Utilisation of personal care services in Scotland: the influence of unpaid carers

Unpaid carers may have an influence on the formal care utilisation of the cared for. Whether this influence is positive or negative will have important implications for the costs of formal care provision. The relationship between unpaid and formal care is of particular importance in Scotland, where personal care is provided for free by Local Authorities, to individuals aged 65+. The existing evidence on the impact of unpaid care on formal care utilisation is extremely mixed, and there is currently no evidence for Scotland. This paper is the first to investigate how the presence of an unpaid carer influences personal care use by those aged 65+ in Scotland, using a unique administrative dataset not previously used in research. Specifically, it uses the Scottish Social Care Survey (SCS) from 2015 and 2016 and compares Ordinary Least Squares (OLS), Generalised Linear Models (GLM), and Two-Part Models (2PM). The results suggest that unpaid care complements personal care services and this finding is robust to a number of sensitivity analyses. This finding may imply that incentivising unpaid care could increase formal care costs, and at the same time it points to the potential for unmet need of those who do not have an unpaid carer. Due to the limitations of the data, future research is necessary

Utilisation of personal care services in Scotland: the influence of unpaid carers

Context: Unpaid carers may have an influence on the formal care utilisation of the cared for. Whether this influence is positive or negative will have important implications for the costs of formal care provision. Scotland, where personal care services are free to all individuals aged 65+, provides an interesting context in which to study this relationship. Moreover, the Scottish government is unique in its collection of administrative data on all social care clients. Objective: To investigate how the presence of an unpaid carer influences personal care use by those aged 65+ in Scotland. Methods: Two-part models (2PMs) are estimated using Scotland’s Social Care Survey (SCS) for the years 2014–2016. An instrumental variable (IV) approach is also implemented to deal with endogeneity concerns. Findings: The results suggest that unpaid care complements personal care services. In particular, the presence of an unpaid carer is associated with an increase in weekly personal care hours by 1 hour and 14 minutes per week, on average, other things being equal. Limitations: Concerns are noted surrounding the generalisability of results and lack of information available on client need and unpaid carers, arising from the very nature of conducting research using administrative data. Nevertheless, the findings are robust to a variety of sensitivity checks. Implications: Complementarity between unpaid and paid care may imply that unpaid carers are encouraging service use or demanding services on behalf of the cared for. Thus, policy interventions aimed at incentivising unpaid care could in fact lead to increased personal care costs to local authorities. Having said that, the complementary relationship might suggest that unpaid carers are being supported in their role and this might reduce pressure on formal care services longer term

Essays on the provision of long term care to older adults in Scotland

This thesis presents three empirical analyses on different aspects of the provision of long term care (LTC), in the paid and unpaid settings, to older adults in Scotland. It contributes to the academic literature by deepening our understanding in three interrelated areas.Firstly, it explores variation in the provision of Free Personal Care (FPC) across Scottish local authorities, in order to establish whether or not FPC provision matches the need of the population. The analysis suggests that there are significant differences in FPC provision, even after accounting for personal care need. This raises equity concerns, suggesting that older Scots might be more or less likely to receive FPC, depending on which local authority they reside. Secondly, it investigates the interaction between paid care and unpaid care, to understand how unpaid carers influence older people’s use of FPC. In particular, it aims to establish whether or not unpaid carers substitute or complement FPC. The paper finds that individuals who have an unpaid carer receive around one hour and a quarter more FPC each week. This raises concerns for the pressure unpaid carers might have on FPC resources and for individuals without unpaid carers, who might not be getting the formal help that they need. Lastly, it focuses on unpaid carers themselves and explores whether or not providing care has an impact on their Standard of Living (SoL). Specifically, it estimates the monetary amount an unpaid carer would need to be compensated by in order to reach the same SoL as a non-carer. In doing so, it offers evidence for the extent to which the current Carers Allowance is sufficient in compensating them for the material impact of their care giving duties. The results suggest that unpaid carers have a significantly lower SoL compared to non-carers and demonstrate that the Carers Allowance falls considerably short of compensating unpaid carers for the loss in SoL they experience due to caring

