Unsatisfied Care Needs of Adults with Disabilities in Bogota, Colombia

Abstract

People with disabilities worldwide encounter barriers to accessing care and support systems. Existing care frameworks often focus on supporting caregivers, operating under the assumption that people with disabilities are largely dependant. However, under a human rights framework it is fundamental to recognise the role that people play, both providing and receiving care, and if care needs are adequately met. This study collects and analyses data from 1001 individuals with disabilities in Bogotá, Colombia, to assess the extent of unsatisfied care needs among this group. We identified individual and household characteristics that are associated with unsatisfied care needs using a multinomial probit and a probit model. The result revealed that 58.7% of participants received an insufficient amount of care, and 7.6% did not receive care at all despite needing it. In total, 66.3% of respondents had unsatisfied care needs. Adults with disabilities experiencing unsatisfied care needs were more likely to be older, male, experiencing functional limitations in daily activities, unemployed, or having lower educational attainment. Notably, 35.7% of respondents also provided care to household members—including children, older adults, individuals with disabilities, and those who were ill or injured. Findings highlight the need for Bogotá’s care system to recognise people with disabilities as both care recipients and caregivers, and to tailor support mechanisms to meet their diverse needs.

1. Introduction

Around the world, countries are increasingly recognising the need to invest in care systems to promote the economic empowerment and social inclusion of caregivers, especially women [1]. Thus, the care agenda has rapidly gained traction globally. In low-middle-income countries (LMICs), this has spurred the development of care policies and systems in a number of jurisdictions [1]. This is the case for the city of Bogota, which has been implementing its care system, “Sistema Distrital del Cuidado”, since 2020. The primary focus of this system is to support unpaid family caregivers, mainly women and girls, in accessing education, employment, and leisure opportunities while redistributing their care responsibilities [2]. In 2025, the care system included 25 establishments and provided support to more than 374 thousand people in the city [3].

Although people with disabilities are usually seen as individuals receiving care [4], and limited examples exist on systems including a human rights perspective in the provision of care for this group [5], it is imperative that care policies address the needs of persons needing and receiving care and human support [6]. Care systems in most cases consider adults with disabilities as dependant [7,8], depicting them as requiring care from and decision-making by others. Thus, public care services do not tend to focus on the needs for independent living and autonomy, essential tenets of disability inclusion (Article 19, CRPD) [9]. Even when disability is addressed, the needs and rights of people with disabilities are still not fully considered.

People with disabilities are on average more likely to be socioeconomically vulnerable and hence more likely to experience barriers to accessing services [10]; they tend to experience higher levels of poverty, lower access to labour markets, lower levels of education, and higher demand for health services [10]. In sum, people with disabilities face a series of circumstances that may hinder access to care services.

Access to care and support services becomes vital to overcoming some of the barriers that people with disabilities face. However, little information exists regarding the needs for care and support of people with disabilities around the globe. To date, only one study focused on 14 LMICs identified that a significant percentage of people with disabilities who receive care reported needing more care than they received, and that a non-trivial percentage of people needing care do not receive any care; thus, both groups presented unsatisfied care needs [7]. Under this perspective unsatisfied care needs are defined as the difference between reported care needs and those actually received by the person with a disability. These results highlight that an important percentage of people with disabilities do not receive the care they need.

In the context of disability policy, the provision of care and support is grounded in a human rights-based approach. This perspective recognises not only the needs of those receiving care, but also of the individuals who provide it. It moves beyond conventional models that centre exclusively on care providers, highlighting instead the diversity of both caregivers and care receivers. Importantly, it acknowledges that men and women with disabilities are not only recipients of care, but also active providers of support to other members of society [4]. In addition, under this approach, it is key to identify the role that contextual aspects play in the provision of care and support and how the characteristics of people with disabilities, such as high levels of poverty, socioeconomic deprivation, lower levels of education, and precarious employment, increase their risk of unsatisfied care needs.

Globally, the evidence on unsatisfied care needs has focused on people older than 50 years. Studies conducted in the global North revealed that disability and difficulties in daily living activities are the two main factors associated with reporting additional care needs [11,12,13]. Other common determinants are education level and income, which are usually negatively associated with reporting unsatisfied care needs. In countries such as Canada, the UK, and Sweden, higher levels of income are associated with a lower demand for informal care. This aspect may be related to the availability of formal care services or more accessible environments in high-income neighbourhoods, allowing persons with disabilities to participate independently without human support. Other common determinants include household size and composition, with people living alone being those who reported more unsatisfied care needs.

