An ecological study on the relationship between supply of beds in long-term care institutions in Italy and potential care needs for the elderly

Abstract

Background: The ageing population in Europe is putting an ever increasing demand on the long-term care (LTC) services provided by these countries. This study analyses the relationship between the LTC institutional supply of beds and potential care needs, taking into account the social and health context, the supply of complementary and alternative services, along with informal care.

Methods: An observational, cross-sectional, ecological study was carried out. Statistical data were obtained from the Italian National Institute of Statistics and Ministry of Health. Indicators, regarding 5 areas (Supply of beds in long term care institutions, Potential care needs, Social and health context, Complementary and alternative services for the elderly, Informal care), were calculated at Local Health Unit (LHU) level and referred to 2004.Two indicators were specifically used to measure supply of beds in long term care institutions and potential care needs for the elderly. Their values were grouped in tertiles. LHU were classified according to the combination of tertiles in three groups: A. High level of supply of beds in long term care institutions associated with low level of potential care needs; B. Low level of supply of beds in long term care institutions associated with high level of potential care needs; C. Balanced level of supply of beds in long term care institutions with potential care needs. For each group the indicators of 5 areas were analysed.The Index Number (IN) was calculated for each of these indicators.

Results: Specific factors that need to be carefully considered were highlighted in each of the three defined groups. The highest level of alternative services such as long-stay hospital discharges in residence region (IN = 125), home care recipients (HCR) (IN = 123.8) were reported for Group A. This group included North regions. The highest level of inappropriate hospital discharges in (IN = 124.1) and out (IN = 155.8) the residence region, the highest value of families who received help (IN = 106.4) and the lowest level of HCR (IN = 68.7) were found in Group B. South regions belong to this group. The highest level of families paying a caregiver (IN = 115.8) was shown in Group C. Central regions are included in third group.

Conclusion: Supply of beds in long term care institutions substantially differs across Italian regions, showing in every scenario some imbalances between potential care needs and other studied factors. Our study suggests the need of a comprehensive rethinking of care delivery "system".

Figure 1

Beds in long term care institutions for the elderly by Region. 2004 year. (Rates per 10,000 elderly). Graduation of colours refers to tertiles of Regions. In brackets the number of regions belonging to each tertile. Data Source: Residential care institutions survey.

Figure 2

Percentage of elderly people with at least one disability by Region. 2004 year. Graduation of colours refers to tertiles of Regions. In brackets of legend there are the number of regions in each tertile. Disability is defined as difficulties in seeing, hearing, movement, functions of activities of daily living. Data Source: Health conditions and recourse to health services survey.

Figure 3

Partitions of LHU in three groups. 2004 year. Graduation of colours refers to the three LHU groups. The white LHU, Parma in Emilia Romagna, was not taken into consideration in the analysis because no information on beds in long term care institutions for the elderly was available.