The demand for the public day and night care in institutions and sheltered housing towards 2060

This report projects the demand for the public day and night care in institutions and sheltered housing (abbreviated from Norwegian to HDOP) towards 2060. Such projections are important for public policy decisions on the future capacity of these services. The main purpose of our projections is to provide quantitative information about the long run consequences of prolonging current policies. Thereby, they can be used to motivate policy changes in time to counteract undesirable trends. Thus, there is a good reason for assuming prolongation of current policies, although it may turn out as unrealistic when considered in hindsight. Specifically, none of our scenarios include reallocation of long-term care from institutions to home services, which is a one of the goals for today’s health and social policy.

However, our ambition is to be as realistic as possible with respect to assumptions about potentially important conditions that are determined mainly by other factors than policy. These include future changes in the size and the age structure of the population, the age- and gender dependency of the demand for public care services, the age specific states of individual health, as well as the supply of informal care provided by family members that reduces the need for public care. The HDOP-demand is calculated by multiplying i) HDOP per user of public care, ii) user ratios by age and gender (i.e. users of public care per person), and iii) number of persons of given age and gender.  

The demographic changes in all our projections are identical to the Main Alternative in the population forecasts made and published by Statistics Norway in 2018. We study two scenarios for the future state of health for persons of age 55 or older:

1. Constant health states: Age- and gender specific user ratios of 2017 are prolonged for the whole projection period.
2. Improved health states for males and females older than 54 years: User ratios for these persons decline, and the decline is related directly to the decline in corresponding death rates, with the health state at age 54 as the lower bound.

Furthermore, we study two scenarios for informal family care:

1. Family care increases proportionally to the demand for public care.
2. Constant family care at the estimated 2017-level of 90 000 man years.

The projection chosen to be our reference scenario is characterized by constant family care and improved health states. Here the HDOP demand grows from the observed occupancy of 65 252 in 2017 to – approximately – 87 000 in 2035 and 133 000 in 2060. This includes a rise in sheltered housing residents from 23 261 in 2017 to 30 000 in 2035 and 42 000 in 2060. The projected growth in HDOP is stronger than projections published in 2016 based on similar assumptions (Holmøy, Haugstveit and Otnes, 2016). The difference passes 19 400 in 2060.

The difference between our scenarios become gradually more significant after two decades. In our minimum scenario, in which health states improve and family care grows, HDOP passes 78 300 in 2035 and 109 300 in 2060. In our maximum scenario, where neither health states and family care change, HDOP grows to 121 100 already in 2035 and further to 228 300 in 2060. The difference between the minimum and the maximum scenario in 2060 is close to 119 000.