Demand For Long-term Care Services Research Articles

How Do Attitudes of Adult Children Toward Long-Term Care Change with Education? International Evidence

ABSTRACT Global demographic trends indicate that the world population is aging and education acquisition is increasing. For the first time in history, people are expected to spend more years as adults with living parents than as a parent of teenage children, and the average years of schooling have increased dramatically over the past several decades for many countries. Additionally, family-provided care is still the most important form of care to meet care demands worldwide. As strong filial norms could affect older adults’ long-term care decision-making, understanding the link between filial obligations and education is critical under these trends. Using individual data from the World Values Survey and an instrumental variables strategy to account for endogeneity, this study finds that adult children with higher education levels have lower filial beliefs. Since population aging is expected to increase the demand for long-term care services, and education can reduce the supply of family-provided long-term care services, countries must start addressing this gap.

Evaluation of China's long-term care insurance policies.

In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system. We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China. Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment. The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.

Market characteristics and entry strategy decision making: The market perspective of Croatian elderly care homes

Background: Socio-demographic changes increase the need for long-term elderly care. Consequently, providing formal institutional service in elderly care homes is an interesting opportunity for entrepreneurs. However, the entry strategy decision is influenced by numerous external variables. Purpose: The main goal is to answer what determines market concentration as one of the most important market entry determinants. Study design/methodology/approach: A linear regression model has been formed and tested on the Croatian elderly care home market, observed on a county level, using data for 2021. Further, a cluster analysis, as a decision-support tool, has been made to assess market characteristics that are more likely to attract new entrants to the elderly care home market. Findings/conclusions: Results indicate that demand for long-term care services plays a significant role, and the market with more elderly will attract more competitors. When the level of GDP per capita and the unemployment rate are observed together, markets with stronger economies tend to attract entrepreneurs. In other words, it is more likely that someone will open an elderly care home in a densely populated county with individuals that can afford formal institutional long-term care for themselves or family members. Limitations/future research: The shortcomings are mainly related to the lack of data on prices and quality measures. Further, information on the number of beds in each elderly care home would enable an alternative calculation of the Herfindahl-Hirschman index, while data on service prices and structure of employees as a proxy for quality (medical and non-medical staff) would enable a more reliable comparative analysis of obtained results. Future studies on this subject include variables related to the portion of unemployed females in the market since female family members more often provide informal care, and at the same time, they are more likely to be employed in formal long-term care institutions.

The Economic Value of Caregiving in Chile

ABSTRACT Population aging will increase the demand for long-term care services. Many countries, including Chile, have not implemented comprehensive responses to address these demands, relying on informal care. This article aims to estimate the economic value of caregiving in Chile, contributing to filling a gap in the literature and the policy debate. Economic value is estimated using replacement and opportunity cost approaches using two nationally representative databases: one survey on time use (to estimate hours of caregiving) and one on socioeconomic characterization (to identify caregivers and wages). Regressions for the determinants of caregiving effort and wages in the formal labor market are used to calculate the market value of caregiving time. Results show that the yearly value of caregiving ranges between US$266 million (when assuming a wage equal to the minimum wage for all caregivers) and US$4,946 million (when replacing all caregivers with nurses), i.e. between 0.11% and 1.95% of the country’s gross domestic product. The analysis provides several estimations of the economic value of caregivers in Chile and, even considering these calculations can be underestimated, the results show the need to highlight and value the contribution of caregivers and implement policies to address the increase in long-term care needs in the country.

From the Perspective of Internal Control, Research on the Government Responsibility for the Construction of Long Term Care Insurance System in China

Under the pressure of aging, aging of the aged, disability, empty nesting and so on, the demand for long-term care services for the elderly in China has risen sharply. To explore and establish a social long-term care insurance system is conducive to meeting the needs of the elderly for long-term care services. This paper demonstrates the necessity of government responsibility in the social long-term care insurance system, discusses the advantages and disadvantages of different government responsibility modes and the choice of government responsibility modes, and analyzes in depth the implementation of government responsibility. Specific contents.

