Living longer is not all it's cracked up to be

Taken from a talk given by Ben Rickayzen, the senior lecturer at City University, London, to a conference on population and ageing

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The topic of long-term care for the elderly, while depressing, is highly topical. Heated debates have been taking place in both English and Scottish Parliaments over how the costs of long-term care for the elderly should be met.

The topic of long-term care for the elderly, while depressing, is highly topical. Heated debates have been taking place in both English and Scottish Parliaments over how the costs of long-term care for the elderly should be met.

At City University, I have been involved in projecting the proportions of disabled lives in the UK over the next 30 years. Clearly, the numbers of severely disabled lives have huge implications as far as long-term care needs are concerned in this country.

The crucial question that needs to be answered to quantify these needs is: we know that people are living longer, but is the average person spending those extra years in a state of severe disability? If so, the implications for long-term care costs could be huge. In fact, the evidence is inconclusive and therefore it is important to do the projections using optimistic, pessimistic and middle-of- the-road assumptions.

To carry out the projections, we start with the proportions of the population disabled at each age. The model that I have built recognises that, from one year to the next, there is a probability that a person will either deteriorate in health, improve or die. The model incorporates assumptions about how these probabilities might change over time.

The initial data comes from the Office of Population Censuses and Surveys (OPCS) of 1986. Over 100,000 lives were surveyed during 1985 and 1986 about their ability to perform tasks such as climbing stairs. From this, they were classed as being healthy or in a disability-state category of 1 to 10 (with 10 being very severely disabled).

The model allows for trends in the UK population's "healthy life-expectancy" over time - that is, the average amount of time that an individual spends "healthy" in their lifetime. The definition of "healthy" is important - I have looked separately at the trend when "healthy" is being free of any disability and the trend when "healthy" is being free of severe disability. The two trends exhibit different features and are used to inform the projection model.

Anyway, the work suggests that the proportion of the UK population over age 20 who would be classed as severely disabled will increase from approximately 2.3 per cent in 1996 to 3.6 per cent in 2036, under the most pessimistic assumptions used.

These percentages may not sound large, but it would mean a 50 per cent increase in the number of severely disabled lives in the UK over that 40- year period. These people would require long-term care - so where is it going to come from?

It is also interesting to look at the projected cost of this long-term care. I have incorporated estimates of the number of hours of care a disabled person would need each week according to their level of disability and the cost per hour of the care within the model. Perhaps controversially, I have only costed the informal care (ie the unpaid care of the disabled person that is provided by friends and relatives) at a rate of £4 per hour (ie approximately the minimum wage) on the basis that this will be unskilled care.

Under the pessimistic projection assumptions described above, I estimate that the cost of long-term care would increase from £42bn in 1996 to £64bn in 2036, using 1999 prices throughout. Hence the cost, before allowing for inflation, could increase by 50 per cent over that 40-year period.

These costs could, in fact, be even higher if less informal care is provided by families in future. This might well happen due to an increasing tendency for females (the usual carers) to be in the workforce, increasing divorce rates and children tending not to live so near their elderly parents.

It must be borne in mind that these results are based on relatively pessimistic assumptions but, clearly, living longer may not be all it is cracked up to be.

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