Abstract
BackgroundChallenges of future dementia care include increasing shortage of qualified healthcare providers and decreasing potential of informal care by relatives. In order to meet those challenges, changes in dementia care are needed. These changes should be based on data of both care utilisation and care supply. The aim of this study was to provide insight into individual and regional characteristics that influence the utilisation of long-term care by people with dementia.MethodsThe study was a retrospective cross-sectional analysis of claims-based data and other available data referring to one index year. All data were aggregated for small geographic districts. The study population comprised people with a dementia diagnosis, 65 years and older in Baden-Wuerttemberg and insured by the largest health insurer. Utilisation of nursing home care, informal care, and respite care was analysed using binary coded logistic multilevel analyses.ResultsSeventy nine thousand three hundred forty-nine people with dementia were included in the analyses. Nursing home care was used by 20.4%, informal care by 30.6%, and respite care by 3.5% of people with dementia. Individual characteristics that influence care utilisation included age, sex and the level of care dependency. The utilisation of informal care (OR = 1.713) and respite care (OR = 2.036) was higher in rural districts than in city districts. Respite care supply had an effect on the utilisation of respite care (OR = 1.173).ConclusionsThe study found differences between districts in the utilisation of long-term care for dementia. These differences were largely explained by the composition of the population within the districts. An exception was the utilisation of respite care, which was higher in districts which have higher supply. Individual characteristics that influenced care utilisation are age, sex, level of care dependency and, with regard to informal care, comorbidity. Further research should be conducted on a small-area level, include further individual characteristics as well as other care and living forms.
Highlights
Challenges of future dementia care include increasing shortage of qualified healthcare providers and decreasing potential of informal care by relatives
Study design The study presented here is embedded in a larger project which was initiated by the Ministry of Social Affairs and Integration of Baden-Wurttemberg, a federal state in southern Germany, and which aims at developing a concept for cross-sectoral care in three districts in Baden-Wurttemberg, based on elaborate analyses of the current and prospective state of care [30]
The mean age was 82.8 years (standard deviation (SD) 7.06) and the oldest included person was 107 years. 63.1% were in need of long-term care (LTC) and classified in a level of care dependency (LoCD), and 51.6% claimed any of the LTC services included. 36.9% of the study population were not in need of LTC
Summary
Challenges of future dementia care include increasing shortage of qualified healthcare providers and decreasing potential of informal care by relatives. In order to meet those challenges, changes in dementia care are needed. These changes should be based on data of both care utilisation and care supply. An independent organisation assesses insurants’ eligibility for LTC benefits based on legally defined criteria focussing on physical need of help with activities and instrumental activities of daily living for at least 6 months [6,7,8]. It was only in 2017 that cognitive impairment has been added to these criteria [9]
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