# "Only 5% of older people ever need nursing home care"



## Saavy99 (7 Sep 2020)

Edit - I have separated this interesting point from another thread - Brendan 

There's alot of talk about parents having to go into nursing homes but really in the grand scheme of things less than 5% of the elderly end up  having to enter a nursing home. So they have an 80% chance of living on at home until their dying days


----------



## NoRegretsCoyote (7 Sep 2020)

Saavy99 said:


> There's alot of talk about parents having to go into nursing homes but really in the grand scheme of things *less than 5% of the elderly end up  having to enter a nursing home. *So they have an 80% chance of living on at home until their dying days



This is surely not true. There are 31,000 people in nursing homes in Ireland. Assume a three-year stay, so about 10,000 entrants a year. About 30,000 people die every year, so on these assumptions about a third of people go to a nursing home.

A lot hinges on those assumptions about normal length of stay, but you would need an average stay of 20 years to get your 5% number. It is almost certainly a lot higher.


----------



## Saavy99 (7 Sep 2020)

NoRegretsCoyote said:


> This is surely not true. There are 31,000 people in nursing homes in Ireland. Assume a three-year stay, so about 10,000 entrants a year. About 30,000 people die every year, so on these assumptions about a third of people go to a nursing home.
> 
> A lot hinges on those assumptions about normal length of stay, but you would need an average stay of 20 years to get your 5% number. It is almost certainly a lot higher.



"Only about 5% of all older people ever need residential or nursing home care"  25000 people currently in nursing homes in Ireland not 31000.






						Residential Care - HSE.ie
					

Public and private residential care,  nursing home inspsection reports, hospice care




					www.hse.ie


----------



## NoRegretsCoyote (7 Sep 2020)

Saavy99 said:


> "Only about 5% of all older people ever need residential or nursing home care"  25000 people currently in nursing homes in Ireland not 31000.
> 
> 
> 
> ...



I am simply quoting HIQA which would appear pretty authoritative:



> As of 31 December 2018, there were 581 registered nursing homes in Ireland,* home to over 31,250 people.*



Please square how there can be about 30,000 people in nursing homes, about 30,000 deaths annually, but only 5% of people ever needing residential or nursing home care..........


Regarding the OP's situation, there is a high likelihood of at least one of his parents needing nursing home care at some point.


----------



## Brendan Burgess (25 Sep 2020)

Folks, I took this up with the HSE and asked them where that figure came from. After going back and forth a bit, here is their final answer:

*Response*: Our numbers on % in care is based on 2016 census data vs. numbers in care by Local Health Office.

I have suggested to thejournal.ie that they factcheck it. 









						Factcheck · TheJournal.ie
					

Read, share and shape the news on TheJournal.ie - Breaking Irish and International News




					www.thejournal.ie
				




Brendan


----------



## tallpaul (25 Sep 2020)

Surely its 30,000 or so people out of however many people are aged 75?+ (where do you draw the line) in Ireland. I would have thought without looking up an figures that this has to be in the ballpark of 5% No?


----------



## NoRegretsCoyote (25 Sep 2020)

Brendan Burgess said:


> Folks, I took this up with the HSE and asked them where that figure came from. After going back and forth a bit, here is their final answer:
> 
> *Response*: Our numbers on % in care is based on 2016 census data vs. numbers in care by Local Health Office.



I think they've made this claim on the basis that 5% o_f over-65s are currently in care_. Indeed 31k is close to 5% of the 720k people aged over 65.

But that is completely different from saying that 5% of people _at some point in their life _will need long-term care. The real figure is clearly much, much higher.


----------



## Brendan Burgess (25 Sep 2020)

We can work out easily enough what percentage of the current population over 75 is in a nursing home.

But I am not sure how to work out the "ever" bit.

Would it be a retrospective calculation? 

Look at all the deaths of people over the age of 75 in the last 5 years. 

Then ask how many of them were ever in nursing homes? 

Brendan


----------



## NoRegretsCoyote (25 Sep 2020)

Assume that people go into nursing home and die there. This is not strictly true in all cases but a useful simplifying assumption

Find out average length of stay in years (*a*)

Find out population of nursing homes (*b*)

Find out annual deaths in the country (*c*)


The % of people who will every need nursing care is 100*((b/a)/c).


