Long-Term Care Benefits and Functional Deterioration in Older Adults: Evidence from the Catalan/Spanish SAAD Registry (2015-2024)

Population ageing is raising the demand for long-term care (LTC), leading many countries to develop publicly funded LTC systems. However, little is known about whether the benefits these systems provide help preserve the functional autonomy of the people who receive them. We use the administrative registry of the Catalan LTC system, covering 320,618 individuals aged 60 or over who entered between 2015 and 2024, and follow them for two, three, five and seven years. Because applicants are assessed and reassessed with the same standardised instrument (the BVD), we observe repeated, comparable measures of functional capacity, down to the level of individual daily-living tasks. We proceed in three steps. First, we estimate how the intensity of exposure to each benefit (informal home care, formal home care, day centre care and institutional care) is associated with death, grade deterioration and within-grade deterioration. Second, we compute life-years and deterioration-free years gained using regression-standardised survival curves. Third, we analyse the size and composition of functional decline among survivors. Greater benefit intensity is associated with lower mortality: full exposure to each benefit is associated with between 0.36 (institutional care) and 1.40 (informal home care) additional life-years over seven years, relative to no benefit. Among survivors, higher intensity is also associated with a greater probability of recorded deterioration, most markedly in institutional care. This pattern is consistent with survival-deterioration selection and with benefits responding to need, rather than with care causing decline. Losses in indoor mobility, changing body position and continence/toileting are most strongly associated with institutional care. Estimates are associations, not causal effects. The results show the value of routine functional assessment data for evaluating LTC policy in ageing societies.