The care system in Bogota has recognised the importance of adopting disability considerations to promote the inclusion of the more than 450 thousand individuals with disability in the city. The system has even proposed developing specific services for caregivers of people with disabilities and people with disabilities themselves [14] and it has been recognised as a promising strategy to provide care and support to people with disabilities [15]. Yet, implementation of said services is limited and lacks an independent-living perspective. Thus, the city has not developed specific programmes focused on fostering the right to independent living. Further, there is a dire lack of data on the care and support needs of people with disabilities and their families, thus inhibiting the development of services that respond to these needs. No studies to date have been conducted on the unsatisfied care needs of people with disabilities or how that relates to their personal characteristics in Colombia. Therefore, aiming to contribute to this area, this study was designed to collect quantitative data on the type and intensity of care that adults with disabilities receive in Bogota, and their levels of unsatisfied care needs.

This article is divided in five sections including this introduction, followed by a second section where we present the methodology and data used for the analysis. We then present the most relevant results, followed by a section discussing the implications of the results in the context of Colombia and for the design of disability inclusive care systems more generally. The final section presents the conclusions of the article.

2. Materials and Methods

2.1. Study Design

We employ quantitative cross-sectional design to analyse unsatisfied care needs of people with disabilities in Bogota, Colombia. This study design was selected given that we aimed to provide representative data for people with disabilities in the city in this topic. In addition, this is the first study analysing unsatisfied care needs from a quantitative perspective in the country, providing valuable information to policy makers implementing the care systems and programmes for the inclusion of people with disabilities.

2.2. Data

We designed a questionnaire to identify the unsatisfied care needs of adults with disabilities in Bogota, Colombia. The questionnaire had 6 sections and 75 questions. The five sections included in the questionnaire were: (1) individual and household characteristics, (2) demand of human support, (3) assistive technology use, (4) environmental accessibility, and (5) provision of care and use of local services. The questions used in the questionnaire were previously tested in other sources of data, including the Model Disability Survey and the Support Needs Survey in Kenya (2022) and in a pilot study of disability assessment in the Philippines (2022). A sample of the questionnaire is available by request.

The questionnaire was piloted in November 2024 with a sample of 200 households. We tested the data collection method and questionnaire; both were adjusted based on the results of the pilot. Data was collected from January to February 2025, and questions were directed to adults with disabilities aged 18 years or older. In case the person needed additional support or sign language interpretation, the team provided the requested support. Data was collected using face-to-face interviews by a team of 28 individuals. All individuals received a three-day training session, during which the project’s objective was explained, and interviewers were trained to administer the Washington Group Short Set (WGSS) of questions. The training also included aspects related to discrimination, how to provide reasonable adjustments, and conducting interviews with people who have different functional difficulties.

The interview averaged 45 min duration and was conducted in a private, quiet location to ensure confidentiality and to minimise response bias. After the data was collected, the supervisor of each group reviewed the information. In cases where inconsistencies were identified, the person was visited a second time, and information was verified. The information was collected only in cases where the person agreed to participate in the study and provided verbal consent. Once the data was collected and cleaned, it was anonymised and shared with the research team. The collected data does not allow the identification of any of the respondents who were interviewed.

2.3. Sample

This study leveraged multistage sampling for data collection, with city blocks used as the primary unit of sampling and the household as the final unit of sampling. The national household and population census 2018 was used as the sampling frame. Blocks were randomly selected and all households in the block were visited. Households that agreed to participate in the interview and respective identified persons with disabilities within the household were included in the sample.

We implemented three filters to accurately identify individuals with disabilities. First, the short set of questions by the Washington Group on Disability Statistics (WGSS) to identify households with members aged 18 years or older who have disabilities [16]. In a second stage, household heads were asked to identify which household member they were referring to in their previous responses. In a final stage, the WGSS questions were asked to people who were initially identified as having a disability. For a person to be considered as having a disability and included in the final sample, they had to report the highest levels of difficulty—“a lot of difficulty” or “cannot do at all”—in one or more of the six functional domains of the WGSS.

