Long-term care beds in institutions and hospitals

The number of beds in long-term care (LTC) institutions and in LTC departments in hospitals provides a measure of the resources available for delivering LTC services to individuals outside of their home.

On average across OECD countries, there were 50 LTC beds per 1 000 people aged 65 and over in 2015 – 46 in LTC institutions and four beds in LTC departments in hospitals (Figure 11.22). The Netherlands had the highest number of LTC beds in 2015, with around 87 beds per 1 000 people aged 65 and over, the vast majority of which were in LTC institutions. On the other hand, there were fewer than 20 beds per 1 000 people aged 65 and over in Italy, Latvia, Poland, and Turkey.

11.22. Long-term care beds in institutions and hospitals, 2015 (or nearest year)
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1. The numbers of long-term care beds in hospitals are not available for Australia, Switzerland, Turkey and the United Kingdom.

Source: OECD Health Statistics 2017.

 http://dx.doi.org/10.1787/888933606053

On average, there has been almost no change in the number of LTC beds per 1 000 population over 65 since 2005, though this masks substantial variation between countries (Figure 11.23). At one extreme, some countries with well-established, comprehensive LTC systems have reduced residential LTC capacity. Between 2005 and 2015, Sweden reduced the number of LTC beds in institutions by 23.5 beds per 1 000 population over 65. These reductions are attributable to a drive to move LTC out of residential facilities and into the community (Colombo et al., 2011). Iceland, Canada and Norway have also made significant reductions in the number of beds available. In contrast, Korea has seen a massive increase in capacity, increasing the number of beds from 13 to 58 per 1 000 population over 65 between 2005 and 2015, with the increase particularly marked since the introduction of a public LTC insurance scheme in 2008.

11.23. Trends in long-term care beds in institutions and hospitals, 2005-15 (or nearest year)
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Source: OECD Health Statistics 2017.

 http://dx.doi.org/10.1787/888933606072

While most countries allocate very few beds for LTC in hospitals, some still use hospital beds quite extensively for LTC purposes. Despite recent increases in the number of beds in LTC institutions in Korea, the majority of LTC beds are still in hospitals – although this may be driven in part by the reimbursement rules of the Korean LTC insurance, which require some facilities to be classified as hospitals. In Japan, many hospital beds are used for long-term care, though the number has decreased in recent years. Some European countries, such as Finland, Hungary and the Czech Republic, still have a significant number of LTC beds in hospitals, but in general there has been a move towards replacing hospital beds with institutional facilities, which are often cheaper and provide a better living environment for people with LTC needs.

Providing LTC in institutions can be more efficient than community care for people with intensive needs, due to economies of scale and the fact that care workers do not need to travel to each person separately. However, it often costs more to public budgets, since informal carers make less of a contribution and LTC systems often pick up board, lodging and care costs. Moreover, LTC users generally prefer to remain at home. Most countries have taken steps in recent years to support this preference and promote community care. However, depending on individual circumstances, a move to LTC institutions may be the most appropriate option, for example for people living alone and requiring round-the-clock care and supervision (Wiener et al., 2009) or people living in remote areas with limited home-care support. It is therefore important that countries retain an appropriate level of residential LTC capacity, and that care institutions develop and apply models of care that promote dignity and autonomy.

Definition and comparability

Long-term care institutions refer to nursing and residential care facilities which provide accommodation and long-term care as a package. They include specially designed institutions or hospital-like settings where the predominant service component is long-term care for people with moderate to severe functional restrictions. Beds in adapted living arrangements for persons who require help while guaranteeing a high degree of autonomy and self-control are not included. For international comparisons, beds in rehabilitation centers should not be included.

However, there are variations in data coverage across countries. Several countries only include beds in publicly-funded LTC institutions, while others also include private institutions (both profit and non-for-profit). Some countries also include beds in treatment centers for addicted people, psychiatric units of general or specialised hospitals, and rehabilitation centers.

References

Colombo, F. et al. (2011), Help Wanted? Providing and Paying for Long-Term Care, OECD Publishing, Paris, http://dx.doi.org/10.1787/9789264097759-en.

Muir, T. (2017), “Measuring Social Protection for Long-term care”, OECD Health Working Papers, No. 93, OECD Publishing, Paris, http://dx.doi.org/10.1787/a411500a-en.

Wiener, J. et al. (2009), “Why Are Nursing Home Utilization Rates Declining”, Real Choice Systems Change Grant Program, US Department of Health and Human Services, Centers for Medicare and Medicaid Services.