WP1 and WP2 were combined to answer the following questions: is it so
that when older adults are required to pay more for a stay in a
nursing home, their admission to a nursing home is postponed? If so,
do they use more home care as a substitute? And has this any adverse
health consequences? We leverage a reform of cost sharing
on LTC that was implemented in the Netherlands. We
find that a higher price for nursing home stays does reduce the time
spent in a nursing home. The offsetting increase in home care use is
small and there is no overall effect on mortality. Because some
people end up staying many years in a nursing home, even a limited
increase in the monthly out-of-pocket payment induces a substantial
rise in the total amount older adults may face over their retirement.
It is often claimed that the help provided to older adults by their
relatives can delay or altogether avoid their nursing home admission.
Is it so? WP8 tackles this question, making use of a unique large
health survey linked with administrative data. We find
that the chance of a nursing home admission is reduced
with informal care for individuals with mild limitations, while it is
increased for individuals with severe limitations. For the latter,
although informal care increases formal care costs, it also results
in lower post-acute care use and mortality.
Following the outbreak of the COVID pandemic, WP9 was initiated. It stems from
the following puzzle: in economics, it is generally assumed that
informal care substitute with home care but vanishes when an
older adult enters a nursing home. Yet, the visit restrictions
imposed on nursing home residents in the early months of the pandemic
seemed to trigger major effects on their daily life.
We show that a majority – over 75% - of residents do receive informal
care. Caregivers are mostly involved in helping with administrative
tasks and mobility within and outside the residence.
WP10 provides an assessment of the aggregate monetary value of the
informal care provided to older adults in France. In this study, we
additionally answer the following question: Are nursing home
residents more likely to receive informal care than older adults in
the community because both populations have different
characteristics, and/or because the determinants of informal care
receipt differ at home versus in nursing homes? We show that both channels are equally relevant
empirically. In the aggregate, informal care for people in the
community remains quantitatively dominant because nursing home
residents represent a limited proportion of all older adults with
care needs and they receive less hours of informal care on average.
Finally, WP11 investigates into options for the financing of long-term care
that have been recently developing in the Netherlands. These options
aim at encouraging ageing-in-place. Has this goal been achieved? Have
these care options played a role in the sustained development of
private nursing homes? How can they contribute to or challenge the
equity in access to long-term care and in its financing in the
Netherlands? Th aim of WP11 is to describe these options and show how
they are being used by older adults, based on aggregate statistics as
well as individual-level data.