In total, 455 blocks were randomly selected, of which 394 were visited; the remainder were not visited because of problems accessing the household (46), insecurity and safety concerns (3), or because the buildings were used for non-dwelling purposes such as businesses, offices, or institutions (12) accessing the household. In 312 of the 394 blocks, we identified people with disabilities. In total, 19,081 households were identified in the 394 blocks, of which 3479 agreed to participate in the study. Among households that participated in the study, in 961 we identified the presence of a person with a disability according to the WGSS (stage 1). In those 931 households, we identified 1086 individuals with a disability living in these households (stage 2), of which 1.001 individuals met the criteria for being included in the study. In total, 77 individuals were identified in stage 2 but refused to participate in the final data collection.

2.4. Variables

2.4.1. Disability

We identified disability using the short set of questions by WGSS. The WGSS measures self-reported difficulty in six domains of functioning: seeing, hearing, walking, cognition, self-care, and communication. For each question corresponding to each domain, response options include “no difficulty”, “some difficulty”, “a lot of difficulty”, and “cannot do at all”. A person was defined as a person living with disability if they answered that they have the highest levels of difficulty—“a lot of difficulty” to “cannot do at all”—in one or more of the six domains of the WGSS [16].

2.4.2. Unsatisfied Care Needs

We define care as human support that helps a person perform activities of daily living. In the survey developed for this study, we asked respondents whether they receive and need care to perform one of the following activities of daily living: walking, eating, going to the toilet, going out, communication, managing their money, following medical treatments, or supporting them in their daily life. These activities are largely consistent with those included in previous studies focused on measuring unsatisfied care needs among adults over the age of 65 [12]. We define unsatisfied care needs as needing more care even if a respondent already receives care. In other words, respondents were identified as having unsatisfied care needs if they report needing additional care beyond what they already receive or needing care that they do not have.

2.4.3. Other Caregiving Variables

The questionnaire developed for this study also asks respondents who report receiving care to identify their primary caregiver. The questionnaire defines caregivers to persons with disabilities as the person who provides care and support to help them conduct their daily life activities. Thus, in this study, we consider persons as caregivers if they are identified as such by the interviewed person with a disability. Respondents are also asked a series of questions to characterise this caregiver based on age, sex, education level, and labour market participation status. Respondents are also asked to report the average number of hours per day they receive care from their primary caregiver.

The questionnaire identifies whether respondents are caregivers within their households. Respondents can report whether they provide care to children, adults over the age of 65, other adults with disabilities, or to household members who are ill or injured. Thus, the analysis in this study allows to include controls for providing and receiving care, as well as the characteristics of caregivers of adults with disabilities and the characteristics of persons receiving care from adults with disabilities.

2.5. Empirical Strategy

To analyse the characteristics related to unsatisfied care needs, we estimated a multinomial probit [17]. The model allows identifying which factors are associated with one of the following groups: 1. receiving care and needs are met, 2. receiving care but needs are not met, 3. not receiving care and needs are not met, and 4. not receiving care but needs are met. We control for a series of individual characteristics such as sex, age, type of functional difficulty, education level, occupation, and receiving government transfers. The model is specified as follows:

$$Y_i^{1\ast }= X_i^{\prime }{\beta }_1+{\epsilon }_1 { Y}_i^1=1 if Y_i^{1\ast } >0 , 0 otherwise$$

(1)

$$Y_i^{2\ast }=X_i^{\prime }{\beta }_2+{\epsilon }_2 Y_i^2=1 if Y_i^{2\ast }>0 , 0 otherwise$$

(2)

$$Y_i^{3\ast }=X_i^{\prime }{\beta }_3+{\epsilon }_{3 } Y_i^3=1 if Y_i^{3\ast }>0 , 0 otherwise$$

(3)

$$Y_i^{4\ast }=X_i^{\prime }{\beta }_4+{\epsilon }_4 Y_i^4=1 if Y_i^{4\ast }>0 , 0 otherwise$$