The over-65 or -75 population is not necessary


----------



## Brendan Burgess (25 Sep 2020)

OK, to put figures on that.

Let's say that a is 2 years - the average length of stay in a nursing home

Let'say that b is 30,0000 the population of nursing homes 

30,000/2 = 15,000 - the average number of people admitted to a nursing home each year.

The Health Service claim is : "Only about 5% of all older people ever need residential or nursing home care"  

So it's not the percentage of the public, it's the percentage of older people - let's say those over 75


----------



## NoRegretsCoyote (25 Sep 2020)

The share of the over 75 population is irrelevant!

Assume a 2-year stay, a 31k nursing population, and 31k annual deaths.

(31k/2)/31k=50%


----------



## twofor1 (25 Sep 2020)

I accept our family is not typical, but 5% as per the tread title does not sound right, I would have expected much higher.

Both my parents, both my parent in laws and 40% of my aunts and uncles ended up in nursing homes.

All were in their 80’s, some late 80’s going in and many lived or are still living way beyond the average stay which I think is 3 years.


----------



## joe sod (25 Sep 2020)

Just shows you how government bodies can make things up , base it on a dubious calculation and get away with it because very few people especially journalists will  query it because they are not numerate. So it should be "Only 5% of over 75s are in nursing homes in Ireland currently", how does that compare with other european countries, that would be a useful statistic.


----------



## Peanuts20 (25 Sep 2020)

_numbers in care by Local health office_, does that imply the 5% is based on those in public nursing homes as opposed to private ones?

Secondly, majority of elderly people I know over 75's are not in nursing homes. There is a much stronger focus on care at home. I know in my street I see 4 carers going in to houses with elderly people in them every evening.


----------



## Brendan Burgess (25 Sep 2020)

NoRegretsCoyote said:


> The share of the over 75 population is irrelevant!
> 
> Assume a 2-year stay, a 31k nursing population, and 31k annual deaths.
> 
> (31k/2)/31k=50%



I don't get that at all? 

Can you spell out your reasoning? 

They are not saying 5% of the total population, they are saying 5% of the elderly. (although they don't define elderly)

So you have to eliminate anyone who died before they became elderly. 

Brendan


----------



## PMU (25 Sep 2020)

Saavy99 said:


> "Only about 5% of all older people ever need residential or nursing home care"  25000 people currently in nursing homes in Ireland not 31000.


I would be inclined to agree with this figure.  The OECD's statbank on long-term care resources shows that for Ireland in 2018 there were 22,236 persons aged 65+ receiving long-term care in 'institutions other than hospitals'  (I presume these are care homes?) and this represents 3.3% of the total population aged 65+. https://stats.oecd.org/ .  [The stats are under “Health” and  then “Long-Term Care Resources and Utilisation”.


----------



## dereko1969 (25 Sep 2020)

PMU said:


> I would be inclined to agree with this figure.  The OECD's statbank on long-term care resources shows that for Ireland in 2018 there were 22,236 persons aged 65+ receiving long-term care in 'institutions other than hospitals'  (I presume these are care homes?) and this represents 3.3% of the total population aged 65+. https://stats.oecd.org/ .  [The stats are under “Health” and  then “Long-Term Care Resources and Utilisation”.


Yeah but actual facts don't suit some people who try and spin everything.


----------



## Early Riser (25 Sep 2020)

According to the 2016 census there were 341,000 females aged 65 and over in ROI. If we arbitrarily accept this as "elderly" then 5% of this number is 17,000.  Lets say this is an estimate of the number of women in nursing home care - a _point prevalence_ of 5%.
But that is very different from saying that 5% "end up in nursing home care". For example, we could say that about 5% of under-20s are in 4th class primary school. But closer to 100% of under 20s either have or will have "ended up in 4th class". The _lifetime prevalence_ for 4th class attendence is closer to 100% than 5%.

Edit: I see that there were 297,000 males aged 65 and over in 2016. So 638,000 people in total. 5% of this is 32,000. If we raised the ceiling for "elderly" above 65 this total would be lower.


