Elderly people living at home for longer increases pressure on other care

People walk down the Coolsingel in Rotterdam.

The population is ageing, and that gives rise to a major social challenge. PhD student Marlies Bär (Erasmus School of Health Policy & Management) has explored this issue in detail. Elderly people are encouraged to live at home for longer in order to reduce the pressure on nursing homes. But Bär's thesis shows that this actually increases the pressure on care in other places. Her research also shows that shortening nursing home waiting times can prevent hospital admissions, thereby reducing the overall pressure on care.

Long-term care is for elderly people who need 24-hour care. And this group is only getting bigger at a time when the pressure on care is already high. "If resources, such as public money and manpower, are not used efficiently, other important issues suffer", says Marlies Bär. But how do we deploy those resources effectively? That is a central question in her research.

Living at home longer isn’t always the solution

In the Netherlands, a great deal of effort is being made to enable elderly people to live at home longer. On the face of it, that seems like a good solution. Not only to reduce the pressure on nursing homes and cut costs, but also because many people prefer to stay in their own homes for as long as they can. But, according to Bär, it’s not that clearcut, because elderly people who have to live at home for longer are more likely to end up in hospital. Elderly people often have a fall at home and have to be admitted to hospital as a result. In a nursing home, that fall could have been prevented. There are staff there to look after them and design choices have been made that take fall prevention into account.

“Elderly people living at home longer does mean less pressure on nursing homes. But those people are more likely to end up in hospital. Including all that that entails", says Bär. And that therefore means that hospital beds are needed and informal care comes under more pressure. "With our research, we want to show that it’s also important to consider these external factors in policy choices."

Hard to choose the 'best' nursing home

But even if you do ultimately want to go into a nursing home, it is not always easy to find an institution that meets your needs. An interesting finding by Bär is that the quality indicators of nursing homes bear little relation to residents' longevity. "Is it a big nursing home or a small nursing home? How many staff are present? There is a lot of information about this. But information on outcomes is scarce. So, the question ‘Where is a resident best off?’ is almost impossible to answer. If, as an elderly person, you want to choose a nursing home where you have the lowest chance of hospitalisation, you can't actually do that because that information is not available."

And this doesn’t just affect the elderly themselves. It also prevents healthcare purchasing organisations from including information on outcomes in their purchasing decisions. Even though research shows that making this kind of information publicly available improves overall quality. Nursing homes are more motivated to deliver better care when they are judged accordingly. And elderly people are in a better position to choose an appropriate nursing home if they have access to this information. But things still need to change. Because with the long waiting times for nursing homes now, most people have virtually no choice.

Fewer hospital admissions due to shorter waiting times

In the media and politics the growing waiting times for care are often discussed. According to Bär's research, reducing waiting times for nursing homes can reduce hospital admissions among the elderly. "In a group of 100 elderly people with dementia, we are currently seeing an average of 13 hospital admissions. When the waiting time is reduced by a month, for every 100 elderly people on the waiting list, 3 fewer go to hospital", says Bär. In other words, a reduction in waiting time of one month leads to around one in four hospital admissions being prevented.

Bär puts it like this: "As time goes on, we will have to contend with a growing group of elderly people and a shrinking group of people to take care of them. That’s why it’s so important now to look at how care can be organised more efficiently. How resources, such as public spending and manpower, can be deployed to deliver the best care to those who need it most. That is what I am trying to achieve with my research."

Researcher

(Marlies) M Bar