(4)

$${\epsilon }_n\sim N(0,\Sigma )$$

(5)

where $Y_i^{1\ast }$ denotes the latent propensity of individual $i$ to belong to group 1, $Y_i^{1\ast }$ denotes the latent propensity of individual $i$ to belong to group 2, $Y_i^{1\ast }$ denotes the latent propensity of individual $i$ to belong to group 3, and $Y_i^{1\ast }$ denotes the latent propensity of individual $i$ to belong to group 4. The vector of controls is represented by $X_i$. The coefficient vectors ${\beta }_1$, ${\beta }_2$, ${\beta }_3$, and ${\beta }_4$ capture the influence of observed characteristics on belonging to one of the four groups of respondents. In other words, the model estimates the probability of outcome values 1 through 4 for $Y_{i }$ or each observation, controlling for a series of factors. The term $\Sigma$ represents the sum of error terms across the four equations, capturing the correlation between the unobserved determinants belonging to each of the four groups.

This study also aims to identify whether individual caregiver characteristics are associated with unsatisfied care needs. To conduct this part of the analysis, we leverage a probit model to estimate the probability of unsatisfied care needs among respondents with caregivers. We include the same vector of controls, plus an additional set of controls corresponding to the characteristics of the caregiver. This model is specified as follows:

$$U_i^{\ast }= X_i{\beta }_i+{\epsilon }_i \sim N(0,{\sigma }^2)$$

(6)

where $U_i^{\ast }$ represents unsatisfied care need and is observed if the latent variable $U_i^{\ast }$ is greater than zero:

$$U_i= 1 if U_i^{\ast } >0$$

(7)

$$U_i=0 if U_i^{\ast } \le 0$$

(8)

Hence, the estimated probit model is:

$$Pr(U_i=1| X_i)=\mathsf{\Phi }(X,\beta )$$

(9)

where Pr is the probability that an individual i has unsatisfied care needs and X is a vector of individual and caregiver controls.

2.6. Ethical Approval

This study was approved by the School of Medicine ethical board at Universidad de los Andes, number 1989. Once the household agreed to receive information regarding the project, the interviewer explained the project, its purpose and procedures, as well as any risks and benefits to participation. The informed consent was read, and verbal consent was obtained from all participants before the start of the data collection. Participants were assured that their responses would be used solely for research purposes. The study adhered to the principles of the Declaration of Helsinki. All the information was recorded to guarantee the quality of the data collection. Once the data was checked, the information was anonymised.

3. Results

3.1. Individual Characteristics

Of the 1001 individuals included in the sample, 61.6% were female and 38.4% were male, and 47.0% were 65 years or older. In total, 11.2% of individuals do not have education, 41.1% primary education, and 17.2% have completed lower secondary education. Regarding labour market participation, 19.9% of respondents reported working, 5.1% were looking for a job, 36.6% were inactive or not participating in the labour market due to being responsible for household chores, and 26.7% reported that they were unable to work because of disability. Of the total sample, 11.5% reported lacking health insurance. The remaining 88.5% of respondents did have coverage, with no significant differences in the percentage of people with disabilities covered by the contributory versus subsidiary regimens. Finally, almost one-third of respondents reported that they or their families receive cash transfers from the government (34.7%).

Of the total sample, we identified that 58.7% of people with disabilities received care but reported needing more and 7.6% did not receive care but reported needing it. Thus, 66.3% of people with disabilities reported that they had unsatisfied care needs. Respondents with unsatisfied care needs were different than respondents who did not report unsatisfied care needs. Those with unsatisfied care needs were more likely to have a functional difficulty walking or climbing stairs compared to adults with disabilities without unsatisfied care needs receiving and not receiving care. Also, they were more likely to have a functional difficulty remembering or concentrating (38.9% and 27.0%). Nonetheless, they were between 6.8 and 4.3 percentage points (pp) less likely to use assistive devices compared to other adults with disabilities receiving and not receiving care but with satisfied care needs. They were also between 10.4 and 6.7 pp more likely to live in a household that receives cash transfers compared to adults with disabilities without unsatisfied care needs receiving and not receiving care.

Among respondents with unsatisfied care needs, those who reported receiving care were also different from those who did not report receiving care. For instance, 35.1% and 30.1% of respondents who receive care but had unsatisfied care needs had self-care and communication functional difficulties, respectively. On the other hand, among respondents who reported not receiving care but needing it, less than 10% reported living with a functional difficulty in self-care or communication, percentages that are higher only relative to adults who do not receive care and do not need more. Hence, while adults who need more care than they receive are more likely to have self-care and communication functional difficulties relative to adults without unsatisfied care needs, this does not hold for adults with unsatisfied care needs who do not receive care.

