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P. Willemé and J. GeertsFederal Planning Bureau

Projecting future needs, use and supply of LTC in Europe

iHEA, Toronto, 10 – 13 July 2011

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• 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

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• 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

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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

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• 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

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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

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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)

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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)

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• 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

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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

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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

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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

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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

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Formal care use by age groups (NL, DELAY, 2010-2060)

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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

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Home care use by household composition

0

100000

200000

300000

400000

500000

600000

700000

Alone Together Alone Together

2010 2060

HF+I HFC HIC

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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+

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• 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)

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• 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)

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• 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 ...