Dementia and long-term care Dementia and long term care

Dementia and long
long-term
term care
Workshop: Monitoring Dementia –
Towards a Dementia Monitoring System
and a Dementia Registry in Germany
Bonn,, 17th November,, 2011
Prof.
f Dr. Heinz
i Rothgang
h
Zentrum für Sozialpolitik
Universität Bremen
Introductory remark
• Centre for Social Policy Research (ZeS) works with claims
data from the GEK for more then 10 years
• We produce the (BARMER) GEK Pflegereport on a yearly
base since 2008, which is a kind of monitor on long-term
long term
care in Germany.
• W
We, ie.
i Rolf
R lf Müll
Müller, R
Rainer
i
U
Unger and
d me plus
l changing
h
i
colleagues
• I mostly report from the Pflegereport 2010, which had a
special focus on dementia.
Prof. Dr. Heinz Rothgang
2
Contents
I.
Long-term care and Dementia – the legal framework
II
II.
Data and measurements
III. Prevalence
IV. Incidence
V.
Dynamics of “careers”
VI Future number of people with dementia
VI.
VII. Expenditures
VIII. Additional services for people with dementia (§ 45b SGB XI)
Prof. Dr. Heinz Rothgang
3
I. Legal framework
• Since 1995: Long-term care insurance (LTCI)
– 90% of population: Social LTCI
– 10% of population: Private mandatory LTCI
• Entitlement
– according to ADL scheme
– with three levels of care
• Basic benefits
– Care allowance (Pflegegeld): informal home care
– Care services at home (Pflegesachleistung): formal home care
– Nursing home care (stationäre Pflege)
Prof. Dr. Heinz Rothgang
4
I. The legal framework: Definition of dependency
See: Rothgang 2010: in Social Policy and Administration
Prof. Dr. Heinz Rothgang
5
I. The legal framework: Definition of dependency
See: Rothgang
g g 2010 in: Social Policy
y and Administration
Prof. Dr. Heinz Rothgang
6
II. Data used (1/2)
• Claims data from GEK (BARMER GEK):
– BARMER GEK: 8.3 Mio. persons insured in December 2009
– GEK: 3.1 Mio. persons insured at one point in time 1999-2009
• Data sets (linked with pseudononomised personal identifier)
– „Stammdaten“: basic data on age, sex, marital status, job status,
insured since …
– Hospital data
– Ambulatory medical service data
– Aides and therapeutical services ((„HeilHeil und Hilfsmittel
Hilfsmittel“))
– LTCI data
•
•
•
LTCI beneficiary, since …
Level of dependency
Benefits received  care arrangement
Prof. Dr. Heinz Rothgang
7
II. Data used (2/2)
• Selection of cases:
– 60 years or older (unless stated otherwise)
– insured with the (BARMER) GEK for at least 4 quarters of a year
• Definition of dementia:
– Based on diagnosis from office-based doctors and hospitals (main
and additional diagnosis)
– Prevalence: as long as one diagnosis within 4 quarters of a year
– ICD-10-GM: F.00-F.03.
(only 3% with G30 (Alzheimer disease) without F
F.00-F.03)
00 F 03)
– Ambulatory: not included it modifier is “Ausschluss”, “Verdacht” or
“Zustand nach”
– Incidence: if diagnosis in one quarter of a year and no respective
diagnosis in the four quarters before.
Prof. Dr. Heinz Rothgang
8
III.1 Comparison of prevalence rates
Prof. Dr. Heinz Rothgang
9
III.1 Prevalence of dementia and need of LTC
LTC & dementia
LTC without dementia
no LTC & dementia
no LTC & no dementia
Men
Women
LTC without dementia > dementia without LTC
Prof. Dr. Heinz Rothgang
10
III.1 Prevalence of dementia and need of LTC
100%
90%
Share of people with
dementia is much
higher for those in
need of LTC
80%
70%
Anteil
60%
50%
40%
Dementia prevalence
is twice as high in
nursing home care
then in home care
30%
20%
10%
0%
60 - 69
70 - 79
80 - 89
90+
60 - 69
Männer
Men
no LTC
ohne
Pflege
70 - 79
80 - 89
90+
Frauen
Women
H
Home
care
ambulante
Pflege
N i h
Nursing
homes
stationäre
Pflege
Source: Rothgang et al. 2008
Prof. Dr. Heinz Rothgang
11
III.2 Prevalence of dementia and need of LTC
• Extrapolated to the German
LTCI population we find (2009):
– 2,108 Mio. in need of LTC
– 1.204 Mio. with dementia
– 0,761 Mio. in need of LTC with
dementia
• Extrapolated to the German
LTCI population aged 60+:
– 1,830 Mio. in need of LTC
– 1.155 Mio. with dementia
– 0,750
0 750 Mio.
