Disability development and the structure of care: some results from simulation of an area-based system of long-term care for elderly people.
In order to study the dynamic properties of an area-based system of long-term care for elderly people a simulation model was developed. The model describes the system of care in terms of the number of persons per level of care, age group, gender and degree of disability. Flows between levels of care and changes in degree of disability are regulated by Markovian transition matrices. The simulation proceeds by calculating for each year the changes in the system state depending on the inflow of new clients, the transfers of clients between levels of care, the changes in disability, mortality and the exit of clients from the care system. Data for the stimulation model have been collected during the period 1985-1991 through the application of the ASIM (Aldre SIMulering meaning 'Elderly Simulation') monitoring system in the municipalities of Solna and Sigtuna, Sweden. Using the observed relationship in Solna between disability development and level of care, it is estimated by the simulation that substituting the residential homes in Solna for sheltered housing would reduce the total care system work-load by about 5%. Approximately the same result is obtained when using the Sigtuna set of data.