Long-term care need in urban China : Haidian, Beijing

Abstract

Background: Results from various studies of Long-term Care (LTC) need in China have remained confusing with LTC rates ranging from 2.4% to 22%. Therefore, it has been difficult to ascertain LTC’s sustainability in China. Methods: 672 households with people aged 60+ in Haidian, Beijing, were successfully interviewed between June – August, 2011. interRAI – Home Care assessment tool and scales were used to identify LTC impairment, LTC services use and want, and LTC services drivers. Findings: If LTC need refers to LTC impairment, based on population of Haidian in 2010, it was estimated 3.7% or 14,000 persons aged 60+ in Haidian have LTC impairment. If LTC need refers to people’s use or want of LTC services, it was estimated 38.7% or 147,000 persons aged 60+ in Haidian used and wanted LTC services. In specific, 11.9% (45,000) used Community Care (CC), 6.7% (25,000) and 20.1% (77,000) wanted Residential Care and CC respectively. LTC impairment rate as identified by this study was lower than most of other LTC studies in China, probably due to varied impairment identification and measurement mechanisms. LTC impairment tended to be affected by social activity level (OR: Odds Ratio = 0.29), subjective environmental hazards (OR = 0.20) and poor self-rated health (OR = 2.00). In addition, as compared to their counterparts, respondents with LTC impairment tended to be older; with “fewer” education, social activity and good health practice; and “high” in caregiver stress, objective environmental hazards, behavioral problems and depressive symptoms. There was no statistically significant relationship between LTC impairment and LTC services use/want. For those who used/wanted LTC services, 95% had no LTC impairment. For those with LTC impairment, 54.2% used or wanted LTC services. As compared to their counterparts, respondents who used or wanted LTC services tended to be in more favorable conditions: younger, higher education, more income, living with others, socially active, good self-rated health and more good health practice. These people also tended to have fewer objective environmental hazards, caregiver stress, chronic conditions, behavioral problems, and depressive symptoms. Use of CC was driven by higher age (OR: Odds Ratio = 1.088), being female (OR = 0.268), higher education (OR = 0.260), higher income (OR =3.218), and more objective environmental hazards (OR = 2.522). CC want was driven by higher age (OR = 1.050), being female (OR = 0.625), higher education (OR = 0.348) and more depression (OR = 1.235). Good health practice was the only factor that affecting RC want (OR = 2.842). The overall Pseudo R^2 was 0.219. Implications: Better projection of LTC impairment and LTC services use/want via standardized assessment tool is needed in China. There is also a need to address the issue of mismatch in LTC impairment and services. This is to ensure allocation of LTC services is based on LTC impairment and not because of higher income or education.