1. Towards the Development of a Predictive Model of Long-Term Care Demand For Northern Ireland and the Republic of Ireland Dr Maev-Ann Wren, Economic and Social Research Institute April 19 th 2013

3. Outline Definitions, method, data, systems Population and disability Care - utilisation and projected utilisation Model performance North-South comparisons Policy questions

4. What is long-term care? Residential care: Residential care homes & nursing care homes Sheltered housing? Intermediate care facilities? Hospitals for older people? Delayed discharge from acute hospitals? Home/community care: Home helps & personal care assistants Meals on wheels? Day centres? Informal care: Spouse, partner, adult child, adult child’s partner, sibling, friend/neighbour

5. Methodology Population + disability -> need 2 projection scenarios: pure population increase vs declining disability 2006 utilisation -> 2007-2021 projected utilisation Cell-based macro-simulation – adapts PSSRU methodology Not prediction of balance between care settings Individual-level data required

6. Model projection methodology Pure population scenario omits second step

7. Data sources DemographicsRoI: Census, Morgenroth NI: NISRA, GAD Need/disabilityRoI: Census, NDS NI: NISALD, CHS Care/nursing homesRoI: DoH/INHO/HSE NI: DHSSPS/BSA/RQIA DomiciliaryRoI: NDS/HSE/TILDA NI: NISALD UnmetRoI: NDS NI: NISALD

8. Systems of care AssessmentNICare management for residential + nursing homes + domiciliary care RoIResidential care needs assessment only EntitlementNIResidential: nursing care free; personal + hotel costs means-tested, family home incl. Domiciliary: means-test for home helps, free aged 75+ RoIResidential: means-tested co-payment, family home % incl. after death; Domiciliary: no legal entitlement, patchy provision, erratic co-payments; 11% people aged 75+ with ADL paid

9. Demographics - Republic Aged 65+: 11% in 2006 to 15%+ in 2021 468,000 to 792,000 – nearly 70% increase Outward migration potential carers Rising female labour force participation Convergence in male and female life expectancies Late to population ageing; care infrastructure under-developed

10. Demographic change Source: Morgenroth (2009)

11. But with less disability? Longer periods, deferred disability; shorter periods, divergent trends Studies using ADL measures show decline Evidence of declining disability for older people in RoI & NI Preferred scenario assumes cohort effect converges to long-run trend of declining disability Prevalence ADL difficulty aged 65+ reduces by 7-8% RoI and NI Rate reduces, numbers with ADL difficulty up

12. Disability, RoI 2002-2006 Source: Census 2002 and 2006

13. Utilisation patterns, Republic Alternative estimates Of people aged 65+ in 2006 base year: 4.4% to 4.8% in residential LTC 8.9% to 10.5% receive formal home help 8.8% have ADL difficulty and receive intense all-day or daily informal care; 28% receive some informal care Gender differences and unmet need

14. Utilisation of care in all settings - proportions

15. Utilisation of care in all settings - numbers

16. Utilisation of care in all settings – 2006 NDS Communal establishment Informal help only Both informal and formal help Formal help only No help Only PHN/ other

17. Utilisation projections, RoI & NI Annual average increase 20062021 ResidentialRoI96722,49136,993 NI2859,58513,858 HomeRoI1,86649,17977,164 NI28011,31515,512 InformalRoI1,56541,01864,500 NI73442,82153,827 NB: Definitions of categories differ in RoI and NI

18. Who will care? Republic 20062021 Nos give all day/daily care to cohabiting family aged 65+ with ADL difficulty 32,01750,470 Intense cohabiting caregivers as % population aged 65+ 6.8%6.4% Nos give all day/daily care to non-cohabiting family aged 65+ with ADL difficulty 15,71724,681 Intense non-cohabiting caregivers as % women aged 35-54 2.8%3.2% Intense non-cohabiting caregivers as % women aged 35-54 not in labour force 10.8%

19. How well does model perform? Republic Residential care: Projection: extra 550-756 places p.a. 2006-2011 Private nursing homes: 590 residents p.a. 2006-early 2010 Count public bed numbers changed but evidence increase to 2009 Within projection range to 2009/2010 Formal home care: Projection: extra 1,050-1,240 recipients p.a. 2006-2011; Public home help recipients: 415 p.a. 2006-Sept 2011 Home care package recipients: 957 p.a. Overlap & private unknown, close to/within projection Unlikely to have met unmet care need, reduced public provision

20. Ageing North & South Increase in numbers of people aged 65 and over

21. Residential LTC North & South Percentage of people aged 65 & over in residential long-term care

22. Home care North & South Percentage of people aged 65 & over receiving formal home care

23. Unmet need, North and South ADL difficulty and no help North South ‘No help’ pie slice on same basis, for other pie slices definitions differ & North- South not comparable.

24. Policy questions How and where to meet need? How to design our systems: availability, entitlement? Does NI system of care management provide a safety net? Does NI free home help for over-75s achieve better outcomes? How to fund care? Is disability the best measure of need? How improve our modelling?