LONG-TERM CARE DATA: PROGRESS AND PROPOSED NEXT STEPS Meeting of OECD Health Data National Correspondents Paris, 11-12 October 2012

• Review progress in data collection on long-term care (LTC) over past few years:

– LTC beds (in nursing homes and hospitals)

– LTC recipients (in institutions and at home)

– LTC workers (formal and informal)

• Proposed change to data collection

– One modification only: discontinue the data collection on informal carers

Purpose

Chapter Specification Unit

Beds Beds in nursing homes

Total

LTC beds in hospitals

Total

Recipients In institutions Total, by gender and age groups (all, 0-64, 65 and over, 80 and over)

At home Total, by gender and age groups (all, 0-64, 65 and over, 80 and over)

Workers Formal Head counts: Total, by gender, occupation (nurses, personal carers), care setting (at home, in institutions) FTE: Total, care setting (at home, in institutions)

Informal Head counts: Total, by gender

2012 Data collection on LTC

Note: data collection on beds included in OECD/Eurostat/WHO joint questionnaire

Chapter Specification Definition

Beds Beds in nursing homes

Inclusion: •Beds in all nursing and residential care facilities •Beds used for palliative care in all types of nursing and residential care facilities Exclusion: •Beds in nursing and residential care facilities which do not provide ongoing health and nursing care together with accommodation •Beds available in hospitals

LTC beds in hospitals

Inclusion: •Beds in LTC departments of general hospitals •Beds for long-term care in specialty hospitals •Beds for palliative care Exclusion: •Beds in mental health and substance abuse hospitals •Beds for rehabilitation

LTC beds: Definitions

Number of countries available

Countries not reported data, 2000-2010

Beds in nursing homes

27 (out of 34) (up from 17 out of 30 since 2008)

7 (CAN, CHL, GRC, MEX, PRT, SVN, TUR)

LTC beds in hospitals 25

9 (AUS, DEU, GRC, MEX, NZL, NOR, PRT, CHE)

Total number of beds: Data availability

Number of beds in nursing homes per 1

000 pop aged 65+, 2010 (or nearest year)

• Large variation: lowest (POL, ITA), highest (SWE, LUX)

• Average: 49 beds per 1 000 pop aged 65 and over

0

10

20

30

40

50

60

70

80

90

Source: OECD Health Data 2012

• Much fewer beds for LTC in hospitals than nursing homes in nearly all countries, except for Korea

• No LTC beds in hospitals in some countries, may give an explanation why some countries have a relatively high number of beds in nursing homes (LUX, NLD)

The number of LTC beds in hospitals per

1 000 pop aged 65+, 2010 (or nearest year)

0

5

10

15

20

25

Source: OECD Health Data 2012

• „Nursing homes‟ varies across countries • Excluding beds in retirement homes that are

not for nursing care (Iceland) • Different classification of “geriatric hospitals”

(e.g. Geriatric care beds excluded in Iceland) • Inclusion of beds for palliative care • Data source not including beds in private

nursing homes • Separating out LTC beds from other hospitals

beds not possible

Definitional issues: LTC beds

Chapter Specification Definition

Recipients In institutions Inclusion: •Persons who receive LTC by paid LTC providers including non-professionals receiving cash payments under a social programmes •Recipients of cash benefits (ex. Care allowances) which are granted with the primary goal of supporting individuals with LTC needs based on an assessment of needs Exclusion: •Persons receiving LTC in hospitals •Disabled persons of working age who receive income benefits or benefits for labour market integration without LTC servivces • Persons who need help only with IADL help, that is, receiving only long-term social care as defined under the Health Accounts questionnaire

At home

LTC recipients: Definitions

Recipients Number of countries available

Number of countries available by age group

In institutions 28 (up from 26 in 2008)

26

At home 23 (up from 21 in 2008)

21

LTC recipients: Data availability

• Five countries not able to provide any data on LTC recipients in institutions or at home (BEL, CHL, GRC, MEX, TUR)

