APLICACIÓN DE UN MODELO NUMERICO DE FLUJOS DE ESCOMBROS Y LODO EN UNA QUEBRADA EN EL PERU 37 Autor: Leonardo Franco Castillo Navarro

Informal care in the community relates to care that is provided to those aged 65 years and over by a spouse/partner, sibling, offspring, other family members, friends and neighbours. In many cases individuals will receive care from a number of informal sources and this may also be supplemented by formal care provided by statutory health service providers and/or care provided by other organisations such as charities and voluntary bodies. In some instances older people may not receive any form of care.

To determine sources of care among respondents in the NISALD who had already been identified as having limitations in day-to-day activities and as therefore requiring care, this analysis focuses on a question within the survey that asked: “Can you tell me who, if anyone, helps you with the activities you have difficulty with?” Such activities related to aspects of daily living, for example, preparing meals, everyday housework, and personal care (such as dressing, bathing, etc.). Possible responses were: spouse/partner; son or daughter; parent; brother/sister; other relative; housemate, friend or neighbour; statutory health services provider; voluntary or charitable organisation; other person or organisation; and no one helps me. The NISALD data are not entirely comparable to the NDS data for the Republic of Ireland since the definitions employed implicitly separate privately purchased formal care from formal care from statutory providers. This makes it a complex task to identify all recipients of public and private formal home care combined or to separate a category that receives informal care only. Privately purchased home care would appear most likely to be included in the category of "other person or organisation". In this analysis responses have been aggregated into five categories of care:

 Formal care (from statutory provider only or combined with other formal care providers):Respondents are categorised as receiving formal care if they indicated that they were either receiving help only from a statutory health services provider or from a statutory health services provider combined with care from a voluntary or charitable organisation and/or other person or organisation.

 Informal care only or combined with care from non-statutory provider:

Respondents are categorised as receiving informal care if they indicated that they were receiving help from a spouse/partner, son or daughter, parent, brother/sister, other relative, housemate, friend or neighbour. Additionally, any respondents who reported receiving care from these informal sources combined with care from non-statutory provider (i.e. a voluntary or charitable organisation and/or other person or organisation) are also deemed to be in receipt of informal care. This category could therefore include recipients of privately purchased care.

 Informal care combined with care from statutory provider: Respondents are categorised as receiving formal and informal care if they indicated that they were receiving help from both informal sources and a formal statutory provider. This category also includes any respondents who indicated that they were in receipt of care

from a voluntary or charitable organisation or other person or organisation in addition to both informal and statutory care.

 Only care from non-statutory provider: Respondents are categorised as receiving other care if they indicated that they were receiving help only from a voluntary or charitable organisation or other person or organisation.

 No care: The final category of respondents is those who indicated that they were not receiving any form of care.

Table 6.5 and Figure 6.5 show the frequencies and percentages for each of the five categories of care in the community for the sample overall and by age cohort and gender. Table 6.5 also shows frequencies and percentages for the more aggregated age groupings of 65 years and over and 75 years and over. Results indicate that for the youngest age group, the majority of respondents (approximately 85%) were receiving care from informal sources only or combined with care from non-statutory providers. Only a very small percentage of respondents in this age group were not receiving any care (3.1% overall). For the 75 to 84 year age group, results indicate that respondents were making somewhat more use of statutory sources of formal care or were receiving a combination of formal care from statutory sources and informal sources of care. An even smaller percentage of respondents than for the 65 to 74 year age group reported not receiving any care (1.3% overall). By the time respondents were in the oldest age group (85+), there was an almost equal reliance on informal care only or combined with non-statutory sources of formal care and informal plus statutory sources of care. There was also somewhat more reliance on statutory sources of care without informal care for this age group but this represents a relatively low level of usage, ranging from 7% for women and 11.1% for men. None of the respondents in this age group reported receiving no care.

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Table 6.5 Frequencies and percentages for types and combinations of care provided in the community to those aged 65 years and over with ADL difficulty. NISALD 2006

Aged 65-74 Aged 75-84 Aged 85 and over Aged 65 and over Aged 75 and over MALE N % N % N % N % N %

Informal care + care from

statutory provider 8 6% 17 19% 9 50% 34 14% 26 24%

Informal care only or + care

from non-statutory provider 113 86% 70 76% 7 39% 190 79% 77 70%

Formal care (statutory only/ +

non-statutory provider) 3 2% 4 4% 2 11% 9 4% 6 5%

Only care from non-statutory

provider 3 2% - - - - 3 1% - -

No care 5 4% 1 1% - - 6 3% 1 1%

FEMALE

Informal care + care from

statutory provider 15 9% 37 26% 26 46% 78 22% 63 32%

Informal care only or + care

from non-statutory provider 137 85% 91 65% 25 44% 253 70% 116 59%

Formal care (statutory only/ +

non-statutory provider) 2 1% 7 5% 4 7% 13 4% 11 6%

Only care from non-statutory

provider 4 3% 4 3% 2 4% 10 3% 6 3%

No care 4 3% 2 1% - - 6 2% 2 1%

TOTAL

Informal care + care from

statutory provider 23 8% 54 23% 35 47% 112 19% 89 29%

Informal care only or + care

from non-statutory provider 250 85% 161 69% 32 43% 443 74% 193 63%

Formal care (statutory only/ +

non-statutory provider) 5 2% 11 5% 6 8% 22 4% 17 6%

Only care from non-statutory

Figure 6.5 Proportions in which care received by men and women living in the community with ADL difficulty by age and gender, 2006 NISALD

Note: these pie diagrams are not directly comparable with those for the Republic of Ireland in Chapter 5 (Figures 5.2 and 5.3). The pies do not include a category for informal care only.

