The impact of income and The impact of income and household situation on the household situation on the

utilisation of long-term utilisation of long-term carecare

- - comparing Sweden (data from the SNAC comparing Sweden (data from the SNAC study) and Japan (Handa)study) and Japan (Handa)

Mårten Lagergren Mårten Lagergren Brussels, October 30th, 2008Brussels, October 30th, 2008

The system of long-term care of The system of long-term care of the elderly in Swedenthe elderly in Sweden

Social services are provided by the municipality Social services are provided by the municipality in ordinary or special housing. Health care in ordinary or special housing. Health care mainly provided by the country council. mainly provided by the country council. Financing by taxes.Financing by taxes.

Many elderly live alone – but with help from Many elderly live alone – but with help from their children their children

Principle of ‘Aging in place’ – support in order Principle of ‘Aging in place’ – support in order to be able to continue independent livingto be able to continue independent living

The system of long-term care of The system of long-term care of the elderly in Japanthe elderly in Japan

National Long-Term Care Insurance National Long-Term Care Insurance system financed by premiums introduced system financed by premiums introduced in 2000in 2000

Traditional emphasis on long-term care in Traditional emphasis on long-term care in hospitals – now more services in the hospitals – now more services in the community and in nursing homescommunity and in nursing homes

Many elderly persons live with their Many elderly persons live with their children -emphasis on relief supportchildren -emphasis on relief support

Long-term care activities in Long-term care activities in Sweden and JapanSweden and Japan

Care activity Japan Sweden

Home help Home help Home help

Other home activities

Home bath

Aids

Home medical care

Home health care

Activities outside home

Day care

Day rehabilitation

Day care

Day rehabilitation Short-time care Nursing home, short time

Health home, short time

Hospital care, short time

Nursing home, short time

Institutional care

Group living

Nursing home

Hospital long-term care

Special housing - around-the-clock care

Assessment of aged care Assessment of aged care needs in Swedenneeds in Sweden

Informal assessment by care managers in Informal assessment by care managers in the municipalitythe municipality

According to the law the entire life According to the law the entire life situation of the old person should be taken situation of the old person should be taken into considerationinto consideration

Detailed decision concerning type and Detailed decision concerning type and amount of services amount of services

Assessment of aged care Assessment of aged care needs in Japan needs in Japan

Very formal assessment of needs through Very formal assessment of needs through detailed questionnaire and computer detailed questionnaire and computer calculationcalculation

According to law only personal According to law only personal dependency should form basis of decision dependency should form basis of decision

Allotment of services in Allotment of services in SwedenSweden

Large differencies between municipalities Large differencies between municipalities when it comes to coverage and amount of when it comes to coverage and amount of allotted services allotted services

Very low co-payments – average 4%. High Very low co-payments – average 4%. High uptake of allotted services uptake of allotted services

Actually executed services may differ from Actually executed services may differ from decideddecided

Allotment of services in Allotment of services in JapanJapan

The assessment results in an allotted care The assessment results in an allotted care level – actual content within that level is level – actual content within that level is decided by the old person in co-operation decided by the old person in co-operation with a care managerwith a care manager

Fairly high co-payments (10%) result in Fairly high co-payments (10%) result in relatively low uptake of services in relation relatively low uptake of services in relation to the allotted care level (40%)to the allotted care level (40%)

Level of need and care time Level of need and care time

indexindex

Level of need

Care time index

Support Less than 30 min.

Level 1 Between 30 and 50 min.

Level 2

Between 50 and 70 min.

Level 3

Between 70 and 90 min.

Level 4

Between 90 and 110 min.

Level 5 More than 110 min.

