People in need of long-term care: the present and the future
Destatis, 7 November 2008
No one wants to need long-term care, but it happens to more and more people. The risk of requiring help with day-to-day activities because of physical or mental impairments increases with age. The demographic change, which has resulted in growing numbers of old people, imposes ever-increasing demands on our health care and social security systems, and not least, on long-term care insurance.This contribution examines the development of the need for long-term care using two scenarios: One scenario assumes constant rates of people requiring long-term care, while the other is based on declining care rates.
Well over two million people require long-term care in Germany
Pflegequoten nach Alter und Geschlecht
According to results of the statistics on long-term care, which are compiled every two years, a total of 2.13 million people in Germany required long-term care as defined by the Long-term Care Insurance Act in December 2005. Of these, 68% were women. The majority (82%) of them were 65 years old or older, while a third (33%) were aged 85 or over. The rate of people in need of care increases with age. While "only" every twentieth (5%) of those aged 70 to under 75 years needed care, 60% of all people aged 90 years or over required long-term care.
More than two thirds (68% or 1.45 million) of the people in need of care received domiciliary care in December 2005. Of them, 980,000 only received long-term nursing care allowances, which meant that, as a rule, they were cared for at home by relatives alone. Another 472,000 people in need of care lived in private households, but received full or part-time home care services. 677,000 (32%) of the people requiring care were accommodated in residential care or nursing homes.
Ever since long-term care statistics were first compiled, the number of people requiring long-term care has risen continuously at federal level: From 2.02 million in 1999, it grew to 2.13 million in 2005, which was an increase of about 6%, or 112,000, over that period. The proportion of those requiring long-term care in the total population showed a slight increase from 2.5% to 2.6%. In 1999, 3.6% of the population were 80 years old or more. In 2005, their share had increased to 4.5%.
A comparison over time also shows that there is a trend towards professional care in care homes or by home care services: The number of persons receiving care in residential care or nursing homes rose by about 18% (+103,000) and that of persons cared for by home care services by 14% (+56,000) as compared to 1999. In contrast, the number of those cared for by relatives, i.e. of persons who only received nursing care allowances, decreased by 5% (-47,000). This development also led to a decline in the proportion of people in domiciliary care from 72% in 1999 to 69% in 2003 and to 68% in 2005.
2030: 3.4 million persons in need of care (status-quo scenario)
The statistical offices of the Federation and the Länder have developed model computations to estimate the future effects of demographic change on the people in need of long-term care. The basic variant of the model computation assumes that the age-specific rates of people requiring long-term care will be identical with the present care rates (status-quo scenario). Consequently, no account is taken, for instance, of possible medical-technical progress in this field.
According to this model computation, the number of people in need of care is likely to rise from 2.13 million in 2005 to 2.40 million in 2010. The total is expected to reach 2.91 million in 2020 and about 3.36 million in 2030. The number of people in need of care will increase by more than a third (37%) between 2005 and 2020, and by 58% from 2005 to 2030. The increase up to 2030 will be higher for men, at 74%, than for women (50%). At the same time, the proportion of people requiring care in the total population will rise: from 2.6% today to 3.6% in 2020 and, finally, to 4.4% in 2030.
Marked shifts can be observed in the age-related structures: While about 33% of the people in need of care were 85 years old or older in 2005, the relevant age group will account for some 41% in 2020 and for about 48% in 2030. In contrast, those aged under 60 years will account for lower percentages: Their proportion in the total of persons requiring care will drop from 14% in 2005 to 10% in 2020 and to well over 7% in 2030.
Lower risk of care because of medical-technical progress (scenario of "declining care rates")
Persons in need of care in Germany from 1999 to 2030
A second, more optimistic scenario is based on the assumption that medical-technical progress will reduce the risk of developing a need for long-term care across the age groups. The expected increases in life expectancy in the relevant ages serve as guideline values, which means that the risk of developing a need for long-term care is postponed to later ages in accordance with the increase in life expectancy.
The scenario of "declining care rates" has a dampening effect; however, the total number of people requiring care rises in this scenario as well. It is expected to total about 2.68 million in 2020 and to reach about 2.95 million in 2030. Consequently, there will be an increase of 26% until 2020 and of 39% until 2030.
The proportion of people in need of care in the total population will reach 3.4% in 2020 and 3.8% in 2030, and thus will be slightly lower than in the first scenario. Persons requiring care at the age of 85 or over will however account for a slightly higher proportion of the total of people in need of care than in the status-quo scenario (2020: 42%; 2030: 51%).
Supplementary information about the model computations
The results of the model computations are not forecasts but only illustrate what effects in particular the demographic development could have on the number of persons in need of long-term care. The model computations are based on simple assumptions concerning the need for long-term care, which have been derived from the current situation and the existing institutional framework conditions, and on the results of the 11th coordinated population projection according to the variant representing the lower threshold of the "medium" population.
Author:
Heiko Pfaff – Federal Statistical Office
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