APUCACIÓN DE UN MODEW NUMERICO DE FLUJOS DE ESCOMBROS Y LODO EN UNA QUEBRADA EN EL PERU 87 Autor: Leonardo Franco Castillo Navarro

The preferred projections are Scenarios 3 and 4 which assume declining disability. In these scenarios, despite reduced overall utilisation rates of formal home care among people aged 65 and over, absolute numbers using formal home care are projected to increase from 2006 to 2021 by between 1,578 and 1,866 on average annually, with the annual increase rising over the projection period (Table 8.9). It should be recalled that this is projected utilisation not need. The assumed constant age-cohort and gender-specific utilisation is vulnerable to

changes in the supply of informal carers on the one hand and changes in the supply of public funding for formal home care or the affordability of privately purchased home care on the other.

Table 8.9 Implication of preferred projections for additional numbers using formal home care over the years 2006-2021

Scenario Increase in numbers in receipt of formal home care Annual average projected increase in numbers using formal home care

Annual average projected increase in numbers using formal home care,

5-yearly intervals

2006-2021 2006-2011 2011-2016 2016-2021

3 23,671 1,578 1,051 1,561 2,122

4 27,985 1,866 1,242 1,846 2,508

The projected average annual increase in utilisation over the five years from 2006 to 2011 of between 1,051 and 1,242 additional recipients of formal home care (Table 8.9) can be compared to the actual evolution of utilisation of publicly supplied or funded home care over the years 2006-2011, reviewed in Chapter 5 (Table 5.15 and Table 8.10). Despite erratic fluctuations in provision, there were an estimated annual average additional 415 recipients aged 65 and over of publicly provided or funded home help services in the years from 2006 to 2011, well below the projected numbers. Public home help provision would have exceeded the projected utilisation had it remained on the trajectory of the years 2007 and 2008. A reduction in services occurred following the onset of the fiscal and economic crisis in 2008. There are no available data on the growth in privately purchased formal home care services over this period. Annual average growth in provision of home care packages at 957 comes closer to the projected annual average growth in formal home care utilisation for these years for people aged 65 and over. This greater proportionate growth of home care packages could represent better targeting of formal home care towards people with greater need or, alternatively, could reflect pressures to provide intensive care at home for people awaiting discharge from acute hospitals.

Table 8.10 Estimates of additional numbers using publicly provided or funded formal home care over the years 2006-2021

2006 2007 2008 2009 2010 Sept- 2011 Average annual increase 2006-2011 Home help recipients

aged 65+ 41,596 44,014 46,536 45,622 45,752 43,672

Annual increase in HH

recipients aged 65+ 2,418 2,522 -914 130 -2,080 415

Home care package

recipients aged 65+ 5,146 7,826 8,386 8,372 9,335 9,929 Annual increase in HCP

recipients aged 65+ 2,680 560 -14 963 594 957

Source: HSE database. Home help recipients aged 65+ in 2006 and HCP recipients aged 65+ in 2006 and 2007 estimated based on proportions in subsequent years.

8.5 Projected utilisation of informal community long-term care

A number of measures of provision of informal community long-term care were examined in Chapter 5 (Section 5.7). Data on caring is compiled either primarily from interviews with carers, as in the 2009 Carers' Module of the Quarterly National Household Survey; or from the perspective of the people who receive care, as in the 2006 National Disability Survey. The composite picture developed in Chapter 5 indicates that while there are very large numbers of people (8% of the adult population in 2009) providing a variety of informal support to family members and others, the more intense care-giving is required by people with significant levels of disability. In this chapter projections are for the utilisation of this form of intense care- giving.

The basis for these projections is the NDS evidence on the sources of care for people with ADL difficulty (Table 5.20), which enables projections of informal home care utilisation based on 2006 utilisation patterns, disaggregated by two older age cohorts and by gender. The projected sources of care are those informal care sources in the NDS: family living with you; family not living with you; and friend or neighbour. Unlike the projections above for residential LTC and formal home care, no alternative estimate of utilisation is employed. In these projections the forecast population with disability is the population with ADL difficulty. Informal home care utilisation is therefore projected for only 2 alternative scenarios but for three different sources of care, and for recipients of intense informal care from one or more sources, generating 8 projections in all:

1. A. Pure population basis for forecast need, population cohort-specific utilisation rates assumed constant, projected care from cohabiting family (Table 8.11 and Appendix A Table A.10);

2. A. Forecast need based on forecast population with ADL difficulty, disability cohort- specific utilisation rates assumed constant, projected care from cohabiting family (Table 8.11 and Appendix A Table A.11).

1. B. Pure population basis for forecast need, population cohort-specific utilisation rates assumed constant, projected care from non-cohabiting family (Table 8.11 and Appendix A Table A.12);

2. B. Forecast need based on forecast population with ADL difficulty, disability cohort- specific utilisation rates assumed constant, projected care from non-cohabiting family (Table 8.11 and Appendix A Table A.13).

1. C. Pure population basis for forecast need, population cohort-specific utilisation rates assumed constant, projected care from friend/neighbour (Table 8.11 and Appendix A Table A.14);

2. C. Forecast need based on forecast population with ADL difficulty, disability -cohort- specific utilisation rates assumed constant, projected care from friend or neighbour (Table 8.11 and Appendix A Table A.15).

1. D. Pure population basis for forecast need, population cohort-specific utilisation rates assumed constant, projected numbers of recipients of intense, informal care from one or more sources (Table 8.11 and Appendix A Table A.16);

2. C. Forecast need based on forecast population with ADL difficulty, disability -cohort- specific utilisation rates assumed constant, projected numbers of recipients of intense, informal care from one or more sources (Table 8.11 and Appendix A Table A.17).