Workshop: Monitoring Dementia Towards a Dementia Monitoring System and a Dementia Registry in Germany. Bonn, 17th November, 2011

Transkript

1 Dementia and long-term care Workshop: Monitoring Dementia Towards a Dementia Monitoring System and a Dementia Registry in Germany Bonn, 17th November, 2011 Prof. Dr. Heinz Rothgang Zentrum für Sozialpolitik Universität Bremen

2 Introductory remark Centre for Social Policy Research (ZeS) works with claims data from the GEK for more then 10 years We produce the (BARMER) GEK Pflegereport on a yearly base since 2008, which is a kind of monitor on long-term care in Germany. We, ie. Rolf Müller, Rainer Unger and me plus changing colleagues I mostly report from the Pflegereport 2010, which had a special focus on dementia. Prof. Dr. Heinz Rothgang 2

3 Contents I. Long-term care and Dementia the legal framework II. III. IV. Data and measurements Prevalence Incidence V. Dynamics of careers VI. Future number of people with dementia VII. Expenditures VIII. Additional services for people with dementia ( 45b SGB XI) Prof. Dr. Heinz Rothgang 3

4 I. Legal framework Since 1995: Long-term care insurance (LTCI) 90% of population: Social LTCI 10% of population: Private mandatory LTCI Entitlement according to ADL scheme with three levels of care Basic benefits Care allowance (Pflegegeld): informal home care Care services at home (Pflegesachleistung): formal home care Nursing home care (stationäre Pflege) Prof. Dr. Heinz Rothgang 4

5 I. The legal framework: Definition of dependency See: Rothgang 2010: in Social Policy and Administration Prof. Dr. Heinz Rothgang 5

6 I. The legal framework: Definition of dependency See: Rothgang g 2010 in: Social Policy and Administration Prof. Dr. Heinz Rothgang 6

7 II. Data used (1/2) Claims data from GEK (BARMER GEK): BARMER GEK: 8.3 Mio. persons insured in December 2009 GEK: 3.1 Mio. persons insured at one point in time Data sets (linked with pseudononomised personal identifier) Stammdaten : basic data on age, sex, marital status, job status, insured since Hospital data Ambulatory medical service data Aides and therapeutical services ( Heil- und Hilfsmittel ) LTCI data LTCI beneficiary, since Level of dependency Benefits received care arrangement Prof. Dr. Heinz Rothgang 7

8 II. Data used (2/2) Selection of cases: 60 years or older (unless stated otherwise) insured with the (BARMER) GEK for at least 4 quarters of a year Definition of dementia: Based on diagnosis from office-based doctors and hospitals (main and additional diagnosis) Prevalence: as long as one diagnosis within 4 quarters of a year ICD-10-GM: F.00-F.03. (only 3% with G30 (Alzheimer disease) without F.00-F.03) F 03) Ambulatory: not included it modifier is Ausschluss, Verdacht or Zustand nach Incidence: if diagnosis in one quarter of a year and no respective diagnosis in the four quarters before. Prof. Dr. Heinz Rothgang 8

9 III.1 Comparison of prevalence rates Prof. Dr. Heinz Rothgang 9

10 III.1 Prevalence of dementia and need of LTC LTC & dementia LTC without dementia no LTC & dementia no LTC & no dementia Men Women LTC without dementia > dementia without LTC Prof. Dr. Heinz Rothgang 10

11 III.1 Prevalence of dementia and need of LTC 100% 90% 80% 70% 60% Share of people with dementia is much higher for those in need of LTC Anteil 50% 40% 30% Dementia prevalence is twice as high in nursing home care then in home care 20% 10% 0% Men Männer Women Frauen ohne no LTC Pflege ambulante Home care Pflege stationäre Nursing homes Pflege Source: Rothgang et al Prof. Dr. Heinz Rothgang 11