----------



## NoRegretsCoyote (25 Sep 2020)

Brendan Burgess said:


> So you have to eliminate anyone who died before they became elderly.



Something like 95% of people make it to 65. I am on mobile but will edit later if I'm much out.

The key term is the use of the word "ever".

Most of us will be elderly, all of us will die.

The issue is whether we will at any point ("ever") need LT Care.

You can't estimate that simply by taking a snapshot.

@Early Riser has explained it better than me.


----------



## Saavy99 (25 Sep 2020)

Does it matter whether the figure is 25000 or 30000, the figure is low and it could be alot lower if the resources were provided to enable the vast majority live out their days at home. Personally I think it's a horrible model of care to cart elderly people off to a nursing home as soon as they can't adequately take care of themselves. It never used to be this way.


----------



## Sarenco (25 Sep 2020)

Saavy99 said:


> Does it matter


I think it's actually quite an important point from a financial planning perspective.

I would guess that the probability that a 65-year old man will require long term care (whether at home or in a nursing home) at some point in his life is around 30% and around 40% for a 65-year old woman (given the fact that women live longer than men).

However, that's just a guess - I've nothing to back it up.


----------



## Saavy99 (25 Sep 2020)

Sarenco said:


> I would guess that the probability that a 65-year old man will require long term care (whether at home or in a nursing home) at some point in his life is around 30% and around 40% for a 65-year old woman (given the fact that women longer than men).
> 
> However, that's just a guess - I've nothing to back it up.



No way are the odds that high, where on earth did you pluck those estimates from..... They simply not true, I would hazard a guess ..a 5% chance for both.


----------



## Sarenco (25 Sep 2020)

Here are some US statistics on the % of people at various ages that will require some form of long-term care assistance at some point during their lives.

It looks like I materially underestimated the probability for a 65 year-old.  Apparently there is a 52% probability that a 65-year old will require LTC at some point during their life.

Pretty sobering stuff.








						Must-Know Statistics About Long-Term Care: 2019 Edition
					

Our annual compendium of long-term care statistics on usage, cost, insurance, and caregivers.




					www.morningstar.com


----------



## Saavy99 (25 Sep 2020)

Sarenco said:


> Here are some US statistics on the % of people at various ages that will require some form of long-term care assistance at some point during their lives.
> 
> It looks like I materially underestimated the probability for a 65 year-old.  Apparently there is a 52% probability that a 65-year old will require LTC at some point during their life.
> 
> ...



You simple canot compare US statistics with Irish ones in the care of older people. For starters their life expectancy is less than ours due to a multitude of factors.


----------



## Sarenco (25 Sep 2020)

Saavy99 said:


> For starters their life expectancy is less than ours due to a multitude of factors.


Surely a lower life expectancy at 65 would imply a lower probability of requiring some form of LTC at some point (all else being equal)?

I would love to see some comparable Irish statistics because I do think this is an important issue.


----------



## NoRegretsCoyote (25 Sep 2020)

Saavy99 said:


> For starters their life expectancy is less than ours due to a multitude of factors.



This is wrong. Male and female life expectancy at 65 is basically the same in the US and Ireland.

It's also not really relevant to the question at hand.


----------



## Saavy99 (26 Sep 2020)

NoRegretsCoyote said:


> This is wrong. Male and female life expectancy at 65 is basically the same in the US and Ireland.


Ireland ranks 14th, USA 38th 









						List of countries by life expectancy - Wikipedia
					






					en.m.wikipedia.org


----------



## torblednam (26 Sep 2020)

Saavy99 said:


> Ireland ranks 14th, USA 38th
> 
> 
> 
> ...



NoRegretsCoyote specifically said life expectancy at 65, not life expectancy at birth.

