Defining Long-Term-Care Need Levels for Older Adults: Towards a Standardized European Classification

ABSTRACT

International comparisons of long-term care (LTC) are hampered by inconsistencies in how to define the need for care. This is especially relevant for the European Union, whose Aging Working Group, which is tasked to project aging expenditure in the long term, has over time used two competing definitions – one based on inability to perform Activities of Daily Living (ADL) and another based on the more subjective Global Activity Limitation Index (GALI). The inconsistency in measurement, as well as problems in defining the intensity of needs, will acquire growing significance as longevity progresses. This paper investigates how the two measures are linked, by analyzing a large European sample survey where respondents replied to both questions. This allows a calibration of the two measures and an investigation of their areas of overlap and difference. The paper concludes by proposing a simple new 4-scale measure of care needs which, by combining the two metrics, introduces some gradation of the intensity of care. Using a consistent measure incorporating intensity, such as the one proposed, will facilitate international comparisons, improve long-term expenditure projections, and aid policy discussion, including the transfer of best practice.

KEYWORDS:

• Long-term care
• public policies for older adults
• Aging
• care need levels
• standardized European classification
• Long-term fiscal planning

Key points

• Europe lacks a consistent definition of needs for long-term care (LTC), an issue which, as longevity progresses, will rise in significance.

• The European Union Aging Working Group overestimates LTC needs, by using the “global activity limitations index” (GALI) as the sole care-need indicator.

• Activities of daily living (ADL) and GALI as measures of LTC need are compared and calibrated using a large European sample of people aged 65+.

• A standardized classification of care-need levels is proposed combining GALI, ADLs, and instrumental activities of daily living (IADLs).

• GALI can complement ADLs and IADLs by introducing some element of severity of need.

Acknowledgments

This paper uses data from SHARE Wave 6 (DOI: 10.6103/SHARE.w6.600), see, Malter and Börsch-Supan (2017) and Börsch-Supan et al. (2013) for methodological details. The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: N°211909, SHARE-LEAP: N°227822, SHARE M4: N°261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the European Commission under the Horizon 2020 Programme (H2020), as part of the project SHARE-COVID19 (grant agreement no. 101015924).