12 III.2 Prevalence of dementia and need of LTC Extrapolated to the German LTCI population we find (2009): 2,108 Mio. in need of LTC Mio. with dementia 0,761 Mio. in need of LTC with dementia 80% 60% 40% 20% 0% Hochrechnung für alle SPV-Versicherten 36,1% Anteil der Dementen an den Pflegebedürftigen 63,2% Anteil der Pflegebedürftigen an den Demente Extrapolated to the German LTCI population aged 60+: 1,830 Mio. in need of LTC Mio. with dementia 0,750 Mio. in need of LTC with dementia 80% 60% 40% 20% 0% Hochrechnung für 60-jährige und ältere 41,0% Anteil der Dementen an den Pflegebedürftigen 64,9% Anteil der Pflegebedürftigen an den Demente Prof. Dr. Heinz Rothgang 12

13 III.2 Relation between dementia and LTC From dementia follows need of LTC When dementia is diagnosed 64% of men and 56% of women are not in need of LTC At the time of death this only holds for 14% of men and 6% of women From need of LTC does not automatically follow dementia. At the time of death 40% of women in need of LTC and 54% of men in need of LTC don t have dementia. Prof. Dr. Heinz Rothgang 13

14 III.3 Life-time prevalence for GEK insurees (all ages) Männer Men Frauen Women ,2 61,9 64, ,7 in % ,3 41,6 43,5 45, Jahr Year Prof. Dr. Heinz Rothgang 14

15 III.3 Life-time prevalence for Germans dying with age 30+ Source: Rothgang et al Prof. Dr. Heinz Rothgang 15

16 III.3 Life-time prevalence for dementia and LTC Tabelle 33: Gesamtlebensprävalenz von Demenz und Pflegebedürftigkeit der Verstorbenen der Jahrgänge hochgerechnet auf Deutschland, in % Pflegebedürftigkeit Männer Frauen Ja Nein Summe Ja Nein Summe Ja Demenz Nein Summe Of those that died in % of men and 47% of women had dementia almost every third men and second women will have dementia before dying. 58% of men and 76% of women will have dementia and/or need of LTC Prof. Dr. Heinz Rothgang 16

17 III.1 Life-time prevalence for dementia and need of LTC LTC & dementia LTC without dementia no LTC & dementia no LTC & no dementia Men Women Prof. Dr. Heinz Rothgang 17

18 IV.1 Comparison of incidence rates Prof. Dr. Heinz Rothgang 18

19 IV.2 Incidence of need of LTC according to dementia status Men Women Prof. Dr. Heinz Rothgang 19

20 IV.3 Incidence dementia according to need of LTC Men Women Prof. Dr. Heinz Rothgang 20

21 IV.4 Incidence: relative risks in an exponential model The relative risk to become a LTCI beneficiary increases with age. Compared to those aged the risk increases by the factor 9 for those aged Dementia increases the relative risk accordingly! (Data from the Pflegereport 2008) Prof. Dr. Heinz Rothgang 21

22 V.1 Further life expectancy with and without need of LTC Prof. Dr. Heinz Rothgang 22

23 V.1 Further life expectancy with and without need of LTC for those aged 60 years or older for Germany in Jah hren ohne Pflege mit Pflege 20, ,21 1,15 1,32 18,89 19,89 23,96 25,1 2, ,74 21,55 22, Männer Frauen Prof. Dr. Heinz Rothgang 23

24 V.1 Further life expectancy with and without need of LTC for those aged 60 years or older for Germany in Jah hren ohne Pflege mit Pflege 20, ,21 1,15 1,32 18,89 19,89 23,96 25,1 2, ,74 21,55 22, ,2% 93,8% 89,9% 89.1% Männer Frauen Prof. Dr. Heinz Rothgang 24

