Long-Term Care Needs Assessment: From Frameworks to Practice

Objectives

Identify and describe instruments used by countries to perform functional ability assessment as eligibility for their long-term care systems and compare them to existing healthy aging frameworks proposed by the World Health Organization (intrinsic capacity and functionality).

Design

Descriptive, case studies.

Setting and Participants

Country-level long-term care systems in 27 countries.

Methods

Selection of countries with long-term care systems in place and with expected increase in long-term care needs. For each country, data regarding the country features, as well as information of the long-term care systems, and the instruments to assess long-term care needs (functional ability) were collected. Features of the assessment tools were compared with the World Health Organization's intrinsic capacity and functionality domains, identifying the specific activities evaluated and the way the assessment is used to classify people and define benefits.

Results

Countries were classified into those with a long-term care system and a standardized instrument for assessing long-term care needs (group 1; n = 6), those that have long-term care initiatives do not have a standardized instrument to identify needs (group 2; n = 8), and those with no information on their systems or instruments for identify long-term care needs (group 3; n = 13). When looking at countries with standardized tools, instruments include several activities related to intrinsic capacity domains such as cognition, mobility, and psychological capacity; for functional ability, all domains except the ability to “contribute” are covered by the instruments.

Conclusions and Implications

Long-term care needs assessment is a complex but necessary task to be performed by long-term care systems. Countries embarking in the design and redesign of their systems can use the existing instruments, frameworks, and the experience from other countries to better adapt this process to their own needs and contexts.