high (ISCED97 5-6)•Income (standardised household income deciles)
Model: Multinomial logit model, cluster robust variance estimations
Stage 2 data and model (cont’d)
plan.be
Macro-simulation model, cell-based Explanatory models of LTC use
Population projections
Projections by care type
•Estimated probabilities of care use for each cell, based on micro-level data
•For different types of LTC:
• Formal care • residential
care• home care:
nursing and personal care
• Informal care• help with
personal care
•Future numbers 65+ population
•Subdivided into groups (cells) by combinations of relevant characteristics:
•age (A)•gender (G)•disability (D)•household composition (H)•other (O)
Ptype = f(A, G, D, H, O) *
N(A, G, D, H, O) =
Ntype(A, G, D, H, O)
plan.be
• Total population by disability status (all scenarios)Breakdown by A, G, D, H, E, O
• Disabled population by care settingDemographic, BMI and SMOK scenarios
• DELAY scenario:Formal care use by age groupsHome care use by household compositionFormal home care use by age group (CBS household projection)
NL: First projection results
plan.be
Total population by disability status (all scenarios)
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
4000000
4500000
2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
BIOL - Dis
BIOL - NoDis
BMI - Dis
BMI - NoDis
CHRON - Dis
CHRON - NoDis
CONST - Dis
CONST - NoDis
DELAY - Dis
DELAY - NoDis
FAT - Dis
FAT - NoDis
LEAN - Dis
LEAN - NoDis
NoSMOK - Dis
NoSMOK - NoDis
PREV - Dis
PREV - NoDis
SMOK - Dis
SMOK - NoDis
plan.be
Disabled population by care setting: demographic scenarios
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
BIOL - Dis - Home
BIOL - Dis - Res
CHRON - Dis - Home
CHRON - Dis - Res
CONST - Dis - Home
CONST - Dis - Res
DELAY - Dis - Home
DELAY - Dis - Res
PREV - Dis - Home
PREV - Dis - Res
plan.be
Disabled population by care setting: BMI scenarios
0
100000
200000
300000
400000
500000
600000
700000
800000
2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
BMI - Dis - Home
BMI - Dis - Res
FAT - Dis - Home
FAT - Dis - Res
LEAN - Dis - Home
LEAN - Dis - Res
plan.be
Disabled population by care setting: SMOK scenarios
0
100000
200000
300000
400000
500000
600000
700000
2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
NoSMOK - Dis - Home
NoSMOK - Dis - Res
SMOK - Dis - Home
SMOK - Dis - Res
plan.be
Formal care use by age groups (NL, DELAY, 2010-2060)
plan.be
Formal care use by age groups (NL, DELAY, 2010-2060)
Home Residential Total FC Grand Total
Agecat Year HC0 HF+I HFC HIC
652010 738850 2989 13850 18777 2780 19619 777246
2060 963770 2695 19695 20924 3361 25751 1010445
Difference 224920 -294 5845 2147 581 6132 233199
702010 556599 11159 27703 16662 5594 44456 617718
2060 846950 11574 42059 21833 7278 60911 929694
Difference 290350 415 14356 5171 1684 16455 311976
752010 422187 13666 29839 15338 13011 56516 494041
2060 713694 16057 47538 22311 17254 80849 816854
Difference 291507 2391 17699 6973 4243 24333 322813
802010 270251 8948 38910 6720 24926 72783 349754
2060 564557 13603 64620 11795 43510 121734 698086
Difference 294306 4656 25710 5076 18585 48950 348332
852010 135777 4593 56935 6646 90255 151782 294206
2060 597622 19736 211150 27616 335326 566212 1191450
Difference 461844 15143 154215 20970 245072 414430 897244
All2010 2123665 41354 167237 64143 136566 345156 2532965
2060 3686593 63664 385063 104480 406729 855456 4646528
Difference 1562927 22311 217826 40336 270163 510300 2113563
plan.be
Home care use by household composition
0
100000
200000
300000
400000
500000
600000
700000
Alone Together Alone Together
2010 2060
HF+I HFC HIC
plan.be
Formal home care use by age group (CBS household projection)
0
50000
100000
150000
200000
250000
2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
Home population: Projection by care type (Scenario : DELAY)
HFC - DELAY - 65-74 HFC - DELAY - 75-84 HFC - DELAY - 85+ HFC - Ref(DELAY) - 65-74 HFC - Ref(DELAY) - 75-84 HFC - Ref(DELAY) - 85+
plan.be
• Logit models of probability of providing informal care (NL)
• Estimated separately for-Care provided by adults aged under 50 (Eurobarometer data)
-To older parents
-Care provided by persons aged 50 and over (SHARE data)-To older generation-To older partners
• Independent variables: age, gender, education, marital status
Projection of number of informal carers (LSE: Linda Pickard and Derek King)
plan.be
• These models are used as cell-based projection models
• Preliminary results for NL:-Show increase of around 7% in numbers of informal care givers between 2010 and 2060 - Show decline in numbers providing care to ‘older generation’ and increase in numbers providing care to older partners
• Apparently more informal care givers than recipients......but further calibration of model now being undertaken
• Drivers: demographics, increasing life expectancy of males, changing marital status composition
Projection of number of informal carers (cont’d)
plan.be
• Build LTC use projection models for D, SP and PL
• Build informal care projection models for D, SP and PL
• Project numbers of formal carers
• Include costs in projections
• Set up and run alternative (policy) scenarios
The road ahead ...