How does availability of county-level healthcare services shape terminal decline in well-being?

Nina Vogel, Nilam Ram, Jan Goebel, Gert G. Wagner, Denis Gerstorf

Both lifespan psychology and life course sociology highlight that contextual factors influence individual functioning and development. In the current study, we operationalize context as county-level care services in inpatient and outpatient facilities (e.g., number of care facilities, privacy in facilities) and investigate how the care context shapes well-being in the last years of life. To do so, we combine 29 waves of individual-level longitudinal data on life satisfaction from now deceased participants in the nationwide German Socio-Economic Panel Study (N = 4557; age at death: M = 73.35, SD = 14.20; 47% women) with county-level data from the Federal Statistical Office. Results from three-level growth models revealed that having more inpatient care facilities, more employees per resident, and more staff in administration are each uniquely associated with higher late-life well-being, independent of key individual (age at death, gender, education, disability) and county (affluence, demographic composition) characteristics. Number of employees in physical care, residential comfort, and flexibility and care indicators in outpatient institutions were not found to be associated with levels or change in well-being. We take our results to provide empirical evidence that some contextual factors shape well-being in the last years of life and discuss possible routes how local care services might alleviate terminal decline.