The intergenerational transmission of filial norms and children's provision of long-term care to parents

Abstract In the light of an increasing future demand for long-term care services in ageing societies, families' provision for current and future long-term care needs has been subject to debate. Within this context, there is little discussion about parents' incentives to socialise their children to their own traits to achieve a desired child behaviour. Our study contributes to the literature by analysing to what extent parents transmit filial norms to their children and whether this transmission process affects children's care-giving behaviour if a parent needs long-term care. Using data from the German Family Panel, we initially analyse the transmission of filial norms from mothers and fathers to their children. Second, we examine the importance of filial norms that prevail in the child's local environment. Third, we assess whether an intergenerational transmission of norms transmits into child behaviour if a parent needs long-term care. We estimate linear regression models and account for child and parent characteristics as well as for the living environment. The results show that children have stronger filial norms when both parents report stronger filial norms. But, children also tend to be influenced by average norms in their local environment. Furthermore, children are more likely to provide support to a parent in need when their filial norms are stronger. We conclude that children's filial norms are at least partially shaped via a process of socialisation and that these norms transmit into children's care-giving behaviour if a parent needs long-term care. It is, therefore, important that filial norms that prevail in a society are in accordance with the institutional long-term care system that prevails within that country.

Influencing factors of willingness to purchase long-term care insurance for employees in Shenzhen, China

Purpose: In the early stage of Shenzhen's long-term care insurance pilot, the awareness, demand, and purchase intention of Shenzhen residents about long-term care insurance and their influencing factors were investigated to provide a basis for improving the government's long-term care insurance system. Methods: A structured questionnaire survey was carried out on the Shenzhen employee medical insurance participants. Descriptive statistics, Chi-square test, and Order logistic regression were performed. Results: 298 respondents (female 57.7%), filled out the questionnaires. About 73% of the respondents have never heard of long-term care insurance. Respondents’ average demand of long-term care was 3.06, which was the general level. The 161(54%) respondents' willing to purchase long-term care insurance and the main influencing factors of purchase willingness are self-assessment of long-term care possibility, monthly income, annual family income and their willingness to pay for long-term care services. Conclusions: Respondents lack risk awareness and have low awareness of long-term care insurance; their effective demand for long-term care insurance is insufficient, but the demand for long-term care services is specialized and diversified, and their intention to purchase long-term care services is slightly higher than purchase intention of long-term care insurance. Recommendations: Departments at all levels should work together to strengthen the publicity of long-term care insurance to raise awareness among the population, improve the quality of practitioners, and improve the elderly care service system to meet the needs of the specialized and diverse population, and broaden financing channels to deal with the risk that the population is not willing to buy.

Household Need and Unmet Need for Caregivers of Older Persons in Thailand

ABSTRACT The need for caregivers is a crucial issue in Thailand. This research examined levels and trends of household needs and unmet needs for caregivers of older persons and explored potential factors associated with these needs. The analysis utilized data from the Survey of Older Persons in Thailand 2007, 2011, 2014, and 2017. The household need for a caregiver of older persons was defined as a household with one or more older people who needed a caregiver to help them perform basic activities of daily living. The unmet need for a caregiver referred to households where at least one older person in the household needed care but did not receive it. Findings illustrated the increasing levels and trends of household needs as well as unmet needs over time. In terms of potential determinants, older person households in Bangkok and households with higher socioeconomic status were more likely to be the household need for caregivers. In contrast, those households in the Northeastern, the poorest region, were more likely to be the unmet need household. These findings are indicative of the rising demand for long-term care services in Thailand. However, it is vital to consider unmet household needs, especially in the worse-off area, when designing national policies.

Community-Dwelling Older Adults' Intended Use of Different Types of Long-Term Care in China and Its Associated Factors Based on the Andersen Behavioral Model.

In light of the increased demand for long-term care services in China, there is an ongoing discussion on what factors contribute to older adults’ intended use of long-term care services. This study empirically recruited 239 community-dwelling older adults aged ≥60 years in China and explored factors influencing their intended use of four types of long-term care (basic life care, basic medical care, rehabilitation care, and psychological care) based on the Andersen behavioral model (i.e., predisposing characteristics, enabling resources, and need factors). The results showed that older adults were most likely to use psychological care. Age (as the predisposing characteristic) was the significant predictor of the intended use of four types of care. Regarding the intended use of basic life care, the enabling resources of marital status, household composition, income, as well as need factors of preference for the care setting, were influential. Moreover, income and need factors of self-rated physical health status were only two variables associated with the intended use of basic medical care. Concerning the intended use of rehabilitation care, household composition, income, self-rated physical health status, and preference for the care setting were significant predictors. The intended use of psychological care was influenced by enabling resources of marital status, household composition, and need factors of self-rated physical health status, preference for the care setting, and preference for the caregiver. These results can promote the sensitivity of policymakers and caregivers to the community-dwelling older adults’ intended use of long-term care and contribute to the delivery of appropriate care services by public policy.