Furthermore, among adults who have unsatisfied care needs, those who receive care were more likely to be aged 65 or older relative to those who do not receive care. They were also less likely to have attained technical schooling or higher and more likely to not have completed any level of education at all compared to those not receiving care and not needing it. Adults with unsatisfied care needs who receive care were also the least likely of all groups to be working (12.8%) and are the most likely to report not working due to occupational disability (37.9%).

Meanwhile, adults with unsatisfied care needs who do not receive care were the most likely of all groups to not be working due to being responsible for house chores (43.9%) and were the most likely to be caregivers of children (23.9%), adults over the age of 65 (24.5%), of another person with a disability in the household (33.5%), or of a family member who is ill or injured (21.5%). Finally, while use of city services for persons with disabilities is low overall (2.8%), respondents with unsatisfied care needs who receive care make greater use of these services than any other group (3.7%).

Table 1. Descriptive statistics of adults with disabilities with and without unsatisfied care needs.

	All Adults with Disabilities	Group 1 Receiving Care-Met Need	Group 2 Receiving Care-Unsatisfied Need	Group 3 Not Receiving Care-Unsatisfied Need	Group 4 Not Receiving Care-Met Need
n (%)	1001 (100.0)	159 (15.9)	588 (58.7)	76 (7.6)	178 (17.8)
Type of functional difficulty (%)
Seeing	57.0	50.1	53.2	56.1	75.6
Hearing	23.0	21.5	26.4	17.9	15.4
Walk or climb stairs	59.9	54.8	70.6	66.3	27.4
Remember or concentrating	31.2	22.9	38.9	27.0	15.9
Self-care	23.3	10.8	35.1	9.9	2.1
Communication	20.9	13.3	30.1	9.5	3.0
Female (%)	61.6	60.5	60.8	57.6	63.3
Age group (%)
18–35	13.2	15.3	11.7	7.3	18.9
36–50	12.7	10.8	11.7	18.3	14.9
51–64	27.1	25.0	21.8	38.1	41.3
65 or more	47.0	48.8	54.8	36.3	24.9
Education level (%)
None	11.2	4.1	16.7	5.9	2.0
Primary	41.1	43.9	45.6	43.1	23.5
Lower Secondary	17.2	23.1	14.0	15.9	22.7
Upper Secondary	16.5	18.9	12.5	16.1	27.1
Technical or more	14.0	9.9	11.7	19.0	24.7
Occupation (%)
Working	19.9	25.5	12.8	25.7	35.2
Looking for a job	5.1	2.6	3.4	8.1	11.8
Studying	0.5	0.5	0.0	0.0	2.1
House chores	36.6	37.6	34.1	43.9	40.5
Occupational disability	26.7	20.6	37.9	13.5	1.9
Other activity	11.2	13.2	11.8	8.9	8.5
Is a caregiver (%)
For a child	16.3	20.3	13.7	23.9	17.6
For an adult 65 or older	15.4	13.6	13.0	24.5	20.7
For another person with disability in the household	17.9	16.5	15.0	33.5	21.5
For someone who is ill or injured	11.2	11.6	10.1	21.5	10.0
Other characteristics (%)
Uses assistive devices	26.0	31.0	24.2	23.8	28.1
Uses services for adults with disabilities	2.8	2.6	3.7	2.1	0.5
Household Characteristics
Average household size	2.7	2.8	2.7	2.5	2.5
Average number of children in the household (17 years or younger)	0.6	0.6	0.6	0.6	0.5
Average number of people 60 years or older in the household	0.6	0.6	0.6	0.4	0.5
Receives cash transfers (%)	34.6	28.3	38.7	33.8	27.1

presents the descriptive statistics of the different groups.

We identified that adults with disabilities who received care and whose needs were met receive an average of 7.6 h of care per day, compared to 9.4 h per day among respondents who receive care but have unsatisfied needs. However, the differences in the average number of care hours received were not significant between the two groups. Furthermore, among respondents with unsatisfied care needs who receive care, the most common activities where more care and support are needed include communicating with others (71.8%), toileting (71.6%), and attending doctor appointments (70.1%).

