Increased Needs among Applicants for Residential Eldercare in a Context of Deinstitutionalisation and Ageing-in-Place Policy: Results from a Population-Based Study

Context: In contexts of ageing-in-place policies and deinstitutionalisation, the mechanisms underlying increased needs in residential care have gained attention. Objective: This study aims to examine trends in care needs among applicants for residential care in the context of ageing-in-place policy and deinstitutionalisation. Method: We use Swedish municipal repeated cross-sectional registry data covering the years 2015–2022 to describe the assessed needs and sociodemographic characteristics among granted and denied applicants for residential care. Logistic regressions were conducted to examine trends over time. Findings: The results show increased needs among applicants over time. The increase in needs was mostly reflected among granted applicants, where we found increased proportions of individuals with extensive dependency in activities of daily living (ADL), severe or very severe cognitive impairment, and moderate or severe anxiety. Anxiety also increased among denied applicants. We found support for an interrupted trend towards more restrictive decision-making, but no overall raise of the eligibility threshold. Other possible mechanisms underlying the increased needs associated with applying for and being admitted to residential care are discussed. Limitations: Our data include assessments of needs registered by needs assessors. Consequently, the results may reflect changes in population characteristics as well as in assessment practices. Implications: The increased needs in residential care have implications for practice as demands on care work intensify, both in residential care and home care. As more comprehensive needs must be met in ordinary housing, it is critical that the public care system meets the needs of home-dwelling older people and their family carers.