long-term care use and supply in europe: projections for germany ...

LONG-TERM CARE USE AND SUPPLY IN EUROPE | 17
3.2 Study design
3.2.1 Aim
The purpose of the present analysis is to identify the main determinants of informal and formal care use
in different LTC systems and to use this information to produce estimated probabilities of care use by
relevant characteristics of older persons. These estimates will be combined in Chapter 4 with projected
numbers of older persons by the same characteristics in order to project future numbers of LTC users.
The analysis includes three countries – Germany, the Netherlands and Spain – each representative of a
cluster of countries with a different type of LTC system, as identified in WP 1 of the ANCIEN project
(Kraus et al., 2010). Cluster 1, to which Germany belongs, consists of countries where a low level of
public spending is combined with a modest share of private spending, high informal care use and high
informal care support. The Netherlands belongs to cluster 2, a cluster of Northern European countries
characterized by high public LTC spending, low private spending, low informal care use and high
informal care support. Spain and the other countries of cluster 3 share the profile of cluster 1 with regard
to informal care use and support, but have a much higher level of private responsibility and a somewhat
higher level of public spending. Poland was selected as representative of a fourth cluster, characterized
by a small public sector involvement, more private spending, high informal care provision combined
with few supportive measures for informal caregivers. However, due to the unavailability of care use
data, Poland could not be included in the present analysis 8 . Given the considerable differences between
the clusters in the organisation and financing of long-term, one can reasonably expect that the effects of
predictors of care use vary across the three countries.
3.2.2 Data and methods
This study uses pooled data from Wave 1 (2004 and 2005) and Wave 2 (2006 and 2007) of the Survey of
Health, Ageing and Retirement in Europe, release 2.3.1. The analytical sample was restricted to
respondents aged 65 and over, living at home, and includes 2,491 observations for Germany, 2,134
observations for the Netherlands and 2,265 observations for Spain.
a. Dependent variable
The variable of interest is the type of help older persons receive with personal care (activities of daily
living or ADLs) or with nursing care. The analysis does not include help with household tasks for the
following reasons:
1. Results are used to make projections of formal and informal care use, which start from
projections of care needs defined as having ADL limitations. In WP 2 of the ANCIEN project,
projections of the number of older persons needing LTC care have been developed. LTC need has
been defined as having ‘at least one limitation in basic activities of daily living (ADL-disability),
based on the Katz ADL disability scale’ and items included are: bathing, dressing, eating, indoor
transferring and toileting/continence (Bonneux, van der Gaag, & Bijwaard, 2011). Projections of
the number of persons needing help with household tasks have not been provided.
2. Information in SHARE on informal help with household tasks is limited. One could argue that
ADL disabled persons generally need help with household tasks or instrumental activities of daily
living (IADLs) also. Therefore, it could be relevant to include household help, all the more so as
studies have shown that use of formal and informal care differs for household help and personal
care, but with a huge variation between countries (see for instance Brandt et al., 2009). However,
the SHARE data on help with IADL only include information on help from outside the household,
not on help provided by household members. This could raise comparability issues, as for
instance co-residence of older parents and their children differs considerably within Europe. By
8 Poland participated in Wave 2 of SHARE, but due to a coding error which resulted in wrong routing the variables
on home care are missing for all Polish cases.