Trend in length-of-stay in nursing homes: Evidence from the Netherlands

Abstract

For an accurate prediction of the future demand of nursing home care, adequate insight in the trend in length-of-stay (LOS) in nursing homes is required. Almost no research has been done on the trend in LOS and its determinants. We used individual data on nursing home use for the entire Dutch population combined with information on age, gender, cohabitation, care needs, and date of death. Our final sample consisted of 433,377 individual nursing home admissions over the period 2012 through 2022 in the Netherlands. Although the average age at admission was relatively stable, the age distribution got more dispersed over time, because of a simultaneous increase in the share of relatively young older adults in the older population due to the post-war babyboom and the postponement of nursing home admissions to higher ages at the individual level. Furthermore, relatively more men and older adults with higher care needs were admitted to a nursing home. We performed a survival analysis to calculate the expected LOS. We decomposed the trend in LOS into three partial effects: a demographic effect, an effect due to changes in care needs, and a residual time trend. We found that over a period of 11 years, the LOS decreased with 8 %, from 930 days in 2012 to 853 days in 2022. This downward trend is explained by a combination of population ageing (27 %), an influx of older adults with higher care needs (40 %), and other factors captured by the time trend (32 %).