Abstract

Objective: Development of projections of need for and utilisation of long-term care (LTC) among people aged 65 and over in Ireland from 2006–2021.

Data and methods: A cell-based, macro-simulation model is developed using a statistical methodology which combines demographic forecasts for population aged 65 and over by year of age and gender with evidence of the evolution of disability to project future numbers of older people with levels of disability that would require formal or informal care. Base year utilisation rates of residential care; informal and formal home care; and unmet need for care are estimated by age, gender and dependency status from a range of data sources. Two projection scenarios are adopted: longterm care utilisation patterns are assumed to remain constant in relation to population by age and gender in the first scenario; and in relation to population with disability in the second preferred scenario. Available data did not support achieving the original aim of this study to develop a predictive model of LTC demand, which would have required multi-variate analysis of a comprehensive range of predictors of utilisation of care.

Results: Population ageing will drive increased need for LTC in all settings in the years to 2021, notwithstanding declining disability rates. The proportion of population aged 65 and over has been forecast to increase by 69% from 11% in 2006 to 15.4% in 2021. Based on longitudinal evidence of declining disability rates, the prevalence of disability defined as experiencing difficulty with activities of daily living (ADL) is projected to decline from 15.9% of people aged 65 and over in 2006 to 14.8% in 2021. The absolute numbers of older people with ADL difficulty is projected to rise from 74,400 in 2006 to 117,000 in 2021, a 57% increase. Assuming constant utilisation rates of alternative forms of care relative to the population with disability, this study projects that of population aged 65 and over in 2021 between 4.2% and 4.7% will utilise residential LTC; between 8.2% and 9.7% will utilise formal home care; and 8.1% will receive intense all day or daily informal home care due to their level of ADL difficulty. Over the years 2006-2021these projections translate into an annual need for: between 820-970 additional residential LTC places; and the supply of formal home care to 1,600 to 1,870 additional recipients; and assume that sufficient informal carers will be available to supply intense all-day or daily care for a further 1,570 recipients.

Policy implications: The evidence that the next decade will see steep increases in need for long-term care in Ireland, when combined with the fiscal constraints which are placing pressure on existing public service provision, are persuasive arguments for the establishment of a statutory basis for eligibility for domiciliary care and the implementation of an integrated system for care needs assessment for residential and domiciliary care to ensure better targeting of resources to meet need in the most appropriate setting.

Slides