Long-Term Care

Einleitung / Introduction

Most of the developed countries face a change in demography, which leads to an increasing share of elderly in the society, while fewer people are in the employable age. At the same time, the elderly are those who often receive long-term care. We analyze the causal effect of providing informal care to parents or stepparents on weekly working hours of the caregiver, considering age cohorts, health, and socioeconomic status.

Methode / Method

In this analysis, we use data from the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) covering the years 2010 to 2016. Since the number of hours worked might affect informal care provision and unobservable determinants might affect both, caregiving and working hours, these endogeneity concerns need to be addressed. Considering that our caregiving variable is binary, we observe a nonlinear relationship of caregiving and working hours. We handle these complicating factors by using two-stage residual inclusion and instruments on family level. We further consider regional level instruments, which include the number of individuals in need of care, the number of outpatient nursing services and nursing homes.

Ergebnisse / Results

We find a positive impact of informal care provision on working hours. This finding might reflect missing flexibility of working hours for the caregiver and competing aims of career and caregiving responsibilities. Furthermore, these effects might reflect the lack of financial support for the caregiver.

AutorInnen

Nadine Schaarschmidt, Universität Hamburg

Ingo Kolodziej, RWI Essen

Einleitung / Introduction

Most individuals are reluctant to move into a nursing home (NH), preferring to age in the own home as long as possible. When the individual’s care needs increase, preferences shift towards nursing home care. While there is a general increase in acceptance of sexual and gender minorities, older Lesbian, Gay, Bisexual and Transgender (LGBT) individuals residing in institutionalized settings perceive that they are discriminated against, due to their sexual orientation. Most research to date has not been nationally representative and has relied on qualitative data. Using nationally representative data, the aim of this study was to identify determinants of preferences related to NH care among LGBT individuals, and specifically whether they plan to move into a NH in old age.

Methode / Method

In this study, data from the most recent sixth wave were derived from the German Ageing Survey (DEAS). In 2017 (sixth wave), around 6,600 individuals participated. The additional written drop-off questionnaire (concerning sensitive issues e.g. sexual orientation) was filled in by approximately 85% (5,608 individuals). Our outcome measure was preferences related to moving into a NH or retirement home (yes; no). The independent variable of interest was sexual orientation (dichotomized responses into sexual minority (homosexual, bisexual or other) and heterosexual)). In our final model, we adjusted for set of socioeconomic, psychosocial and health-related factors. Multiple logistic regressions with integrated cross-sectional drop-off sampling weights to obtain a nationally representative sample and to solve the problem of selective panel mortality were used. Penalized logistic regressions were also calculated.

Ergebnisse / Results

Altogether 4,645 individuals provided data concerning sexual orientation, and other control variables. Weighted mean age was 60.8 (0.3) years, 7.3% belonged to sexual minorities and 4.9% had the preference to move into NH in the future. Regressions showed that sexual orientation was not significantly associated with plans to move to a NH. Preference to move into NH were consistently positively associated with age (OR: 1.04 (1.02-1.07), not having at least one child (OR: 2.17 (1.41-3.36)), high education (OR: 3.82 (1.32-11.11)), greater loneliness (OR: 1.44 (1.05-1.96)) and worse physical functioning (OR: 0.99 (0.98 - 1.00)).

Zusammenfassung / Conclusion

Our results showed that plans to move to a NH did not differ significantly between heterosexual individuals and sexual minorities. This may indicate that sexual orientation does not play a significant role in shaping preferences around moving into a nursing home in general. In contrast, other factors like age, greater loneliness and worse physical functioning were important. Those factors should be taken into account when shaping and updating policies on nursing homes.

AutorInnen

Elzbieta Buczak-Stec, Universitätsklinikum Hamburg-Eppendorf / HCHE

Hans-Helmut König, Universitätsklinikum Hamburg-Eppendorf / HCHE

André Hajek, Universitätsklinikum Hamburg-Eppendorf / HCHE

Einleitung / Introduction

In the next decades, the proportion of individuals in highest age, 85 years old and older, is projected to rise considerably. Due to the strong association between old age and the need for long-term care, the number of individuals in need for care is also projected to increase noticeably. From a societal perspective, admission to an old age or a nursing home (NH) is expected to be associated with a marked economic burden. Therefore, the purpose of this study was to identify the determinants on institutionalization exclusively among the oldest old using panel regression models.

