# Older people in Sweden increasingly enter long-term care with extensive care needs–a register study of first-time users based on the SNAC Stockholm Eldercare study

## TL;DR

Older people in Sweden are entering long-term care with greater care needs over time, according to a study of first-time users in Stockholm.

## Contribution

The study reveals a growing trend of high dependency at LTC entry and identifies factors influencing this shift.

## Key findings

- The proportion of older adults entering LTC with high dependency increased from 21% in 2015 to 29% in 2022.
- Higher age, cohabiting, lower income, and regular informal care were linked to entering LTC with extensive needs.
- Home care was the most common LTC type, though granted hours slightly decreased over the study period.

## Abstract

Although previous studies have addressed factors associated with current long-term care (LTC) use, little is known about older adults’ care needs and life situation at the point of entry into formal LTC (e.g., home care, institutional care). Using data from the SNAC Stockholm Eldercare study, we identified all individuals aged ≥ 65 in the municipality of Stockholm who entered publicly funded LTC for the first time between 2015 and 2022 (n = 33,393). Descriptive statistics and regression models were used to examine: (1) temporal trends in sociodemographic characteristics and care needs among individuals entering LTC between 2015 and 2022; (2) factors associated with entering LTC with a high level of dependency; and (3) the type and amount of LTC granted.

Sociodemographic characteristics remained largely stable over time, but the proportion entering LTC with high dependency increased from 21% in 2015 to 29% in 2022, suggesting a shift toward more extensive care needs at admission. Higher age (≥ 90), cohabiting, lower income, and at least weekly informal care significantly increased the likelihood of entering LTC with extensive needs. Most first-time users were granted home care (85–87%), although the predicted number of monthly hours slightly declined from 27 to 25, adjusted for sociodemographic and need-related factors. Entry into LTC reflects an interplay of care needs, care-seeking-behaviour, and policies and eligibility criteria. Our findings highlight the importance of further research into how attitudes and beliefs shape care-seeking behaviour, and whether earlier entry into LTC during functional decline could help prevent the development of more extensive needs.

The online version contains supplementary material available at 10.1007/s10433-025-00906-5.