Long-Term Care Sustainable Networks in ADRION Region

The Long-Term Care (LTC) industry mainly comprises networks managed by providers of services other than informal caregivers and government agencies. Among the providers are the local providers of community-based services. The segment still consists of mostly small businesses. As such, it needs many improvements in logistics, information and communication technology (ICT) support, and educational programs, specifically in the ADRION region, where the rural areas require a high percentage of travel time in a working day for service providers. The demand for LTC services must be known early enough for providers to adapt to the growth of these demands, and they also need methods to support decisions on how to optimize the number of care workers to be able to plan the necessary human resources in the long term. The results are based on the authors’ previous studies of sustainable hierarchical spatial systems. The paper presents the achievements of these research activities and policies, governance and financing in the hierarchically organized services and networks of educational programs for human resources and ICT innovations in LTC, which are currently in short supply. Projections of capacities from facilities are necessary. Logistic networks to human resources are based on geo-gerontological projections, such as the multistate transition model, which is a new achievement in this area, and the adequate norms and standards of these services. The optimal number of human resources is based on the combination of the Patterson-Albracht algorithm and Multiple Travelling Salesman Problem (mTSP), as a new Home Health Care Routing and Scheduling Problem (HHCRSP), which helps in ensuring the inclusion of travel time in the concept of norms and standards, to achieve a work balance and care schedule according to the wishes of clients. The proposed approach might help professionals adapt in advance to the coming changes caused by the growing number of seniors and rapid changes in technology, and might also help in considerations as to whether the priorities of clients should be included in the basic national insurance programs or additionally charged as a higher standard of home care services. The aim is to make care and supply networks as sustainable as possible.

Research on the Supply and Demand of Long-term Care for Disabled Elderly in Hohhot Under the Background of Combination of Medical Care and Nursing

With the growing number of semi-disabled and disabled elderly people in China, the demand for long-term care services is is growing faster. With the service conditions of “maintenance integration”, the elderly with disabilities are increasingly favored by the combination of medical and nursing institutions. From the perspective of supply and demand of long-term care services, this paper explores the current situation of long-term care service supply in medical and nursing institutions in Hohhot and the demand for long-term care services of disabled elderly residents. Findings indicate that there is a contradiction between the supply and demand of long-term care services in medical and nursing institutions due to the lack of government guidance in funding investment, unclear positioning of medical and nursing institutions, lack of professional nursing personnel and imperfect long-term care security system. It is suggested to resolve the contradiction between supply and demand of long-term care services from optimizing resource allocation, perfecting the needs assessment system of disabled elderly, cultivating nursing talents, and perfecting the long-term care security system.

Factors associated with the willingness of older people to engage with long-term care services: A systematic review.

The ageing of the population has resulted in an increase in the demand for long-term care services for older people, but with limited resources, its challenges have also been highlighted. Although factors affecting the willingness of older people to engage with long-term care services have been widely reported, however, systematic review has not synthesised the evidence, and its associated factors remain unclear. This systematic review aims to study and synthesise the best available evidence on the potential factors related to the willingness of older people to engage with long-term care services. Eight electronic databases were comprehensively searched from inception to January 2021: the Cochrane Library, PubMed, Web of Science, CINAHL, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Literature Database (CBM). The original literatures were screened according to selection criteria. Two researchers used 11-item checklist recommended by the Agency for Healthcare Research and Quality to evaluate the quality of the included literatures. And the review used narrative synthesis to integrate factors related to the willingness of older people to engage with long-term care services. In total, 7794 studies were screened and 35 studies were included in this review. Among them, 23 studies were rated as moderate quality and 12 was high quality. Data synthesis identified that age, education, number of children, living arrangements, the relationship with children, primary caregivers, place of residence, social support, household income, medical insurance, activities of daily living ability and spiritual comfort should all be taken into account when establishing the appropriate long-term care service model or formulating relevant policies. However, many factors remain undetermined and require more rigorous original literature support. And multiple areas can be also considered in the future studies, especially psychological factors.

Grey systems in the management of demand for palliative care services in Poland

BackgroundThe concept of care for people in a critical or even terminal health condition, who are in the last stage of their life, has become the mission of palliative care facilities. Therefore, the life of a sick patient poses a number of challenges for health care services to make sure that medical services are tailored to the trajectory of the disease, as well as the various needs, preferences and resources of patients and their families.MethodsHealth systems financed from public funds need to adopt new methods of management to meet the high and arising demand for a long-term care. There are several ways of assessing the demand for long-term care services. The method recommended by the author and presented in more detail in this paper is the one relying on grey systems, which enables the estimation of forecasting models and, finally, actual forecasts of the number of potential future patients.ResultsGST can be used to make predictions about the future behaviour of the system, which is why this article aims to present the possibility of using the first-order grey model GM (1,1) in predicting the number of patients of palliative care facilities in Poland. The analysis covers the data from 2014 to 2019, whereas the prediction of the number of patients has been additionally formulated for 2020.ConclusionsHealth systems, particularly publicly funded ones, are characterised by a certain kind of incompleteness and uncertainty of data on the structure and behaviour of its individual components (e.g. potential patients or payers). The present study aims to prove how simple and effective grey systems models are in the decision-making process.

