Allocation of Care and Services in an Area-Based System for Long-Term Care of Elderly and Disabled People

Abstract

ABSTRACTIn order to analyse the allocation of public care services in the city of Solna, Sweden, and how they changed in response to a rapid growth of the number of elderly people, a comparison was made between two surveys, 1985 and 1991.The surveys comprised all citizens of Solna who, on the day of the survey, were receiving long-term public medical and/or social care services. Living arrangements and services received were registered together with assessments of social support and disability/dependency. The latter was measured according to a special scale (the ASIM index) and – for 1991 – the Katz index of ADL. The assessments were made by the ordinary staff. The analysis showed that older and non-married persons were more likely to become clients of the public care system. Institutionalisation was also more common among the non-married – especially for men.Connected to the rapid increase in the number of the very old in the context of limited resources was a sharp decline during the period 1985–1991 in the proportion of the Solna population that received public care services in some form. This decline concerned all age-groups of both sexes, married as well as non-married, but the married were more affected than the non-married – especially among the women. The reductions in the proportion of the population that received care in the home affected mostly married persons in the oldest age group. Reductions in institutionalisation had most impact on very old, non-married men – partly counteracted by increases in the provision of home help. Multivariate analysis showed functional disability – in 1991 dependency in ADL according to Katz - and living arrangements to be the most important variables in explaining the allocation of home help in domiciliary care and sheltered housing.