How Much (formal) Eldercare in Request? Learnings from the Projections of Demand for Care Among the Elderly in Poland.

Wojciech Łątkowski, Institute of Statistics and Demography, Warsaw School of Economics

The aim of the paper is to make a projection of future demand for care among the elderly that quantitatively evaluates the impact of changes in health status and living arrangements on future care requirements. The demand for care is defined as the number of people requiring care according to their health status. The paper attempts to contribute to the field by performing a study that links changes of the population age structure with changes of health status and living arrangements.

The research makes use of a dynamic multistate projection model. Health and living arrangements transition probabilities are estimated at micro-level using EU-SILC panel data. In the next step they are integrated with official Eurostat population projections using simulation methods. The model allows to estimate the effect of change in the health status by age over demand for care according to various morbidity hypotheses which are used to formulate projection scenarios. The information about the elderly’s living arrangements in the model allows to assess the influence of household’s diminishing informal care resources on the scale of demand for formal care.

The preliminary analyses show the expected overall growth in future’s elderly care demand, especially at older ages. However, the scale of future care requirements is sensitive to health improvement scenarios. A growing share of the elderly in bad health and living solitarily suggests a need of development of institutional care facilities.

The results of the research may be used by social policy for adjusting the supply of formal institutional care and development of social and care services according to the future needs.


Extended abstract

The increasing number of elderly people that comes together with population ageing can be considered as a challange for care arrangements in the future. Requesting a care need by seniors is above all related with one’s health status (Doblhammer et al. 2008) that together with income level is the most important factor determining the use of institutional forms of support (Gaymu et al. 2006). From the point of view of the elderly''s household composition, living alone is very much a living arrangement that is concentrated at older ages (Fokkema & Liefbroer 2008) but is also increasing the chances to use institutional care (Gaugler et al. 2007).

The aim of the paper is to make a projection of future demand for care among the elderly that quantitatively evaluates the impact of changes in health status and living arrangements on future care requirements. The demand for care is defined as the number of people requiring care according to their health status. Including information about the elderly’s family situation, which allows for evaluation of potential care resources within household, is supposed to allow the estimation of future demand for formal care (provided by public or private institutions) and informal care (provided mainly by family members).

Population projections by age, sex and health status are rarely extended with additional attributes. Demand for care is primarily considered in projections of expenditures on health care and long-term care (e.g. Comas-Herrera et al. 2006). There are also projections focusing solely on health status (Lutz & Scherbov 2005; Van der Gaag et al. 2015). Some use extended projection models but they either did not cover Poland (Gaymu et al. 2008) or made basic projections only (Geerts et al. 2012). Poland can be considered an interesting comparison with the western countries as it is still economically lagging behind and is one of the countries affected most by the demographic change.

The research makes use of a dynamic multistate projection model that requires the estimation of transition probabilities between distinguished states of the health status and the family situation with respect to age and sex. Health and living arrangements transition probabilities are estimated at micro-level using EU-SILC panel data. In the next step they are integrated with official Eurostat population projections using simulation methods (e.g. Eggink et al. 2016). The model allows to estimate the effect of change in the health status by age over demand for care according to various morbidity hypotheses which are used to formulate projection scenarios. The information about the elderly’s living arrangements in the model allows to assess the influence of household’s diminishing informal care resources on the scale of demand for formal care.

The preliminary analyses show the expected overall growth in future’s elderly care demand, especially at older ages. However, the scale of future care requirements is sensitive to health improvement scenarios. A growing share of the elderly in bad health and living solitarily suggest a need of development of institutional care facilities.

The results of the research may be used by social policy for adjusting the supply of formal institutional care and development of social and care services according to the future needs.

Acknowledgments

This research has been funded by the National Science Centre (Poland), decision number: 2016/23/N/HS4/03827.

References

Comas-Herrera, A. et al., 2006. Future long-term care expenditure in Germany, Spain, Italy and the United Kingdom. Ageing and Society, 26(2), pp.285–302.

Doblhammer, G. et al., 2008. Health and its effect on the future demand for care. In J. Gaymu et al., eds. Future Elderly Living Conditions in Europe. Paris: Les Cahiers de l’Ined, INED, pp. 141–163.

Eggink, E., Woittiez, I. & Ras, M., 2016. Forecasting the use of elderly care: a static micro-simulation model. The European Journal of Health Economics, 17(6), pp.681–691.

Fokkema, T. & Liefbroer, A.P., 2008. Trends in living arrangements in Europe: Convergence or divergence? Demographic Research, 19(36), pp.1351–1418.

Van der Gaag, N. et al., 2015. A multistate model to project elderly disability in case of limited data. Demographic Research, 32, pp.75–106.

Gaugler, J.E. et al., 2007. Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatrics, 7.

Gaymu, J. et al., 2006. Determinants of the living arrangements of older people in Europe. European Journal of Population, 22(3), pp.241–262.

Gaymu, J., Ekamper, P. & Beets, G., 2008. Future trends in health and marital status: effects on the structure of living arrangements of older Europeans in 2030. European Journal of Ageing, 5(1), pp.5–17.

Geerts, J., Willeme, P. & Mot, E., 2012. Long-term care use and supply in Europe: projections for Germany, the Netherlands, Spain and Poland. ENEPRI Research Report No. 116.

Lutz, W. & Scherbov, S., 2005. Will Population Ageing Necessarily Lead to an Increase in the Number of Persons with Disabilities? Alternative Scenarios for the European Union. Vienna Yearbook of Population Research, pp.219–234.

Presented in Session 1123: Ageing and Intergenerational Relations