Abstract

Background: At any time only a small proportion of the population is in need of long-term care (LTC). In order to understand the relevance of this condition, however, it is necessary to account for the probability to become in need of LTC in the course of the lifetime.

Objective: The aim of this study is to measure lifetime prevalence for dependency on (i) long term care and (ii) long-term care in a nursing home.

Data and methods: The study is based on claims data from 57,911 insurant of a German long-term care insurance fund (Gmünder Ersatzkasse) who deceased in 2000-2009. For them the proportions of insurants of all ages who (i) have received any of 3 nationally defined levels of long-term care (LoC) and (ii) have been resident of a nursing home at some point in life are calculated. Data are sex- and age-standardized with respect to the German population by either (i) those deceased in 2000 (to adjust for age effects; “Standard 2000”) or (ii) those who deceased in the respective year (“Standard 2000-2009”) to allow for increasing age at death during 2000-2009.

Results: The proportion of men having received benefits during lifetime from LTC rose from 39.9% (decedents in 2000) to 46.9% in 2009 (+17.5%; “Standard 2000”). In women, this proportion rose from 64.1% in 2000 to 69.6% (+8.5%) in 2009. Standardizing rates by the respective calendar year (“Standard 2000–2009”), proportions rose more steeply (to 49.6 % in 2009 for men (+24.1%) and to 71.1.6% in women (+10.8%). The proportions of ever having been a nursing home resident increased in men from 13.2% (95%-Confidence Interval [CI]: 11.7% to 14.7%) in 2000 to 16.2% (+22.8%) and from 32.3% (CI: 28.9%-35.6%) in 2000 to 35.1% in women (“Standard 2000”) in women (+8.9%). Standardizing rates by the respective calendar year (2000-2009), the proportion of the population having ever resided in a nursing home rose more steeply (to 17.5% in 2009 for men (+32.5 %) and to 36.8% in women (+14.2%).

Conclusions: Almost half of men and more than two thirds of women deceased in 2009 had been dependent on LTC at some point in time of their lives. One in six men and one in 3 women even spent some period of life in a nursing home. Ageing of the German population during 2000-2009 accounted only for a small fraction of the observed increase in LTC and nursing home use.