Cost limits per level of need and uptake Cost limits per level of need and uptake percentagepercentage

Level of

need

Monthly

amount

(YJP)

Usage

(percent)

Support 61 500 48.9

Level 1 165 800 38.2

Level 2

194 800 44.1

Level 3

267 500 44.1

Level 4

306 000 32.9

Level 5

358 300 35.7

Data set from SwedenData set from Sweden

Data collected in the SNAC study – care Data collected in the SNAC study – care system part, Kungsholmen, 2002 -2005system part, Kungsholmen, 2002 -2005

Data include needs assessment variables Data include needs assessment variables and allotted services and allotted services

Dataset contains 2676 observations Dataset contains 2676 observations

SNACSNACSwedish National Swedish National

study on Ageing and study on Ageing and CareCare

SNACSNAC

The development of longitudinal areaThe development of longitudinal area

databases for monitoring and analysis ofdatabases for monitoring and analysis of

the system of long-term care for elderlythe system of long-term care for elderly

persons in Swedenpersons in Sweden

  

SNAC - a four-centre SNAC - a four-centre individual-based longitudinal study individual-based longitudinal study

intended tointended to describe the ageing processdescribe the ageing process from different from different

aspects aspects the development of health, the development of health, functional and cognitive ability, social and functional and cognitive ability, social and economic situation etc., and economic situation etc., and

  monitor the total consumption of health monitor the total consumption of health and social careand social care of the elderly population in of the elderly population in the area. the area.

Four different areasFour different areas      Five municipalities in Region SkåneFive municipalities in Region Skåne

(Eslöv, Hässleholm, Malmö, Osby, Ystad)(Eslöv, Hässleholm, Malmö, Osby, Ystad)

      KarlskronaKarlskrona municipality in Blekingemunicipality in Blekinge

        Kungsholmen district, StockholmKungsholmen district, Stockholm

        Municipality of NordanstigMunicipality of Nordanstig

  

All four areas follow the same design and use All four areas follow the same design and use the same core protocol the same core protocol

Basic study designBasic study design

Population perspectivePopulation perspective in order to describe the life situation of in order to describe the life situation of

the elderly and the ageing process the elderly and the ageing process

Care system perspective Care system perspective     in order to describe the functioning of the in order to describe the functioning of the

system of health and social care for the system of health and social care for the elderly in relation to their needselderly in relation to their needs

Care system perspectiveCare system perspective

Systematic, longitudinal, individual-based Systematic, longitudinal, individual-based collection of data concerning the operations of collection of data concerning the operations of the system of long-term care for the elderly the system of long-term care for the elderly 

All changes in the provision of long-term care All changes in the provision of long-term care by municipality or county council are recorded by municipality or county council are recorded

The recording includes measures of The recording includes measures of dependency/ functional ability, housing and dependency/ functional ability, housing and informal care and allotted servicesinformal care and allotted services

Data set from Japan Data set from Japan

Data collected in Handa municipality in Data collected in Handa municipality in connection to needs assessment in connection to needs assessment in National Long-Term Care Insurance National Long-Term Care Insurance

Data include need assessment variables, Data include need assessment variables, allotted level of need (0 (support) and 1 – allotted level of need (0 (support) and 1 – 5 ) and provided services5 ) and provided services

Comparability of dataComparability of data

Swedish and Japanese datasets differ Swedish and Japanese datasets differ but contain essentially comparable but contain essentially comparable information information

Sometimes combinations of variables Sometimes combinations of variables or calibration is needed in order to or calibration is needed in order to achieve comparabilityachieve comparability

Average age among recipients of Average age among recipients of care, per gender and totalcare, per gender and total

Handa SNAC-K

Men 80.1 82.9

Women 82.9 86.7

Total 82.1 85.8

Distribution on type of Distribution on type of household – urban Sweden household – urban Sweden

(Kungsholmen)(Kungsholmen)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65 - 74 75 - 84 85+ 65 - 74 75 - 84 85+

Men Women

Co-habitating

Single-living

Distribution on type of Distribution on type of household – rural Sweden household – rural Sweden

(Nordanstig)(Nordanstig)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65 - 74 75 - 84 85+ 65 - 74 75 - 84 85+

Men Women

Co-habitating

Single-living

Distribution on type of Distribution on type of household – recipients of LTC household – recipients of LTC urban Sweden urban Sweden (Kungsholmen)(Kungsholmen)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65 - 74 75 - 84 85+ 65 - 74 75 - 84 85+

