Local variation in longterm care

This report is about long-term care services in Norway, and describes how the coverage and extent of various services varies with the type of municipality. The data is taken from the IPLOS register, which contains encrypted information about all care recipients in Norwegian municipalities. The report also examines data that up to now has not been used for statistical purposes; data on refusals and the waiting time from when a decision is made up to the implementation of services. The findings for refusals and waiting time should be considered preliminary.

The unit of analysis is type of municipality, rather than municipality. The typology is based on information about the municipalities’ population size, mandatory costs and free income, which in total results in 16 groups of municipalities. See section 1.4 for a detailed description.

Coverage of services

For some types of services there seems to be a correlation between municipality group and coverage (number of recipients as a percentage of population in the relevant age group). Municipality groups with a high free income have the highest coverage of practical assistance, while municipality groups consisting of small municipalities have the best coverage of home nursing. Oslo and the other three main cities (Bergen, Trondheim and Stavanger) have the lowest coverage of home nursing for the population aged 80 years and over.

Municipality groups with high mandatory costs seem to have the highest coverage of long-term care in institutions. In Oslo and the other main cities, the coverage of long-term institutional care for 80-year-olds is higher than the national average. On the other hand, these municipalities have the lowest coverage of fully staffed residential care other than in institutions. All municipality groups consisting of small municipalities have a higher than average coverage of residential care in units that are not staffed 24-7.

Short-term stays in institutions seem to be prioritised in the three main cities excluding Oslo. The differences between municipality groups are relatively small for this type of service. The differences between municipality groups are also small for some other types of services, for instance respite care and user-directed personal assistance. The coverage for practical assistance as training in daily activities seems to be highest in municipality groups with a medium-size population (5 000-19 999 inhabitants).

Extent of services (number of hours per week per recipient)

There is little or no systematic difference between groups of municipalities and the extent of services delivered. One reason for this may be differences between municipalities in how the number of hours granted is registered. The results presented here may be a basis for further studies.

For the most common services, such as practical assistance and home nursing, there is little variation in number of hours delivered per week between groups of municipalities. In groups consisting of small and medium-sized municipalities, recipients with extensive needs are granted significantly more hours per week than corresponding recipient groups in Oslo and the other main cities.

Refusals

Apparently, almost all applications for services were granted (99 per cent), with only 1 per cent of the applications being denied. A further study on how the municipalities register applications is recommended. Almost none of the applications for practical assistance and home nursing were denied (less than 1 per cent), while the percentage of refusals for long-term institutional care was somewhat higher.

Waiting time between decision and implementation of services

Waiting time is calculated as the number of days from the date of decision to the date of actual implementation of the service. There is insufficient data on the date of application, so it has not been possible to calculate the waiting time from application to implementation. In general, the data on dates is incomplete. The results should therefore be considered preliminary. Based on the decisions with known dates, the waiting time is less than 15 days in about four out of five cases. Few recipients had to wait more than 15 days for services such as home nursing and practical assistance. The waiting time for these services varied little between types of municipalities, while the percentage of recipients that waited more than 30 days for admission to a long-term care institution varied from 6 per cent in some of the municipality groups consisting of small municipalities to 24 per cent in the group consisting of Bergen, Trondheim and Stavanger.