Assessing the long-term care (LTC) service needs of older adults based on Time-Driven Activity-Based Costing (TDABC)——A cross-sectional survey in central China

Abstract

Background The global population's aging has led to an increasing demand for long-term care (LTC), yet a significant gap exists between the high demand for LTC and the low availability of services, especially in developing countries like China. Comprehensive assessment of LTC service demands by including the time and cost analysis is crucial to inform the planning and financing of LTC resources, yet such research is lacking in China. Methods A cross-sectional study was conducted in Changsha City, Hunan Province, China, from June 2021 to December 2022. A stratified multistage cluster sampling method was used to recruit 1,270 older adults from five nursing homes and three communities/streets in three regions of Changsha City. The LTC service needs were assessed by calculating the service time required from caregivers, nurses, and doctors and the total service time (min/d). Participants' disability, activities of daily living (ADLs), mental status and social involvement (MSSI), and sensory and communication (SC) were assessed using standard scales. Generalized linear regression models were used to analyze factors associated with LTC service needs. Results The participants had an average age of 76.41 ± 8.38 years, with 43.7% being female. The median service time required from caregivers, nurses, and doctors was 53.34 min/d, 3.66 min/d, and 0.33 min/d, respectively, and the total service time was 83.31 min/d. The generalized linear regression model identified the following factors that were associated with higher total service time: Aged 75–84 years, Living in nursing homes, Income over 5000 per month, ADLs, MSSI (9 ~ 40), SC and having 3 ~ 4 kind comorbidity of geriatric (P < 0.05). Conclusions Older adults have a high need for LTC services, especially those provided by caregivers, indicating an urgent need to expand and improve LTC systems. The LTC service time needed is associated with multilevel factors encompassing sociodemographic, functional, and psychological aspects. This study assess the service time required of older adults and their influencing factors based on Time-Driven Activity-Based Costing (TDABC) and offer deeper insights into the needs, demands, and costs of LTC services for older adults and provide essential guidance for future planning and financing of LTC resources.