Men Women

Co-habitating

Single-living

Distribution on type of Distribution on type of household – recipients of LTC, household – recipients of LTC,

rural Sweden rural Sweden (Nordanstig)(Nordanstig)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65 - 74 75 - 84 85+ 65 - 74 75 - 84 85+

Men Women

Co-habitating

Single-living

Recipients of LTC care – SwedenRecipients of LTC care – Sweden Distribution on income-groups per Distribution on income-groups per

age-group and genderage-group and gender

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65-74 75-84 85+ 65-74 75-84 85+

Men Women

15000- SEK

10000-14999 SEK

7500 - 9999 SEK

5000 - 7499 SEK

< 5000 SEK

Proportion with LTC services Proportion with LTC services - single person households, - single person households,

Sweden (Kungsholmen)Sweden (Kungsholmen)

0

10

20

30

40

50

60

70

80

65-74 75-84 85+ 65-74 75-84 85+

Men Women

In special housing

In the community

0

10

20

30

40

50

60

70

80

65-74 75-84 85+ 65-74 75-84 85+

Men Women

In special housing

In the community

Proportion with LTC services Proportion with LTC services - co-habitating - co-habitating

Sweden (Kungsholmen)Sweden (Kungsholmen)

Average dependency (SNAC-Average dependency (SNAC-index) per income-groupindex) per income-group

- recipients of LTC, Kungsholmen- recipients of LTC, Kungsholmen

0,0

2,0

4,0

6,0

8,0

10,0

12,0

< 5000SEK

5000 - 7499SEK

7500 - 9999SEK

10000-14999SEK

15000-SEK

Men

Women

Average weekly hours of home help for Average weekly hours of home help for recipients of LTC in the communityrecipients of LTC in the community

per income groupper income group

Sweden, KungsholmenSweden, Kungsholmen

0

2

4

6

8

10

12

14

< 5000SEK

5000 - 7499SEK

7500 - 9999SEK

10000-14999SEK

15000-SEK

Men

Women

Prop. of recipients of LTC in special Prop. of recipients of LTC in special

accomodations per income groupaccomodations per income group Sweden, Kungsholmen Sweden, Kungsholmen

0

5

10

15

20

25

30

35

40

45

50

< 5000SEK

5000 - 7499SEK

7500 - 9999SEK

10000-14999SEK

15000-SEK

Men

Women

Distribution on type of Distribution on type of household for recipients of LTC household for recipients of LTC

– Japan (Handa)– Japan (Handa)

0%

20%

40%

60%

80%

100%

65-74 75-84 85+ 65-74 75-84 85+

Men Women

Co-habitating other

Co-habitating 3 - generations

Co-habitating 2 -generations

Co-habitating with spouse

Single-living

Distribution on income-group per Distribution on income-group per age-group and gender, Japan age-group and gender, Japan

(Handa)(Handa)

0%

10%

20%

30%

40%

50%

60%

65-74 75-84 85+ 65-74 75-84 85+

Men Women

Income group 1

Income group 2

Income group 3

Income group 4

Income group 5

Distribution on income-groups per Distribution on income-groups per

type of household, Japan (Handa)type of household, Japan (Handa)

0%

10%

20%

30%

40%

50%

60%

70%

80%

Single-living Co-habitatingw ith spouse

Co-habitating, 2-generations

Co-habitating, 3-generations

Co-habitating,

other

Income group 1

Income group 2

Income group 3

Income group 4

Income group 5

Distribution on allotted level of Distribution on allotted level of need per type of household, Japan need per type of household, Japan

(Handa)(Handa)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Single-living Co-habitatingw ith spouse

Co-habitating, 2 -generations

Co-habitating, 3 -generations

Co-habitating,other

Support

Care level 1

Care level 2

Care level 3

Care level 4

Care level 5

Distribution on level of need per Distribution on level of need per income-group, Japan (Handa)income-group, Japan (Handa)

