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
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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
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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
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I. The legal framework: Definition of dependency
See: Rothgang 2010: in Social Policy and Administration Prof. Dr. Heinz Rothgang
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I. The legal framework: Definition of dependency
See: Rothgang g g 2010 in: Social Policy y and Administration Prof. Dr. Heinz Rothgang
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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
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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
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III.1 Comparison of prevalence rates
Prof. Dr. Heinz Rothgang
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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
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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
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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
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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
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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
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III.3 Life-time prevalence for Germans dying with age 30+
Source: Rothgang et al. 2011 Prof. Dr. Heinz Rothgang
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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
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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
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IV.1 Comparison of incidence rates
Prof. Dr. Heinz Rothgang
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IV.2 Incidence of need of LTC according to dementia status
Men
Women
Prof. Dr. Heinz Rothgang
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IV.3 Incidence dementia according to need of LTC
Men
Women
Prof. Dr. Heinz Rothgang
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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
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V.1 Further life expectancy with and without need of LTC
Prof. Dr. Heinz Rothgang
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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
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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
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V.2 Care arrangements after dementia diagnosis
Prof. Dr. Heinz Rothgang
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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
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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
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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
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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
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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
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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
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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
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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
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