Scottish Care Homes and COVID-19

Key Findings • As with other parts of the UK, COVID-19 has caused a significant increase in deaths in Scotland, particularly amongst older individuals. • Scotland’s care home sector has not expanded in response to demographic change: rather the focus of care provision has moved to care at home. • Many of the characteristics of the care home sector in Scotland are similar to those in the rest of the UK. • The COVID-19 epidemic has spread to the majority of Scotland’s care homes. • The impact of COVID-19 on deaths in care homes lagged those in hospitals but have now surpassed deaths in all other settings. • Although the total number of deaths is now declining, the share of care home deaths in the total continues to increase. • Excess mortality during the pandemic has been high in all settings in Scotland, but has been particularly high in care homes. • Non-COVID deaths in hospital settings have declined during the pandemic, which may be the result of re-orienting hospital activity towards dealing with the immediate crisis. Increased deaths in other settings, including care homes, may have been the consequence. • Whereas care homes have been particularly affected by COVID-19, there has also been significant excess deaths attributed to causes other than COVID-19 outside hospitals and care homes. Specifically, there have been 616 non-COVID “excess deaths” in care homes and 1,320 such deaths outside care homes and hospitals. Given the age profile of deaths, these are likely to have been concentrated among the oldest old. • Scotland, unlike England, does not report the number of deaths of care home residents who die in hospital and elsewhere. If the shares of such deaths are similar across both jurisdictions, then the number of care home resident deaths in Scotland attributable to COVID-19-would be significantly larger.COVID-19 has caused a significant increase in deaths in Scotland, particularly amongst older individuals. Professor David Bell and colleagues explore key trends about the impact of coronavirus in Scotland's care homes

Deaths in Scottish care homes and COVID-19

Key points - As with other parts of the UK, COVID-19 has caused a significant increase in deaths in Scotland, particularly amongst older individuals. - Scotland’s care home sector has not expanded in response to demographic change: rather the focus of care provision has moved to care at home. - Many of the characteristics of the care home sector in Scotland are similar to those in the rest of the UK. - The COVID-19 epidemic has spread to the majority of Scotland’s care homes. - The impact of COVID-19 on deaths in care homes lagged those in hospitals but have now surpassed deaths in all other settings. - Although the total number of deaths is now declining, the share of care home deaths in the total continues to increase. - Excess mortality during the pandemic has been high in all settings in Scotland, but has been particularly high in care homes. - Non-COVID deaths in hospital settings have declined during the pandemic, which may be the result of re-orienting hospital activity towards dealing with the immediate crisis. Increased deaths in other settings, including care homes, may have been the consequence. - Whereas care homes have been particularly affected by COVID-19, there has also been significant excess deaths attributed to causes other than COVID-19 outside hospitals and care homes. Specifically, there have been 616 non-COVID “excess deaths” in care homes and 1,320 such deaths outside care homes and hospitals. Given the age profile of deaths, these are likely to have been concentrated among the oldest old. - Scotland, unlike England, does not report the number of deaths of care home residents who die in hospital and elsewhere. If the shares of such deaths are similar across both jurisdictions, then the number of care home resident deaths in Scotland attributable to COVID-19-would be significantly larger

Health Economic Studies of Colorectal Cancer and the Contribution of a National Administrative Data Repository: a Systematic Review

Introduction: Several forces are contributing to an increase in the number of people living with and surviving colorectal cancer (CRC). However, due to the lack of available data, little is known about the implications of these forces. In recent years, the use of administrative records to inform research has been increasing. The aim of this paper is to investigate the potential contribution that administrative data could have on the health economic research of CRC. Methods: To achieve this aim, we conducted a systematic review of the health economic CRC literature published in the United Kingdom and Europe within the last decade (2009–2019). Results: Thirty-seven relevant studies were identified and divided into economic evaluations, cost of illness studies and cost consequence analyses. Conclusions: The use of administrative data, including cancer registry, screening and hospital records, within the health economic research of CRC is commonplace. However, we found that this data often come from regional databases, which reduces the generalisability of results. Further, administrative data appear less able to contribute towards understanding the wider and indirect costs associated with the disease. We explore several ways in which various sources of administrative data could enhance future research in this area