How access to long-term care affects short-term care

Abstract Objective Healthcare systems face growing pressure due to rising demand, population aging, and staffing shortages. In the Netherlands, limited access to long-term care often results in clients being admitted to short-term care while awaiting nursing home placement, increasing strain on these services. Over 50% of nursing home clients are admitted via short-term care, an outcome considered undesirable. This study takes a macro-level approach to assess to what extent more efficient nursing home bed allocation can reduce waiting times and ease pressure on the system. Methods Modeling admission trajectories of older adults in need of nursing home care across long- and short-term care settings in the Netherlands, using discrete-event simulation. The model simulates client arrivals, admissions to and discharges from both short-term care and long-term care. We compare the current decentralized admission policy to a centralized admission policy, using average waiting times and fraction of short-term care admissions as performance metrics. Results A centralized admission policy substantially reduces waiting times and short-term care admissions. For the base case scenario, with 90% regional bed occupancy, waiting times drop from 336 to 35 days, and short-term care admissions decrease from 45% to 4.5%. When demand variation across nursing homes is higher, these reductions can be even larger. Conclusions Results show that long waiting times and uneven demand across nursing homes increase short-term care admissions and place additional pressure on the system. Efficient bed allocation may help reduce this pressure. Its effectiveness is largest when the system is working close to its full capacity, while it’s less affected when it’s running far below or well beyond that point. Additionally, an increase in non long-term care client admissions to the short-term care triggers a multiplier effect, further straining the system. These dynamics highlight the interdependency between long-term care and short-term care.