1. 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

2. 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

3. 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

4. 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

5. plan.be 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

6. 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

7. 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 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)

8. 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)

9. 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

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

11. plan.be Disabled population by care setting: demographic scenarios

12. plan.be Disabled population by care setting: BMI scenarios

13. plan.be Disabled population by care setting: SMOK scenarios

14. plan.be Formal care use by age groups (NL, DELAY, 2010-2060)

15. plan.be Formal care use by age groups (NL, DELAY, 2010-2060) HomeResidentialTotal FC Grand Total AgecatYearHC0HF+IHFCHIC 65 201073885029891385018777278019619777246 2060963770269519695209243361257511010445 Difference224920-294584521475816132233199 70 2010556599111592770316662559444456617718 2060846950115744205921833727860911929694 Difference290350415143565171168416455311976 75 20104221871366629839153381301156516494041 20607136941605747538223111725480849816854 Difference2915072391176996973424324333322813 80 201027025189483891067202492672783349754 206056455713603646201179543510121734698086 Difference29430646562571050761858548950348332 85 2010135777459356935664690255151782294206 206059762219736211150276163353265662121191450 Difference4618441514315421520970245072414430897244 All 2010212366541354167237641431365663451562532965 20603686593636643850631044804067298554564646528 Difference156292722311217826403362701635103002113563

16. plan.be Home care use by household composition

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

18. 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)

19. 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 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)

20. 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...