Predicting demand for long-term care using Japanese healthcare insurance claims data.

Driven by the rapid aging of the population, Japan introduced public long-term care insurance to reinforce healthcare services for the elderly in 2000. Precisely predicting future demand for long-term care services helps authorities to plan and manage their healthcare resources and citizens to prevent their health status deterioration. This paper presents our novel study for developing an effective model to predict individual-level future long-term care demand using previous healthcare insurance claims data. We designed two discriminative models and subsequently trained and validated the models using three learning algorithms with medical and long-term care insurance claims and enrollment records, which were provided by 170 regional public insurers in Gifu, Japan. The prediction model based on multiclass classification and gradient-boosting decision tree achieved practically high accuracy (weighted average of Precision, 0.872; Recall, 0.878; and F-measure, 0.873) for up to 12 months after the previous claims. The top important feature variables were indicators of current health status (e.g., current eligibility levels and age), risk factors to worsen future healthcare status (e.g., dementia), and preventive care services for improving future healthcare status (e.g., training and rehabilitation). The intensive validation tests have indicated that the developed prediction method holds high robustness, even though it yields relatively lower accuracy for specific patient groups with health conditions that are hard to distinguish.

Blockchain-IoT-Driven Nursing Workforce Planning for Effective Long-Term Care Management in Nursing Homes.

Due to the global ageing population, the increasing demand for long-term care services for the elderly has directed considerable attention towards the renovation of nursing homes. Although nursing homes play an essential role within residential elderly care, professional shortages have created serious pressure on the elderly service sector. Effective workforce planning is vital for improving the efficacy and workload balance of existing nursing staff in today's complex and volatile long-term care service market. Currently, there is lack of an integrated solution to monitor care services and determine the optimal nursing staffing strategy in nursing homes. This study addresses the above challenge through the formulation of nursing staffing optimisation under the blockchain-internet of things (BIoT) environment. Embedding a blockchain into IoT establishes the long-term care platform for the elderly and care workers, thereby decentralising long-term care information in the nursing home network to achieve effective care service monitoring. Moreover, such information is further utilised to optimise nursing staffing by using a genetic algorithm. A case study of a Hong Kong nursing home was conducted to illustrate the effectiveness of the proposed system. We found that the total monthly staffing cost after using the proposed model was significantly lower than the existing practice with a change of −13.48%, which considers the use of heterogeneous workforce and temporary staff. Besides, the care monitoring and staffing flexibility are further enhanced, in which the concept of skill substitution is integrated in nursing staffing optimisation.

Population with Long-Term Care Needs in Six Latin American Countries: Estimation of Older Adults Who Need Help Performing ADLs.

The population in Latin America is ageing, and there is an inevitable demand for long-term care services. However, there are no comparative analyses between Latin American countries of the dependency situation of older adults. This study aims to calculate and compare percentages of older adults who need help performing the activities of daily living in six Latin American nations. The study is observational, transversal, and cross-national and uses microdata drawn from national surveys conducted in Argentina (n = 3291), Brazil (n = 3903), Chile (n = 31,667), Colombia (n = 17,134), Mexico (n = 7909), and Uruguay (n = 4042). Comparable indicators of the need for help in performing the basic and instrumental activities of daily living were calculated. The percentages of older adults in need of help for basic activities of daily living ranged from 5.8% in Argentina to 11% in Brazil; for instrumental activities of daily living, from 13.8% in Mexico to 35.7% in Brazil; and combined, from 18.1% in Argentina to 37.1% in Brazil. Brazil thus has the highest indicators, followed by Colombia. The results warn of the frail physical condition of older people and the high potential demand for long-term care services. The information provided could be useful for further research on and planning for long-term care needs in Latin American and middle-income countries.

