The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study

Abstract

Background Variation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality. Methods This cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions. Results In total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities’ structural characteristics and care service models were weak. Conclusions The influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.

Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study

“…Municipal clustering in the number of hours of adult day care services allocated was slightly above 20%, which is considerably higher than for home-based services (3.5%). 33 However, except for a significant negative association between unrestricted revenues and allocation of adult day care to care recipients without dementia, the structure and care model of municipalities did not significantly impact the allocation of adult day care. Future research should seek to identify the degree of municipal clustering in allocation of other long-term care services to increase transparency in the allocation process.…”

“…34 , 35 The limited influence of municipality characteristics compared to individual characteristics is consistent with a similar Norwegian study investigating allocation of home-based services and long-term stay in institutions. 33 Consequently, future studies that investigate municipal variation should include individual characteristics given their large influence and diversity across municipalities.…”

“…14 Indeed, a previous Norwegian study using the NRPHC found that municipalities with higher unrestricted revenues allocate more long-term institutional stays. 33 A main reason for this probably stems from the lower costs of adult day care services compared to other long-term care services, especially institutional care. 6 Such unwanted municipal variation based on differing resources should be further investigated to ensure equal and just allocation of services.…”

“…Age is also influential in allocation of home-based services, where a previous study reported that younger care recipients received more hours of care. 33 Older care recipients are, however, more likely to be allocated a long-term institutional stay. 39 …”

“…The decreased likelihood of adult day care services for highly disabled and elderly dementia patients can probably be attributed to a higher chance of long-term institutional stays for this group. 33 Again, we see that younger people with intellectual disability and psychiatric disorders are a priority for home-based rehabilitation, reablement, socialisation and activation. 40…”