Most adults with disabilities in the study reported receiving care. Indeed, 74.6% of respondents mentioned that they received care from someone else. The most common types of care received was support going to a doctor’s appointment or for receiving health services (60.8%), support to participate in activities outside the home (50.0%), and support for preparing and consuming meals (40.8%). Among respondents who receive care, 75.5% mentioned that they needed more care, especially for using the toilet (73.7%), attending healthcare appointments (71.0%), and communicating with others (70.2%). Of the 25.4% of the sample that did not report receiving care, 29.9% mentioned needing care, especially in providing care in their daily life activities (25.2%) and walking (19.5%). In sum, among the total sample of respondents with disabilities, 15.9% received care and did not need more, 58.7% received care but needed more, 7.6% did not receive care but needed it, and 17.8% did not receive care and did not need it (

Table 2. Activities that people with disabilities receive or need additional support.

Activities That the Person Needs Additional Support	Persons Receiving Care	Additional Support Needed of Those Receiving Care	Even If Not Received, Do You Need Support
Walking or climbing stairs	39.4%	68.4%	19.5%
Taking a shower or getting dressed	19.9%	64.7%	7.0%
Support for preparing and consuming meals	40.8%	57.5%	11.0%
Use the toilet	12.5%	73.7%	2.7%
Getting in and out of bed	18.1%	66.9%	4.6%
Support to participate in activities outside the home	50.0%	68.4%	15.5%
Communicate with others	26.9%	70.2%	7.2%
Manage money or finances	25.9%	56.5%	5.8%
Go to the doctor	60.8%	71.0%	18.6%
Supporting their daily life activities	34.7%	55.5%	25.2%

).

3.2. Characteristics of People with Disabilities Providing Care

Further, an important proportion of adults with disabilities provide care to other household members (35.7%) (

Table 3. Characteristics of adults with disabilities who provide care to others compared to those not providing care.

	No Caregiver	Caregiver	p-Value *
n	644	357
Average age	63.3	56.1	0.000
Female (%)	57.5	67.4	0.001
Education level (%)
None	13.8	6.4	0.000
Primary	43.2	37.2
Secondary	18.5	14.7
High School	13.3	22.3
Technical or more	11.2	19.3
Occupation (%)
Working	17.8	23.8	0.000
Looking for a job	4.6	6.2
Studying	0.6	0.25
House chores	31.2	46.4
Occupational disability	34.1	13.2
Other activity	11.8	10.7
Average number of hours providing care	NA	9.8 (5.9)

* A chi-squared test was performed to analyse independency between being or not being a caregiver with disability, with the variable analysed.

). Relative to adults with disabilities who are not caregivers, caregivers with disabilities were more likely to be women, also on average they were 7.2 years younger than adults with disabilities who did not provide care.

The education level of caregivers with disabilities was higher than that of adults with disabilities who did not provide care; only 6.4% of individuals had no education, compared to 13.8% for those who did not provide care, and more than 40% had a high school education or more, compared to less than 15% of those who did not provide care. Additionally, caregivers with disabilities were more likely to be working (23.8 vs. 17.8%) and to report that their main economic activity was household chores compared to adults with disabilities who did not provide care (46.4 vs. 31.2%). Thus, adults with disabilities who provide care are more likely to be younger, female, higher-educated, and working or responsible for household chores compared to adults with disabilities who are not caregivers (Table 3).

3.3. Characteristics of Caregivers

We also analysed the characteristics of the care received by adults with disabilities, and the individual characteristics of their caregivers (

Table 4. Characteristics of caregivers of adults with disabilities.

	Percentage
Relationship with the person with disability (%)
Partner	23.1
Daughter/granddaughter or daughter/son in low	45.2
Sister or brother	10.7
Mother or father	10.9
Other outside the family	10
Average age	49.4 (SD = 17)
Female	73.1
Education level (%)
None or incomplete primary	13.2
Secondary school	58.8
Higher education	26.9
Receives a payment (%)	6.3
Average number of hours providing care	8.9
Use the services of the district care system (%)	2.0
Caregiver does additional economic activities (%)	54.7

). Among caregivers of adults with disabilities 73.1% were female and the average age was 49.4 years. Among these caregivers, 23.1% were the partner of the person with a disability, 45.2% were their daughter or son, and 10.0% were not related. Only 6.3% of these caregivers received any payment for the care they gave. One aspect to highlight is that all caregivers engage an additional economic activity; thus, they do not provide care exclusively, with 54.7% performing additional household chores and 24.1% having a business.

