Background: Long-term care services for the elderly in Norway are characterised by increased specialisation and ageing in place strategies. The local councils (municipalities) (n=356) are responsible for provision of long-term care and have the freedom, within national regulations, to design their services according to local needs. Typically, the services are divided into preventive and low threshold services (including technology and daycare centers), homecare services (including practical assistance and nursing), sheltered housing and nursing homes (including both short-term and long-term stays). How elderly patients use and move between these services is less studied.
Objectives: To explore elderly persons' (80 +) use of long-term care services and how they move between different types of services. Further to explore differences between municipalities and in gender in the use of services.
Methods: Register data on all care service recipients 80 + were retrieved from the Norwegian IPLOS registry and linked with data on municipality size from national statistics. A multistate model (mstate in R) was used to analyse the movement of patients between different services.
Results: A large portion of elderly people need care services. In Norway, 35% of persons 80 -89 years of age, and 75% of persons 90+ received publicly financed care services. Homecare is most common, representing 74% and 64 % of the care service recipients respectively. Looking at older persons receiving homecare, the probability of receiving homecare decreases relatively steeply with time, mostly due to death, or for a smaller number of persons, due to moving to nursing home. In the beginning of the trajectory there is an increased probability of receiving a short-term stay in nursing home, followed by return to home or continued long-term stay in the nursing home. There is also a small number of persons receiving homecare for a limited time, followed by periods of no services. There is an expected difference between genders, due to the higher life expectancy for women, where women have a probability to receive homecare services for a longer period and remain in nursing home for longer. Elderly persons in medium-sized municipalities have a slightly lower probability of receiving services in nursing home. However, looking at the probability of being dead, there is no difference between municipalities of different sizes.
Conclusion: The results show that most elderly people receiving care services stay at home until the end of life. A smaller portion moves to long-term care in nursing home. Short-term stays are a less used service among the elderly and appear most frequent at the start of the care trajectory. There are some small and expected gender differences in use of services, women having a higher probability to remain in homecare for longer and live longer in nursing homes. Municipality size has limited influence on patient trajectories in long-term care.