6.6 Residential care - analysis of current utilisation

To project future utilisation rates of residential LTC, it is necessary to establish the current number of residents in nursing and residential homes in Northern Ireland. In practice this information is difficult to ascertain. The Regulation and Quality Improvement Authority (RQIA), who have a statutory responsibility for the registration, regulation and inspection of care homes, do not hold information about the number of residents in or admissions to care homes. The Northern Ireland Audit Office (NIAO) stated that in March 2009 there were 9,500 places occupied in care homes for the older people in Northern Ireland but information on yearly admissions was not available (Comptroller and Auditor General 2010).

The DHSSPSNI Elderly Care in the Community division carries out a census on the 31st March of each year to determine the number of service users in residential care. In 2010, there were 264 residential homes for older people in Northern Ireland providing 4,932 available places. These data exclude nursing homes. At the same census point there were 9,677 older people in Northern Ireland benefiting from residential care (31%) or nursing home care (69%) packages. This does not include private treatment in nursing and residential homes. Available spaces increased by 11% from 4,444 in 2005/6 to 4,932 in 2009/10. The increase in care packages over this time was smaller at 3%. The DHSSPSNI does not provide statistics on the number of new care packages issued each year (i.e., on the yearly admissions to care homes).

In light of the limitations in establishing accurate rates of care home utilisation or the age and gender of residents, these data had to be estimated from two alternative sources. The total number of residents in care homes was taken as the number of care packages allocated to those aged 65 years and over, derived from the DHSSPSNI’s Community Statistics bulletin for Northern Ireland in 2006/2007 (DHSSPS 2006/2007). Since this source does not provide a breakdown of how care packages were allocated by age and gender, this was estimated from a separate exercise in which addresses of residences designated as Care Homes by the RQIA had been linked to people registered for a health card in Northern Ireland at the Business Services Agency. This produced an accurate list of people living in care homes, though because of data restrictions this was only possible for 2008 and was restricted to five-year age cohorts. The age-specific distributions in 2008 were then applied to the 2006 care package totals to give an estimated age/gender breakdown of care home residents in 2006, the assumption being that the distributions were unchanged over this two-year period. From these estimates it was possible to calculate: the proportion of the population in each age/gender group in care; and the proportion of those in each age/gender group with a disability who were in care (Table 6.6). These estimates are used in the modelling of projected utilisation in Chapter 9.

The approach adopted in this analysis for Northern Ireland of basing the definition of residential LTC utilisation on the number of care packages allocated to those aged 65 years and over has the effect of excluding residents who pay privately for care homes and people who reside in elderly care hospital beds, categories of residential LTC that are included in the

definition of residential LTC utilisation for the Republic of Ireland. The implication of such differing definitions for the comparability of the utilisation estimates and projections in this analysis is discussed in Chapter 10.

Table 6.6 Estimates of numbers and proportions of the population in care homes in Northern Ireland in 2006 Aged 65-69 Aged 70-74 Aged 75-79 Aged 80-84 Aged 85-89 Aged 90 and over Aged 65 and over MALE Population 33,280 26,920 20,051 12,756 5,861 2,019 100,887 Numbers in residential care 174 287 479 574 569 366 2,448 % Population in care 0.5% 1.1% 2.4% 4.5% 9.7% 18.1% 2.4%

Total with disability 5,305 4,308 4,139 3,899 1,765 838 20,256

% With disability in care 3.3% 6.7% 11.6% 14.7% 32.2% 43.6% 12.1% FEMALE Population 36,843 32,529 28,651 22,007 12,037 6,393 138,460 Numbers in residential care 222 376 876 1,618 2,031 2,015 7,137 % Population in care 0.6% 1.2% 3.1% 7.4% 16.9% 31.5% 5.2%

Total with disability 6,594 5,135 7,820 6,307 5,303 4,708 35,866

% With disability in care 3.4% 7.3% 11.2% 25.6% 38.3% 42.8% 19.9% TOTAL Population 70,123 59,449 48,702 34,763 17,898 8,412 239,347 Numbers in residential care 397 662 1,356 2,191 2,598 2,382 9,585 % Population in care 0.6% 1.1% 2.8% 6.3% 14.5% 28.3% 4.0%

Total with disability 11,901 9,480 11,772 10,204 7,005 5,566 55,927 % With disability in

care 3.3% 7.0% 11.5% 21.5% 37.1% 42.8% 17.1%

Note: this analysis of utilisation of residential care is limited to the population in care homes who are in receipt of care packages. Numbers in receipt of care packages in 2006 are disaggregated by age and gender in proportion to an analysis of residents in 2008 by linking datasets as described in text. Numbers with disability are estimated as demonstrated in Table 6.4.

6.7 Conclusion

This chapter has provided an overview of population estimates and current levels of disability and utilisation of care for those aged 65 years and over in Northern Ireland in 2006. Examination of sources of care in the community of persons with disability demonstrates reliance on informal care alone or in combination with non-statutory sources of care for the majority of the younger cohorts aged 65-74 and 75-84. There is an increasing use of both formal care from statutory providers and informal care provision with advancing age. There

were very few individuals aged 65 years and over who reported receiving no care in the community. Information presented in this chapter provides the basis for projecting residential and long-term care needs in the community in 2011, 2016, and 2021 in Chapter 9.