Defining Long-Term-Care Need Levels for Older Adults: Towards a Standardized European Classification.

International comparisons of long-term care (LTC) are hampered by inconsistencies in how to define the need for care. This is especially relevant for the European Union, whose Aging Working Group, which is tasked to project aging expenditure in the long term, has over time used two competing definitions - one based on inability to perform Activities of Daily Living (ADL) and another based on the more subjective Global Activity Limitation Index (GALI). The inconsistency in measurement, as well as problems in defining the intensity of needs, will acquire growing significance as longevity progresses. This paper investigates how the two measures are linked, by analyzing a large European sample survey where respondents replied to both questions. This allows a calibration of the two measures and an investigation of their areas of overlap and difference. The paper concludes by proposing a simple new 4-scale measure of care needs which, by combining the two metrics, introduces some gradation of the intensity of care. Using a consistent measure incorporating intensity, such as the one proposed, will facilitate international comparisons, improve long-term expenditure projections, and aid policy discussion, including the transfer of best practice.