25 V.2 Care arrangements after dementia diagnosis Prof. Dr. Heinz Rothgang 25

26 V.2 Care arrangements after LTCI entitlement Abbildung 57: Pflegearrangements nicht dementer Männer nach Pflegezugang in den Jahren 2005/06 100% 90% 80% 70% 60% 50% 40% 30% tot 20% vollstationäre Pflege formell-ambulante Pflege 10% informelle Pflege ohne Pflegearrangement 0% Quartale ab Inzidenz Abbildung 59: Pflegearrangements dementer Männer nach Pflegezugang in den Jahren 2005/06 100% 90% 80% 70% 60% 50% 40% 30% tot 20% vollstationäre Pflege formell-ambulante Pflege 10% informelle Pflege ohne Pflegearrangement 0% Quartale ab Inzidenz Abbildung 58: Pflegearrangements nicht dementer Frauen nach Pflegezugang in den Jahren 2005/06 100% 90% 80% 70% 60% 50% 40% 30% tot 20% vollstationäre Pflege formell-ambulante Pflege 10% informelle Pflege ohne Pflegearrangement 0% Quartale ab Inzidenz Abbildung 60: Pflegearrangements dementer Frauen nach Pflegezugang in den Jahren 2005/06 100% 90% 80% 70% 60% 50% 40% 30% tot 20% vollstationäre Pflege formell-ambulante Pflege 10% informelle Pflege ohne Pflegearrangement 0% Quartale ab Inzidenz Prof. Dr. Heinz Rothgang 26

27 VI. Projection: Number of people with dementia ,8 3 2,5 23 2, ,2 1,8 1,5 1 0 Number Anzahl in in millions Mio. Share Bevölkerungsanteil of population in % Number of LTCI beneficiaries People in dementia per LTCI beneficiary ,5 3,9 4,2 0,48 0,46 0,60 Prof. Dr. Heinz Rothgang 27

28 VII. Expenditures for people with and without dementia Abbildung 1: Monatliche Kosten der Kranken- und Pflegekasse für Personen mit und ohne Demenz im Jahr 2008 Pflege Arzneimittel Reha Krankenhaus Heilmittel Hilfsmittel Ärzte 800 Expenditure for those with dementia are 800 Euro higher than for those without dementia if age and sex is controlled for Most of it (550 Euro) 600 shows up in LTCI But about 300 Euro show up in SHI 0 Dem. Dem. Dem. Dem. Dem. Dem. Dem. Dem Männer Frauen Prof. Dr. Heinz Rothgang 28

29 VIII. Additional benefits ( 45b SGB XI) Abbildung 1: Hochrechnung zusätzliche Betreuungsleistungen auf die Bevölkerung der BRD im Alter ab 60 Jahren 0.7% 0.6% 05% 0.5% 0.4% 0.3% 0.2% 0.1% 0.0% Männer Frauen Die Leistungsausweitung des PfWG führt zu einer höheren Akzeptanz der Betreuungsleistung Hochgerechnet ist die Zahl der Leistungsempfänger von 2007 bis 2009 um 100 Tsd. gestiegen, davon beziehen nur 5% keine weiteren SPV- Leistungen Die gleiche Quote ergibt sich bei den Neufällen Betreuungsleistungen nutzen in erster Linie Pflegebedürftigen!! Prof. Dr. Heinz Rothgang 29

30 VIII. Additional benefits prevalence according to type 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Prävalenz (in %) zusätzlicher Betreuuungsleistungen pro Erkrankungsgruppe in der Gesamtbevölk kerung Demenz psychische Erkrankung geistige Behinderung Prof. Dr. Heinz Rothgang 30

31 VIII. Additional benefits utilization according to level of care er ufen 0-3 r zusätzliche die Pflegestu er Empfänger n (in%) auf d erteilung alle gsleistungen Ve Betreuung 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Pflegestufe 0 Pflegestufe I Pflegestufe II Pflegestufe III Prof. Dr. Heinz Rothgang 31

32 The end Thank you for your attention! (BARMER) GEK Pflegereport can be downloaded for free: GEK Pflegereport 2008 GEK Pflegereport 2009 BARMER GEK Pflegereport 2010 BARMER GEK Pflegereport 2011 (from 29th November, 2011 onwards) Prof. Dr. Heinz Rothgang 32

33 Contents I. Long-term care and Dementia the legal framework II. III. IV. Data and measurements Prevalence 1. Prevalence of dementia 2. Prevalence of dementia and long-term care 3. Life-time prevalence of dementia and long-term care Incidence V. Course of events and duration 1. Survival 2. Levels of need of LTC 3. Care arrangement VI. VII. VIII. Future number of people with dementia Expenditures Additional services for people with dementia ( 45b SGB XI) Prof. Dr. Heinz Rothgang 33