plan.be P. Willemé and J. Geerts Federal 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 use Projected numbers of pers. 65+ Groups by age (A), gender (G), disability (D), other (O) Persons residing at homeResidential 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, ) 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 Sample (Share) Pooled wave1 and 2 data Respondents 65+ and over n (weighted sample): The Netherlands 2,134Germany 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 ), 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 projectionsProjections 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) P type = f(A, G, D, H, O) *N(A, G, D, H, O) =N type (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 setting Demographic, BMI and SMOK scenarios DELAY scenario: Formal care use by age groups Home care use by household composition Formal home care use by age group (CBS household projection) NL: First projection results

plan.be Total population by disability status (all scenarios)

plan.be Disabled population by care setting: demographic scenarios

plan.be Disabled population by care setting: BMI scenarios

plan.be Disabled population by care setting: SMOK scenarios

plan.be Formal care use by age groups (NL, DELAY, )

plan.be Formal care use by age groups (NL, DELAY, ) HomeResidentialTotal FC Grand Total AgecatYearHC0HF+IHFCHIC Difference Difference Difference Difference Difference All Difference

plan.be Home care use by household composition

plan.be Formal home care use by age group (CBS household projection)

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 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...