• No breakdown available by setting in one country (AUS)

• Large variations: lowest (POL, PRT), highest (AUS, BEL

NLD)

LTC recipients in institutions, per 1 000 pop

65+, 2010

0

10

20

30

40

50

60

70

80

Source: OECD Health Data 2012

• Variations: lowest (PRT, SVN), highest (ISR,CHE)

LTC recipients at home, per 1 000 pop

65+, 2010

0

50

100

150

200

250

Source: OECD Health Data 2012

Different interpretation of LTC

institutions and nursing homes

• Which facilities should be included as LTC institutions (or nursing homes)

• When a “home” becomes an “institution” (e.g. sheltered housing for elderly people)

• Inclusion of hospitals as LTC institutions

• Data source may not include LTC recipients without any public support or if included, not possible to distinguish public and private

Chapter Definition

(formal) LTC workers

(1) Nurses: defined by the ISCO-08 classification, providing LTC at home or in LTC institutions (other than hospitals)

Inclusion: • Salaried and self-employed nurses delivering services at home or in LTC

institutions • Nurses providing LTC to patients affected by dementia and/or Alzheimer‟s

disease Exclusion: • Nursing aids/assistants and care workers who do not have any recognised

qualification/certification as a nurse (2) Personal care workers (caregivers)

Inclusion: • Nursing aids/assistants and care workers providing LTC services, who do

not have any recognised qualification/certification in nursing • Family members, neighbours or friends employed by care recipient or

agency to provide care Exclusion: • Caregivers in assessment teams employed to evaluate care needs and other

persons employed in administrative positions • Social workers/community workers

LTC workers: Definitions

Number of countries available,

Headcounts by setting

Headcounts by occupation

FTE

In institutions

18 16 16 17

At home 16 16 16 14

Total 18 18 17 15

LTC workers: Data availability

• Some countries only able to provide data in headcounts (DEN, HUN, MEX, SVN, ESP, GBR), while two countries reported only FTE data (BEL, LUX)

• Some countries only able to provide total number of breakdown by setting (ESP , SWE)

• Substantial variations

– Institutions: lowest (EST, ISR, KOR, SVK), highest (NLD, USA)

– Home: lowest (CZE), highest (ISR)

– Total: lowest (SVK, HUN), highest (USA, NOR, SWE)

LTC workers, headcounts, per pop 65+

2010 (or nearest year)

0

20

40

60

80

100

120

140

Institutions Home Total

Source: OECD Health Data 2012

Data sources vary across countries

• Data sources on LTC workers in institutions based on facility surveys, statistics on social services or registry

• Data sources on LTC workers at home come from administrative records or household/community surveys

• Labour force survey is rare but limited in comparability

Specification

Definition

Informal caregivers

Informal caregivers include individuals providing LTC services on a regular basis, typically at home, for example spouses/partners, family members, neighbours and friends. Inclusion:

• Uncompensated informal caregivers • Informal caregivers who receive cash benefits/allowances, i.e. caregivers providing LTC services on a regular basis and who receive benefits, cash payments or allowances as part of cash programmes and/or consumer-choice programmes, providing some compensation for their caring activities. • Undeclared/illegal informal caregivers

Exclusion: •Formally employed caregivers, including family members and friends on contract with the care receiver and/or registered as caregivers to relevant social security offices

LTC Informal caregivers: Definitions

LTC informal caregivers:

Data availability and proposal

• Only 9 countries provided recent data from national surveys on disability and carers at more or less regular intervals

• Data available for more countries in 2004 and 2006 because of the cross-country Survey on Health, Ageing and Retirement in Europe (SHARE) conducted, but new waves of data not released

• Proposal: to discontinue the data collection on informal carers given these data are usually based on ad hoc or irregular surveys.

• COMMENT on progress made in data collection on long-term care resources and utilisation, and any challenge face in responding to OECD data collection;

• COMMENT on proposal to discontinue data collection on informal carers, given limited data availability and irregular data updates.

Issues for discussion