Mio in need of LTC with
dementia
Hochrechnung für alle SPV-Versicherten
80%
63 2%
63,2%
60%
40%
36,1%
20%
0%
Anteil der Dementen an den
Pflegebedürftigen
Anteil der Pflegebedürftigen an den
Demente
Hochrechnung für 60-jährige und ältere
80%
64 9%
64,9%
60%
41,0%
40%
20%
0%
Anteil der Dementen an den
Pflegebedürftigen
Anteil der Pflegebedürftigen an den
Demente
Prof. Dr. Heinz Rothgang
12
III.2 Relation between dementia and LTC
• From dementia follows need of LTC
– When dementia is diagnosed
• 64% of men and
• 56% of women
are not in need of LTC
– At the time of death this only holds for
•
•
14% of men and
6% of women
• From need of LTC does not automaticallyy follow dementia.
– At the time of death
• 40% of women in need of LTC and
• 54% off men iin need
d off LTC
don‘t have dementia.
Prof. Dr. Heinz Rothgang
13
III.3 Life-time prevalence for GEK insurees (all ages)
Männer
Men
Frauen
Women
80
70
61,9
60,2
66,7
65
64,3
60
in %
50
40,3
41,6
43,5
45,4
47
40
30
20
10
0
2001
2003
2005
2007
2009
Jahr
Year
Prof. Dr. Heinz Rothgang
14
III.3 Life-time prevalence for Germans dying with age 30+
Source: Rothgang et al. 2011
Prof. Dr. Heinz Rothgang
15
III.3 Life-time prevalence for dementia and LTC
Tabelle 33: Gesamtlebensprävalenz von Demenz und Pflegebedürftigkeit der Verstorbenen der Jahrgänge 2005-2009 hochgerechnet auf Deutschland, in %
Pflegebedürftigkeit
Männer
Ja
Demenz Nein
Summe
Frauen
Ja
Nein
Summe
Ja
Nein
Summe
25
4
29
44
3
47
29
42
71
29
24
63
54
46
100
73
27
100
•
Of those that died in 2005-2009 29% of men and 47% of women had
dementia
 almost every third men and second women will have dementia
before dying
dying.
•
58% of men and 76% of women will have dementia and/or need of LTC
Prof. Dr. Heinz Rothgang
16
III.1 Life-time prevalence for dementia and need of LTC
LTC & dementia
LTC without dementia
no LTC & dementia
no LTC & no dementia
Men
Women
Prof. Dr. Heinz Rothgang
17
IV.1 Comparison of incidence rates
Prof. Dr. Heinz Rothgang
18
IV.2 Incidence of need of LTC according to dementia status
Men
Women
Prof. Dr. Heinz Rothgang
19
IV.3 Incidence dementia according to need of LTC
Men
Women
Prof. Dr. Heinz Rothgang
20
IV.4 Incidence: relative risks in an exponential model
• The relative risk to become a LTCI beneficiary increases
with age. Compared to those aged 50-59 the risk increases
by the factor 9 for those aged 70-79.
• Dementia increases the relative risk accordingly!
(Data from the Pflegereport 2008)
Prof. Dr. Heinz Rothgang
21
V.1 Further life expectancy with and without need of LTC
Prof. Dr. Heinz Rothgang
22
V.1 Further life expectancy with and without need of LTC
for those aged 60 years or older for Germany
30
ohne Pflege
in Jah
hren
25
20
20 04
20,04
mit Pflege
21 21
21,21
23,96
25,1
2,41
2 74
2,74
1,15
1,32
18,89
19,89
21,55
22,37
1999-2003
2004-2008
1999-2003
2004-2008
15
10
5
0
Männer
Frauen
Prof. Dr. Heinz Rothgang
23
V.1 Further life expectancy with and without need of LTC
for those aged 60 years or older for Germany
30
ohne Pflege
in Jah
hren
25
20 04
20,04
mit Pflege
21 21
21,21
23,96
2,41
2 74
2,74
22,37
1,15
1,32
10
18,89
19,89
21,55
5
94,2%
93,8%
89,9%
2004-2008
1999-2003
20
25,1
15


89.1%
0
1999-2003
Männer
2004-2008
Frauen
Prof. Dr. Heinz Rothgang
24
V.2 Care arrangements after dementia diagnosis
Prof. Dr. Heinz Rothgang
25
V.2 Care arrangements after LTCI entitlement
Abbildung 57: Pflegearrangements nicht dementer Männer nach Pflegezugang in
den Jahren 2005/06
Abbildung 59: Pflegearrangements dementer Männer nach Pflegezugang in den
Jahren 2005/06
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
tot
vollstationäre Pflege
formell-ambulante Pflege
informelle Pflege
ohne Pflegearrangement
20%
10%
tot
vollstationäre Pflege
formell-ambulante Pflege
informelle Pflege
ohne Pflegearrangement
20%
10%
0%
0%
1
2
3
4
5
6
7
8
9
10
11
1
12
2
3
4
5
Abbildung 58: Pflegearrangements nicht dementer Frauen nach Pflegezugang in
den Jahren 2005/06
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
tot
vollstationäre Pflege
formell-ambulante Pflege
informelle Pflege
ohne Pflegearrangement
20%
10%
7
8
9
10
11
12
Abbildung 60: Pflegearrangements dementer Frauen nach Pflegezugang in den
Jahren 2005/06
100%
30%
6
Quartale ab Inzidenz
Quartale ab Inzidenz
tot
vollstationäre Pflege
formell-ambulante Pflege
informelle Pflege
ohne Pflegearrangement
20%
10%
0%
0%
1
2
3
4
5
6
7
Quartale ab Inzidenz
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
Quartale ab Inzidenz
Q
Prof. Dr. Heinz Rothgang
26
VI. Projection: Number of people with dementia
4
2010
2030
3
3,8
2060
2,5
23
2,3
1,8
2
1,5
12
1,2
1
0
Anzahl
Mio.
