Changes in admission to long-term care institutions in the Netherlands: comparing two cohorts over the period 1996-1999 and 2006-2009.

Using data from two cohorts, we examine to what extent a decline in institutional care in the Netherlands is associated with changes in the need for care and/or societal factors. We compared older adults, aged 65-89, who were admitted to a long-term care (LTC) institution in the period 1996-1999 and 2006-2009. Using the Andersen model, we tested per block of predisposing, enabling and need factors, which factors were significant predictors of admission to institutional care. With a Blinder-Oaxaca decomposition regression, we decomposed the difference in admission to an LTC institution between the period 1996-1999 and 2006-2009 into a part that is due to differences in health needs and other factors such as effect of policy, social values, and technology. Between 1996 and 2006, the percentage of co-residing partners and income increased and the average level of loneliness decreased significantly. The prevalence of disability, chronic diseases, however, increased. Whereas the care by partners declined, the formal care by professionals increased. Although the observed decline in the admission rate to institutional care was relatively small across the 10 years (from 5.3 % in 1996-1999 to 4.5 % in 2006-2009, a 15 % decrease), the probability of admission in 2006-2009 was relatively much lower when accounting for changes in the health and social conditions of the participants: the probability was 1.7-2.1 % point lower for adults in the period 2006-2009 compared to 1996-1999, a 32-40 % decrease. Our results show that the decline in the admission rate to LTC institutions is not the result of changes in need. The decline is suggested to be the combined effect of changes in policy, technological advances and changes in social norms.