3.4. Factors Associated with Unsatisfied Care Needs

We estimated a multinomial probit model to analyse which individual characteristics were associated with unsatisfied care needs for adults with disabilities in Bogota (

Table 5. Estimation results of multinomial probit and probit models.

	Receiving Care and Not Needing Additional Support (1)	Receiving Care and Needing More (2)	No Receiving Care but Needing It (3)	No Receiving Care and No Need for It (4)	Probit Model (Unsatisfied Care Needs) (5)	Probit Model (Unsatisfied Care Needs) (6)
Visual difficulties	−0.05 *	−0.02	−0.00	0.07 **	−0.00	0.03
	(−1.88)	(−0.59)	(−0,20)	(2.82)	(−0.00)	(1.05)
Hearing difficulties	−0.00	0.01	−0.01	−0.00	−0.00	0.01
	(−0.06)	(0.25)	(−0.28)	(−0.04)	(−0.00)	(0.23)
Walking difficulties	−0.03	0.10 **	0.04 *	−0.11 ***	0.12 ***	0.08 **
	(−0.95)	(3.14)	(1.88)	(−4.23)	(3.70)	(2.50)
Remembering difficulty	−0.03	0,03	0.01	−0.01	0.05	0.06 *
	(−1.25)	(0.80)	(0.62)	(−0.29)	(1.60)	(1.87)
Self-care activities difficulties	−0.07 **	0.25 ***	−0.05 **	−0.13 ***	0.14 ***	0.14 ***
	(−2.61)	(6.78)	(−2.42)	(−4.95)	(3.96)	(4.42)
Communication difficulties	−0.02	0.20 ***	−0.04 *	−0.14 ***	0.10 **	0.07 **
	(−0.72)	(4.97)	(−1.66)	(−5.56)	(2.52)	(1.99)
Female	0.01	−0.03	−0.01	0.03	−0.04	−0.08 **
	(0.59)	(−1.07)	(−0.80)	(1.42)	(−1.51)	(−2.43)
Age	0.00	0.00	−0.00	−0.00	0.00	−0.00
	(0.35)	(1.31)	(−0.59)	(−1.59)	(0.33)	(−0.67)
Primary education	0.08 **	−0.16 **	0.02	0.06	−0.11 **	−0.11 **
	(2.09)	(−3.05)	(0.61)	(1.47)	(−2.37)	(−2.40)
Secondary education	0.12 **	−0.25 ***	−0.00	0.14 **	−0.21 ***	−0.18 ***
	(2.52)	(−4.35)	(−0.13)	(3.17)	(−3.80)	(−3.29)
High school education	0.05	−0.18 **	−0.00	0.13 **	−0.14 **	−0.11 *
	(1.19)	(−2.94)	(−0.08)	(2.82)	(−2.53)	(−1.93)
Technical or higher education	0.01	−0.22 ***	0.03	0.18 ***	−0.11 **	−0.03
	(0.15)	(−3.47)	(0.65)	(3.78)	(−2.05)	(−0.52)
Working	0.08 **	−0.16 **	0.02	0.06	−0.11 **	−0.11 **
	(2.09)	(−3.05)	(0.61)	(1.47)	(−2.37)	(−2.40)
Receiving social transferences	−0.04 *	0.07 **	−0.01	−0.03	0.06 **	0.07 **
	(−1.70)	(2.40)	(−0.33)	(−1.11)	(2.21)	(2.37)
Provide care to others					0.33 ***	0.31 ***
					(8.84)	(4.29)
Size household						−0.00
						(−0.44)
Daughter/granddaughter or daughter/son in low						0.15 **
						(2.76)
Sister or brother						0.13 **
						(2.29)
Mother or father						0.09
						(1.32)
Other outside the family						0.21 ***
						(3.80)
Age caregiver						0.00
						(0.63)
Female caregiver						−0.08 **
						(−2.50)
Secondary school: Caregiver						0.04
						(0.94)
Higher education: Caregiver						−0.01
						(−0.29)
Number of other activities: Caregiver						0.003
						(0.03)
Number of hours providing care						0.00
						(1.52)
Payment to the caregiver: Yes						−0.041
						(−0.60)
N	1001	1001	1001	1001	1001	795

p-value: *** 0.001, ** 0.001, * 0.05.