"• U.S.: Life expectancy for men at the age of 65 years 2017 | Statista" https://www.statista.com/statistics/266657/us-life-expectancy-for-men-aat-the-age-of-65-years-since-1960/#:~:text=Now men in the United,20.6 more years on average.&text=As of 2017, the average,United States was 78.54 years.
"The life expectancy for men aged 65 years in the U.S. has gradually increased since the 1960s. Now men in the United States aged 65 can expect to live 18 more years on average. Women aged 65 years can expect to live around 20.6 more years on average"

"Life expectancy rises for both males and females" https://www.irishexaminer.com/news/arid-31009701.html?type=amp
"Life expectancy at age 65 in Ireland in 2016 was 18.3 years for men, a rise of 0.6 years since 2011, and was 21.0 years for women, an increase of 0.4 years over the same time period."


----------



## joe sod (26 Sep 2020)

Sarenco said:


> I would love to see some comparable Irish statistics because I do think this is an important issue.



Yes there seems to be alot of statistics the CSO do not do around death, and other topics maybe because its an unsexy topic. When Nphet I think were trying to find out what excess deaths were caused by the corona virus they had to use RIP.ie rather than the CSO because they dont gather those sort of statistics. Whats the reason ? other countries have these statistics.


----------



## Early Riser (26 Sep 2020)

joe sod said:


> When Nphet I think were trying to find out what excess deaths were caused by the corona virus they had to use RIP.ie rather than the CSO because they dont gather those sort of statistics. Whats the reason ? other countries have these statistics.



They do gather those statistics. The issue is that Ireland, unlike most countries, allows up to three months for next-of-kin to register a death. The CSO statistics are based on official death registrations and are always several months behind for this reason.
 While relatives usually will put in a death notice contemporaneously (eg RIP.IE) they may not register the death for quite a while. Apparently this was more evident during the height of the pandemic, with people slower to attend their local registration office. It is possible now to register online but many people may be unfamiliar with this or less comfortable using the online process. In any event, they still have 3 months to do so.


----------



## NoRegretsCoyote (26 Sep 2020)

Saavy99 said:


> Ireland ranks 14th, USA 38th
> 
> 
> 
> ...



This is life expectancy at birth.

In the US a lot more young people die from homicide, suicide, and car crashes than in Ireland.

Once you make it to 65 in the US your prospects are good.


----------



## Saavy99 (26 Sep 2020)

NoRegretsCoyote said:


> This is life expectancy at birth.
> 
> In the US a lot more young people die from homicide, suicide, and car crashes than in Ireland.
> 
> Once you make it to 65 in the US your prospects are good.



When you look at the average American at 65, you would wonder about the rate of obesity related diseases. I am not surprised they would be far more likely to use long term care facilities long term.


----------



## Sarenco (26 Sep 2020)

Saavy99 said:


> When you look at the average American at 65, you would wonder about the rate of obesity related diseases. I am not surprised they would be far more likely to use long term care facilities long term.


We’re actually not that far behind the US on the obesity front.








						FactCheck: Is Ireland really one of the world's most obese countries?
					

TheJournal.ie’s FactCheck puts some alarming recent headlines to the test.




					www.google.ie


----------



## Sarenco (26 Sep 2020)

In any event, obesity is hardly associated with longevity which would increase the probability of requiring LTC at some point.


----------



## NoRegretsCoyote (26 Sep 2020)

In the grand scheme, Ireland is not all that different from the US.

I would say US estimates of likelihood of ever needing LT care are a good rule of thumb for Ireland.

It would be great to find Irish-specific rates if they exist.

Casual empiricism alert. Only one of my grandparents dropped dead. The other three all needed home or nursing home care at some point.


----------



## Early Riser (26 Sep 2020)

This is from a 2017 ESRI report ( https://www.esri.ie/system/files/publications/RS67.pdf ):

_•The demand for long-term and intermediate care resident places is projected to  increase  by  between  40  to  54  per  cent  by  2030,  from  a  level of 29,000 in 2015;  

•The  demand  for  long-term  and  intermediate  care  bed  days  is  projected  to  increase by between 40 to 54 per cent by 2030, from a level of 10.6 million in 2015.

•The demand for home care packages is projected to increase by between 44 to 66 per cent by 2030, from a level of 15,300 in 2015; 

•The  demand  for  home  help  hours  is  projected  to  increase  by  between  38  to  54 per cent by 2030, from a level of 14.3 million in 2015.  _


----------

