HBI Deals+Insights / Healthcare Reform

No correlation: ageing population and nursing home demand

Will the growth in the elderly population lead to a massive increase in demand for residential nursing home beds? The evidence from Sweden suggests the answer is no.

The percentage of over 65s in residential nursing homes in Sweden has fallen from 5.2% in 2013 to 4% in 2017. “It was stable at 4.2% for three years and then dropped in 2017 to 4%,” says Michaela Prochazka, Programme Officer, Coordinator for elderly issues at Socialstyrelsen, the Swedish National Board of Health and Welfare.

She says this reflects several trends. Elderly people in Sweden are generally healthier than their counterparts 20 years ago. There has also been a gradual move towards more home care and the development of day centres. Sweden doesn’t force elderly people to move into residential nursing homes.  Unlike many countries, elderly people who continue to live at home may have as many as 5-8 home care visits every 24 hours, although an operator told us that Stockholm county encourages a move to residential if someone uses more than 130 hours of homecare a month.

In 2013 the state spent 120.5 bn SEK (€11m) on elderly care. That rose by just under 1% to just 121.7bn SEK by 2017. This at a time when the Swedish over-60s rose by 7% to 2m.

Over that period the amount spent on nursing home care fell from 70.5bn SEK to 69.3bn SEK, a fall of 1.7%, with homecare (including day centres and short-stay) rising from 48.3bn SEK to 50.7bn SEK, a total rise of 5%.

It is interesting to note that the share of the social care budget spent on elderly care has dropped from around 57% of the budget in 2001 to under 52% in 2017. Also noteworthy is the fact that the annual survey carried out by the government shows fair to high levels of satisfaction. The fall in budget share doesn’t seem to be a reflection of lower standards. Expenditure on people with disabilities (functional impairment) has increased over that period from 21% of the budget to over 29%.

These trends may continue. Who knows what impact new medical treatments will have on people with heart problems or dementia? Meanwhile, Sweden is looking at cutting costs further. Municipalities can now open or commission new type of “in-between” homes. These look exactly like normal nursing homes (in all nursing homes each individual has his or her own bathroom and kitchen) but do not have 24-hour medical care. Permission for in-betweens was only granted recently. Prochazka says it will be interesting to see how many municipalities request permission to open such homes.

Our Analysis: It is worth looking at Sweden for several reasons. First, it has impeccable statistics. Secondly, it has one of the most advanced and intelligently thought-through social service systems in Europe. OECD stats show similar trends in other countries with long-term care beds, including those in hospitals, dropping in Canada, the UK, the USA and across the Nordic region over the period 2005-2015.

What emerges is that there is no straightforward correlation between ageing demographics and demand for residential care. New care methods, a fitter population and a horror of nursing homes may mean we will see little or no growth over the next decade. It is also the case that the care a nation gives its elderly is a cultural artefact that is far more dependent on beliefs than on medical outcomes.

Having said that it is clear that the elderly wave has a long way to go yet. Swedish Statistics expects the number of over 80s to rise 50% to 755,000 by 2027. We will have to wait another decade to see if that volume rise can be accommodated without a big increase in expenditure.

We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.