A Systematic Review on The Insurability Risk for Long-Term Care Insurance in Europe and Asia Countries

Due to the trends of the increase in life expectancies and decrement in fertility rates, the world population is moving towards becoming an ageing nation. With the rise in the number of older people, the demand for long-term care services is expected to increase. Long-term care services are ubiquitous in the developed country, especially in the European region as the countries have become the aged nations. Apart from that, the cost for long-term care services differs for individuals based on the level of needs and the service provider, either public or private nursing home for long-term care. Due to the growing cost of long-term care services, a long-term care insurance policy may be seen as an alternative to covering the cost of long-term care services because the risk is mitigated for individuals. However, most Asian countries are not familiar with the long-term care insurance policy as there is no specific insurance policy for long-term care services offered yet in these countries. The essential factor in constructing a long-term care insurance policy is to identify the risks that are insurable to be included in the policy to be used later for pricing long-term care insurance policy in Malaysia. This study provides an in-depth review and understanding of the insurable risks associated with long term care insurance in European and Asian countries.

Social Infrastructure supporting Ambient Assisted Living in a Smart Silver City: Literature Review and Research Agenda

Abstract Cities in EU member states are ageing. The increasing number of older urban residents have difficulties with basic activities of daily living due to physical and cognitive functional decline. Therefore, the demand for long-term care services in urban areas is rising. In the last 20 years, emerging technologies such as wireless communication, Internet of Things (IoT), sensors, ambient intelligence and cloud computing have opened up the possibilities of developing cyber-physical systems with various applications supporting older adults to remain physically and mentally active and live autonomously while being engaged in their communities. This paper shows that social infrastructure is an under-researched area of a smart city compared with digital infrastructure, transport infrastructure and utilities. This paper aims to review the digital transformation of social infrastructure for older adults in a smart city based on ambient assisted living technologies and propose a future research agenda.

A Systematic Review on The Insurability Risk for Long-Term Care Insurance in Europe and Asia Countries

Due to the trends of the increase in life expectancies and decrement in fertility rates, the world population is moving towards becoming an ageing nation. With the rise in the number of older people, the demand for long-term care services is expected to increase. Long-term care services are ubiquitous in the developed country, especially in the European region as the countries have become the aged nations. Apart from that, the cost for long-term care services differs for individuals based on the level of needs and the service provider, either public or private nursing home for long-term care. Due to the growing cost of long-term care services, a long-term care insurance policy may be seen as an alternative to covering the cost of long-term care services because the risk is mitigated for individuals. However, most Asian countries are not familiar with the long-term care insurance policy as there is no specific insurance policy for long-term care services offered yet in these countries. The essential factor in constructing a long-term care insurance policy is to identify the risks that are insurable to be included in the policy to be used later for pricing long-term care insurance policy in Malaysia. This study provides an in-depth review and understanding of the insurable risks associated with long term care insurance in European and Asian countries.

Risk Management in nursing homes: an Italian experience in 2019

Abstract Background The ageing of the European population leads to an increasing demand for Long-Term Care services. The security and well-being of the elderly population hosted in nursing homes (NHs) needs an effective Risk Management policy, officially sanctioned in Italy by the so-called “Legge Gelli” n.24 (March 8th, 2017) and the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. In order to verify the effective application of common “best practices” in terms of Risk Management in NHs, a tool useful to analyse risk management attitudes in Northern Italy was conceived and applied in a sample of NHs. Methods The tool, developed in collaboration with the health insurance company SHAM Italia, is composed of 124 items (with a dichotomous answer -YES/NO) on topics related to various Risk Management practices. This tool was submitted in a face-to-face interview to several Directors (Health Directors or Nursing Coordinators) of NHs in the Piedmont Region. A list of randomly-chosen NHs was contacted: 4 of them were selected for the pilot study and compiled the questionnaire. Answers were gathered and analyzed through Microsoft Excel. Results Only the 25% of NHs has a Risk Management plan with objectives and indicators of effectiveness and uses Risk Analysis instruments for a pre- and post-” risk detection. Only one has employees working mainly on Risk Management alone. The 75% of the reported events were “Adverse Events”, and all the NHs (100%) have a protocol for a patient voluntary departure or for fall prevention or for bedsores prevention; while 50% have a protocol for prevention of aggressions towards operators or for patients' suicide prevention. Conclusions This work provides a starting point to face new challenges that are looming on the European Health-care Systems: the care for the elderlies needs to be perfected to reduce inefficiencies, cut useless costs and improve safety of patients in the NHs setting. Key messages Despite safety of older patients in nursing homes is not only important but mandatory in Italy, risk management tools for this setting are lacking in literature. A new tool applied in Italian nursing homes showed that risk management needs to be implemented in practice and these results can be extended to European context.