Number
ininmillions
Number of LTCI beneficiaries
2010
2030
2060
2,5
3,9
4,2
Bevölkerungsanteil
in %
Share
of population
People in dementia per LTCI beneficiary
2010
2030
2060
0,48
0,46
0,60
Prof. Dr. Heinz Rothgang
27
VII. Expenditures for people with and without dementia
Abbildung 1: Monatliche Kosten der Kranken- und Pflegekasse für Personen mit
und ohne Demenz im Jahr 2008
Pflege
Arzneimittel
Reha
Krankenhaus
Heilmittel
Hilfsmittel
Ärzte
1.400
1.200
1 000
1.000
• Expenditure for
those with dementia
are 800 Euro higher
than for those
without dementia if
age and sex is
controlled for
800
• Most of it (550 Euro)
shows up in LTCI
600
• But about 300 Euro
show up in SHI
400
200
0
Dem.
60-69
Dem.
70-79
Dem.
80-89
Männer
Dem.
90+
Dem.
60-69
Dem.
70-79
Dem.
80-89
Dem.
90+
Frauen
Prof. Dr. Heinz Rothgang
28
VIII. Additional benefits (§ 45b SGB XI)
Abbildung 1: Hochrechnung zusätzliche Betreuungsleistungen auf die Bevölkerung
der BRD im Alter ab 60 Jahren
0.7%
Männer
Frauen
0.6%
• Die Leistungsausweitung des PfWG
führt zu einer höheren Akzeptanz der
Betreuungsleistung
• Hochgerechnet ist die
Zahl der Leistungsempfänger von 2007
bis 2009 um 100 Tsd.
gestiegen davon
gestiegen,
beziehen nur 5%
keine weiteren SPVLeistungen
0 5%
0.5%
0.4%
0.3%
0.2%
0.1%
0.0%
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
2002
2003
2004
2005
2006
2007
2008
2009
• Die gleiche Quote
ergibt sich bei den
Neufällen
Betreuungsleistungen
nutzen in erster Linie
Pflegebedürftigen!!
Prof. Dr. Heinz Rothgang
29
Prävalenzz (in %) zusäätzlicher Bettreuuungsleistungen
pro Erkrrankungsgru
uppe in der G
Gesamtbevölk
kerung
VIII. Additional benefits – prevalence according to type
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
1
2
3
4
1
2005
2
3
2006
Demenz
4
1
2
3
2007
psychische Erkrankung
4
1
2
3
4
1
2008
2
3
4
2009
geistige Behinderung
Prof. Dr. Heinz Rothgang
30
Veerteilung alleer Empfängerr zusätzlicheer
Betreuung
gsleistungen
n (in%) auf d
die Pflegestu
ufen 0-3
VIII. Additional benefits – utilization according to level of care
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
2002
2003
2004
Pflegestufe 0
2005
Pflegestufe I
2006
Pflegestufe II
2007
2008
2009
Pflegestufe III
Prof. Dr. Heinz Rothgang
31
The end
Thank you for your attention!
(BARMER) GEK Pflegereport can be downloaded for free:
• GEK
G
Pflegereport
f
2008
• GEK Pflegereport 2009
• BARMER GEK Pflegereport 2010
• BARMER GEK Pflegereport 2011 (from 29th November, 2011 onwards)
Prof. Dr. Heinz Rothgang
32
Contents
I.
Long-term care and Dementia – the legal framework
II.
Data and measurements
III.
Prevalence
1.
2.
3.
Prevalence of dementia
g
care
Prevalence of dementia and long-term
Life-time prevalence of dementia and long-term care
IV.
Incidence
V.
Course of events and duration
1.
2.
3.
Survival
Levels of need of LTC
Care arrangement
VI.
Future number of people with dementia
VII.
Expenditures
VIII. Additional services for people with dementia (§ 45b SGB XI)
Prof. Dr. Heinz Rothgang
33