Abstract
The increase in the proportion of elderly people in most industrialized countries triggers higher demand for long-term care (LTC) associated with limitations in activities of daily living (ADL). The aim of this research is to derive the drivers affecting the probability of reporting limitations in ADL and the probability of demanding formal LTC, e.g., personal care and services in domestic tasks. By using the most recent wave of a cross-national European survey on individuals aged over 50 years (SHARE, wave 6), we develop econometric models for identifying the effect of demographic, social and medical factors on ADL limitations and formal LTC along five conjectures. On the one hand, we analyze functional limitations and we find that characteristics such as the age, the gender, the wealth status and the education level influence the probability to report limitations. Further, while we find that pathologies significantly increase the probability to become dependent in general, the effect of cancer is lower. On the other hand, we find again an influence of the demographic and social factors on the probability to use formal LTC. We emphasize on the decrease in the probability due to the presence of the partner in the household, in particular for housekeeping tasks. This is less the case for help related with personal care. In addition, we note that pathologies such as cancer have no influence on the probability to report formal LTC while others like mental and Parkinson diseases highly increase it. We find that elderly living in countries with LTC family care schemes report less formal care than in others. This indicates the importance of LTC policies. Finally, we validate the robustness of our results by applying the models to data from earlier waves of the survey. Our findings give insights for the underwriting standards to be used in future LTC insurance products and for the design of LTC policy environments across Europe.
Highlights
Handling the forthcoming high number of elderly and in particular the financing threat and infrastructure needs due to the demand for long-term care (LTC) is at the foreground of many policy debates in Europe [38]
In addition to the regression results, we study the deviance decrease for each of the variables included in models (1) and (3)
We address five conjectures hypothesizing on the importance of demographic, social, medical and policy factors as well as of the activities of daily living (ADL) and types of formal care in the determination of the aforementioned probabilities
Summary
Handling the forthcoming high number of elderly and in particular the financing threat and infrastructure needs due to the demand for long-term care (LTC) is at the foreground of many policy debates in Europe [38]. In this context, more and more developed countries consider LTC as a new social risk [32]. LTC characterizes the help provided to elderly in need of assistance with the activities of daily living (ADL), namely, bathing, dressing, using the toilet, transferring in and out of a bed or a chair, continence and feeding [65] Such care is mainly delivered to individuals aged over 65 years [3] with prevalence rates rising exponentially after the age of 80 years [47]. While LTC help provided by professionals, namely formal care, is statistically measurable, help provided by relatives, i.e. informal care, mostly stays hidden beneath the surface and is not directly observable
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