Ageing, disability and long-term care

Introduction The probability of entering a nursing home is not the same for everyone. Age, being a woman, and living alone are all risk factors. These risk factors are also interrelated: women have a higher probability of entering a nursing home, largely because they live longer and are more likely to live alone during their last years. Disability also increases the risk of entering a nursing home. The more assistance a person needs, the greater the risk of being institutionalized. Certain types of disabilities have also been associated with increased risk of nursing home admission. For example, people who are cognitively impaired have a greater probability of entering a nursing home because cognitive disorders usually require constant supervision. The existence of informal caregivers reduces the risk of nursing home use. Many studies have closely examined the role of informal caregivers in reducing the probability of nursing home admission. These studies also show that the attitude families have towards nursing homes influences the institutionalization of a family member. Most users of nursing-home care have multiple and severe impairments, and they are dependent for care in more than three activities of daily living. In relation to general health, the institutionalized elderly have a multiple variety of diagnoses. The more common are diseases of the circulatory system, along with the mental disorders associated with that problem. Those with dementia normally have behavioral problems. Many recent studies have estimated that nursing home utilization rates may be declining, and that the decline will continue to occur even though the number of very old is increasing. However, it is difficult to find a simple reason to explain trends in institutionalization. Declining utilization rates can be better explained by a reduction of supply, rather than by a decrease in the of prevalence of severe disability. Financing of nursing home care – and who pays for it – is a particularly salient issue with regard to public expenses. Admission control, and payment for complexity, thus become priorities for those who manage this type of long-term care. The group includes family members, providers, and care-payers. In Portugal, the payment for long-term care is a co-payment divided between the elderly, or their family members, and the state.