Long-term care use among old people in their last 2 years of life: variations across Finland

Abstract

Variations across Finland in the use of six different long-term care (LTC) services among old people in their last 2 years of life, and the effects of characteristics of municipalities on the variations were studied. We studied variations in the use of residential home, sheltered housing, regular home care and inpatient care in health centre wards by using national registers. We studied how the use of LTC was associated with characteristics of the individuals and in particular characteristics of the municipalities in which they lived. Analyses were conducted with multilevel binary logistic regression. Data included all individuals (34,753) who died in the year 2008 at the age of 70 or over. Of those, 58.3% used some kind of LTC during their last 2 years of life. We found considerable variations between municipalities in the use of different kinds of LTC. A portion of the variation was explained by municipality characteristics. The size and location of the municipality had the strongest association with the use of different kinds of LTC. The economic status of the municipality and morbidity at the population level were poorly associated with LTC use, whereas old-age dependency showed no association. When individual-level characteristics were added to the models, these associations did not alter. Results indicated that the delivery system characteristics had an important effect on the use of LTC services. The considerable variation in LTC services also poses questions with respect to equity in access and to quality of LTC across the country.

Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans

“…More affluent regions or municipalities may provide more services (i.e., have lower eligibility thresholds) or be able to attract more providers and this postal code lottery may be exacerbated by older people’s limitations to travel or relocate. On this matter, available empirical findings suggest plenty of geographical variation across countries [ 30 , 31 , 32 , 33 , 34 ], but these seem to be small and closely associated with geographical distribution of need and may not therefore reflect inequity.…”

Observed Risks of Client Safety by Social Care Professionals in Finland

“…In Finland, we know that the distribution of health and social welfare services and access to services are relatively good at the macro level (Pulkki et al, 2015;Vaarama et al, 2014;Valkonen et al, 2014). Even though most clients feel that the accessibility of social services is at a good level, some clients repeatedly reported that client payments were too expensive, services could not be accessed quickly enough, or there were other difficulties with the accessibility of services (Ilmarinen et al, 2016).…”

Does use of long-term care differ between occupational classes among the oldest old? Vitality 90 + Study

“…Upper non-manuals were more frequently in privately provided LTC facilities than other groups. It is known that the care delivery system characteristics, the availability of LTC by different providers, affect the use of LTC services in Finland (Pulkki et al 2016). Participants in this study, however, reside in the same municipality, where service provision is the same for all inhabitants.…”