# Reasons for long-term care need: analyzing combinations of health limitations in Germany

## TL;DR

This study explores how different combinations of health limitations affect long-term care needs in Germany, highlighting the importance of tailored care strategies.

## Contribution

The study identifies five distinct classes of care needs based on co-occurring health limitations among first-time LTC recipients in Bavaria.

## Key findings

- Five distinct classes of care needs were identified among first-time LTC recipients.
- Three of these classes involved combinations of health limitations, varying by age, gender, and care grade.
- Co-occurring health limitations are central to LTC needs, even at initial stages of dependency.

## Abstract

Health limitations affect long-term care (LTC) needs differently. For instance, people with cognitive limitations require more organizational support, whereas those with functional limitations require more personal care. While the impact of singular health limitations on LTC has been widely studied, little attention has been given to the prevalences of co-occurring health limitations that drive LTC needs.

Our exploratory study seeks to address the gap in understanding the prevalence of multiple, intertwining health limitations that contribute to the need for LTC.

We used data from the German Medical Service (MD). The MD assesses LTC needs and assigns care grades, which serve as the basis for LTC insurance benefits. The available data contains all assessments in 2019 of adults living in Bavaria (the largest state in Germany), focusing on those with first-time LTC needs (N = 101,227). Using latent class analysis, we identified combinations of limitations across six health dimensions (e.g., mobility, cognition).

Among first-time LTC recipients, 5 distinct classes of care needs were identified. Two classes reflect single limitations: mobility limitations, and the need for assistance with medical therapy. Three classes point to various combinations of limitations. While classes differed in size, they also varied significantly by age, gender, and care grade.

The co-occurrence of health limitations is not an exception but a central feature of LTC needs even at the initial stages of dependency, emphasizing the importance of tailored care strategies. These insights can help local authorities and care providers offer targeted LTC services more strategically.

The online version of this article (10.1007/s00391-025-02498-2) contains supplementary material, which is available to authorized users.