Methode / Method

Longitudinal data for this study were gathered from a multicenter prospective cohort study (“Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)”; AgeQualiDe). This study used data from the Follow-Up (FU) 7 (n=861), FU 8 (n=755) and FU 9 (n=640). Main reasons for drop-off were refusal and death. Our outcome variable of interest was institutionalization. Individuals admitted to an old-age home, nursing home or residing in assisted living were defined as institutionalized. As regards to sociodemographic variables age, sex, widowhood, and the educational level (CASMIN) were used. Social support was measured using the Lubben Social Network Scale. In our analysis, we also included a set of variables indicating functioning and health status (cognitive impairment – GDS, functional decline – IADL, depressive symptoms - Geriatric Depression Scale). We also adjusted for visual impairment, hearing impairment, urinary and fecal incontinence. To study the factors leading to institutionalization longitudinally we used logistic random-effects models with participant level random effect.

Ergebnisse / Results

At baseline, complete measures were available for 763 individuals. The average age was 88.9 years (SD 2.9), range 85-100, 68% were female. Regressions showed that conditional odds of being institutionalized were lower for men. Furthermore, higher age increased the odds of being institutionalized (OR=1.27). Widowed individuals had more than eight times higher odds of being institutionalized compared to non-widowed individuals (OR=8.95) and institutionalization was associated with functional decline (OR=0.16).

Zusammenfassung / Conclusion

Study findings showed that institutionalization was significantly associated with female sex, increasing age, widowhood status, and functional decline longitudinally, whereas it was not significantly associated with e.g. cognitive decline and lower social support. Our findings stress the importance of functional decline as a one of important determinants of institutionalization among oldest old. Preventing or postponing functional decline might help to delay as far as possible institutionalization.

AutorInnen

Elzbieta Buczak-Stec, University Medical Center Hamburg-Eppendorf

Hans-Helmut König, Universitätsklinikum Hamburg-Eppendorf / HCHE

Martin Scherer, Department of Primary Medical Care, University Medical Center, Hamburg-Eppendorf

Wolfgang Maier, Department of Psychiatry, University of Bonn; German Center for Neurodegenerative Diseases (DZNE)

Steffi G. Riedel-Heller, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig

Michael Wagner, Department of Psychiatry, University of Bonn; German Center for Neurodegenerative Diseases (DZNE)

André Hajek, Universitätsklinikum Hamburg-Eppendorf / HCHE

Einleitung / Introduction

The Swiss long-term care market is heavily regulated with ongoing efforts to further expand market interventions to offset the alleged lack of competition. This paper evaluates the consumer response to prices of care and accommodation in the choice of a nursing home, taking advantage of the special conditions of the Swiss market.

Methode / Method

Using data from the official administrative statistics for social-medical institutions (SOMED) of the Federal Statistical Office for the years 2014 to 2017, a conditional multinomial logit model is used to analyze to which extent prices, quality and distance influence the nursing home choice.

Ergebnisse / Results

The findings suggest a negative relationship between the price of accommodation, which is not covered by social security contributions (out-of-pocket price), and the choice of the nursing home. By comparison, the price for medical care, which is almost entirely covered by insurance and public finances, appears to have no influence on the nursing home choice. The choice is also significantly associated with shorter distance from the client’s prior residence, higher total staffing ratio and larger facility size.

Zusammenfassung / Conclusion

Individuals in need of care and about to move to a nursing home do not only consider location but also compare prices and the quality of providers. Measures for the promotion of competition can therefore enhance efficiency. However, demand is only affected by out-of-pocket expenditures and easy-to-assess quality measures.

AutorInnen

Stefan Felder, WWZ Universität Basel

Rachel Straumann, WWZ Universität Basel