Characteristics of Long-Term Care Service Settings and Their Associated Political Factors: An International Exploratory Panel Ecological Study

Recent reforms of Long-Term Care policy across the world have expanded services into the home and community, creating new service provision sectors with lower cost and better flexibility than institutional settings. This study investigates the percentage of the population over 80 years old receiving home-based services across 25 countries (n = 437) and institutional services across 28 countries (n = 543) from 2000 to 2024, and explores whether political factors are associated with these trends using theoretical frameworks on political class coalitions and welfare regimes. Panel trend analysis shows significant upward trends in home-based LTC services across 17 countries and significant downward trends in institutional services across 15 countries. Bootstrap LASSO robustly selected two political indicators for institutional services. Mundlak estimation identified Plebiscites Credible Threat and GDP Per Capita as positive indicators at the within-country level, whereas the Autonomy of Election Management Body, Population over 65 years old, and Health Expenditure Per Capita are negative factors. This result suggests that de-institutionalization of caregiving correlates with effective electoral processes, while majoritarian decision-making correlates with a more conservative solution that favors institutional LTC. However, this should be treated as exploratory, as none of the indicators were considered robust when predicting trends in home-based services.