ALLOCATION OF CARE AND SERVICES IN AN AREA-BASED SYSTEM FOR LONG-TERM-CARE OF ELDERLY AND DISABLED PEOPLE

In order to analyse the allocation of public care services in the city of Solna, Sweden, and how they changed in response to a rapid growth of the number of elderly people, a comparison was made between two sur veys, 1985 and 1991. The surveys comprised all citizens of Solna who, on the day of the survey, were receiving long-term public medical and/ or social care services. Living arrangements and services received wer e registered together with assessments of social support and disabilit y/dependency. The latter was measured according to a special scale (th e ASIM index) and - for 1991 - the Katz index of ADL. The assessments were made by the ordinary staff. The analysis showed that older and no n-married persons were more likely to become clients of the public car e system. Institutionalisation was also more common among the non-marr ied - especially for men. Connected to the rapid increase in the numbe r of the very old in the context of limited resources was a sharp decl ine during the period 1985-1991 in the proportion of the Solna populat ion that received public care services in some form. This decline conc erned all age-groups of both sexes, married as well as non-married, bu t the married were more affected than the non-married - especially amo ng the women. The reductions in the proportion of the population that received care in the home affected mostly married persons in the oldes t age group. Reductions in institutionalisation had most impact on ver y old, non-married men - partly counteracted by increases in the provi sion of home help. Multivariate analysis showed functional disability - in 1991 dependency in ADL according to Katz - and living arrangement s to be the most important variables in explaining the allocation of h ome help in domiciliary care and sheltered housing.