0%

5%

10%

15%

20%

25%

30%

35%

Income group 1 Income group 2 Income group 3 Income group 4 Income group 5

Support

Care level 1

Care level 2

Care level 3

Care level 4

Care level 5

Uptake rate per age-group and Uptake rate per age-group and

gender, Japan (Handa)gender, Japan (Handa)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

65-74 75-84 85+ 65-74 75-84 85+

Men Women

0 - 25%

25 - 50%

50 - 75%

75 - 100%

>100%

Average up-take rate per age-Average up-take rate per age-group and gender, Japan (Handa)group and gender, Japan (Handa)

0%

10%

20%

30%

40%

50%

60%

65-74 75-84 85+ 65-74 75-84 85+

Men Women

Mean value

Uptake rate per level of Uptake rate per level of dependency (PADL-groups), Japan dependency (PADL-groups), Japan

(Handa)(Handa)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

No or slightdependency

Moderatedependency

Dependent Verydependent

Totaldependency

Total

0 - 25%

25 - 50%

50 -75%

75 - 100%

>100%

Average uptake rate per level of Average uptake rate per level of dependency (PADL-groups), Japan dependency (PADL-groups), Japan

(Handa)(Handa)

0%

10%

20%

30%

40%

50%

60%

70%

No or slightdependency

Moderatedependency

Dependent Verydependent

Totaldependency

Total

Mean value

Uptake rate per level of need, Uptake rate per level of need, Japan (Handa)Japan (Handa)

0%

5%

10%

15%

20%

25%

30%

35%

40%

Support Care level 1 Care level 2 Care level 3 Care level 4 Care level 5

0 - 25%

25 - 50%

50 -75%

75 - 100%

>100%

Average uptake rate per level of Average uptake rate per level of need Japan (Handa)need Japan (Handa)

0%

10%

20%

30%

40%

50%

60%

70%

Support Care level 1 Care level 2 Care level 3 Care level 4 Care level 5

Mean value

Uptake rate per income group, Uptake rate per income group, Japan (Handa)Japan (Handa)

0%

5%

10%

15%

20%

25%

30%

35%

Income group 1 Income group 2 Income group 3 Income group 4 Income group 5

0 - 25%

25 - 50%

50 - 75%

75 - 100%

>100%

Average uptake rate per income Average uptake rate per income group Japan (Handa)group Japan (Handa)

0%

10%

20%

30%

40%

50%

60%

70%

80%

Income group 1 Income group 2 Income group 3 Income group 4 Income group 5

Mean value

Uptake rate per type of household, Uptake rate per type of household, Japan (Handa)Japan (Handa)

0%

5%

10%

15%

20%

25%

30%

35%

Single-living Co-habitatingw ith spouse

Co-habitating,2-generations

Co-habitating,3-generations

Co-habitating,other

0 - 25%

25 - 50%

50 - 75%

75 - 100%

>100%

Average uptake rate per type of Average uptake rate per type of household, Japan (Handa)household, Japan (Handa)

0%

10%

20%

30%

40%

50%

60%

70%

80%

Single-living Co-habitatingw ith spouse

Co-habitating, 2-generations

Co-habitating, 3-generations

Co-habitating,other

Mean value

Main conclusions Main conclusions

Income does not seem to affect the provision of Income does not seem to affect the provision of care in Sweden, but type of household makes a big care in Sweden, but type of household makes a big difference when it comes to receiving servicesdifference when it comes to receiving services

Some differences between income groups in Some differences between income groups in Sweden conc. type of LTC services Sweden conc. type of LTC services

In Japan allotted level of need in Japan is generally In Japan allotted level of need in Japan is generally lower for single-living than co-habitating persons lower for single-living than co-habitating persons reflecting differences in possibility to copereflecting differences in possibility to cope

Income and type of household affect uptake rate in Income and type of household affect uptake rate in Japan reflecting higher co-paymentsJapan reflecting higher co-payments

That´s all folks! That´s all folks!

Thanks for your attentionThanks for your attention