, columns 1 through 4), using four categories: 1. receiving care and not needing additional support, 2. receiving care and needing more 3. not receiving care but needing it, and 4. not receiving care but not needing it. We identified that having self-care functional difficulties increased the probability of receiving care and having an unsatisfied need by more than 24 pp but simultaneously reduced the probability of not receiving care and having an unsatisfied need (−4.2 pp) and of not receiving care without an unsatisfied need (−13.2 pp). Results revealed that increases in the level of education significantly reduced the probability of receiving care and having an unsatisfied need compared to those who did not have any education. Additionally, people who reported working also had a lower probability of receiving care and still had an unsatisfied need (−10.9 pp) (Table 5, columns 1 through 4).

The probit model (Table 5 column 5) revealed that people with self-care functional difficulties were more likely to report unsatisfied care needs, with an increase in 19.2 pp compared to those who did not report functional difficulties in this domain. Also, higher levels of education were associated with lower levels of unsatisfied care needs, with a 12.9 pp reduction in the probability of having unsatisfied care needs associated with having completed primary school compared to not having any education. Individuals who reported working had a 8 pp lower probability of having unsatisfied care needs in comparison to those not working, holding all else constant. Belonging to a household that receives cash transfers was also associated with a 7.0 pp increase in the probability of having unsatisfied care needs. Finally, providing care to other members of the household was associated with a 2 pp increase in the probability of presenting unsatisfied care needs, but this increase was not significant.

Column 7 in Table 5 presents the results of a modified version of the probit model including the characteristics of primary caregivers as controls. The most relevant finding was that individuals with disabilities whose main caregiver is someone from outside the household have a higher and significant probability of presenting unsatisfied care needs relative to those whose main caregiver was their partner (21 pp). In addition, when the main caregiver is a woman, the probability of reporting unsatisfied care needs significantly decreases by 8 pp. Aspects such as caregivers receiving payment and number of hours receiving care were not significantly different from zero, yet they presented the expected. Indeed, people whose main caregiver received a payment had a negative probability of reporting unsatisfied care needs (−4.1 pp) and an increase in the number of hours receiving care by day, reducing the probability of unsatisfied care needs by 0.3 pp (Table 5).

4. Discussion

This paper collects data to identify the percentage of adults with disabilities 18 years or older living in Bogota that have unsatisfied care needs. The analysis identified that 74.1% of the population received care. However, 58.7% received care but needed more and 7.6% did not receive care but reported needing care to conduct different activities. Adults with disabilities with unsatisfied care needs were more likely to be older, female, living with functional difficulties in their daily life activities, and having lower levels of education or not working. In addition, an important percentage (34%) of the population with disabilities provided care to other members of the household, including children, people older than 65 years, with disabilities, or those who have been injured or sick.

This is the first study in Colombia and, to our knowledge, in LMICs analysing the percentage of adults with disabilities who present unsatisfied care needs. Based on these findings, disability should be a key consideration in designing care systems since an important percentage of people with disabilities receive care but still have unsatisfied care needs. In line with the suggestions made by the United Nations General Assembly (UNGA) [5], programmes providing care and support services for adults with disabilities should aim to increase their autonomy and independence and should be designed and adapted to their needs. Education and employment are two key aspects positively associated with having their care needs met. Thus, care and support services should be provided jointly with services that promote inclusion of people with disabilities, particularly in the labour and education sectors. In the case of Bogota, it is fundamental that the district design and implement services complement each other, so that adults with disabilities receive the care and support that they need but also for the opportunity to participate in society on an equal basis as others.

One characteristic of caregivers that was positively and significantly related to increased probability of unsatisfied care needs was the relationship of the caregiver to the person with a disability. Indeed, adults with disabilities who received care from someone outside their household were more likely to report unsatisfied care needs. This might be associated with the fact that people outside the household usually do other activities in addition to providing care to the person with a disability, such as cleaning or taking care of other household members. In Bogota, two pilot strategies to provide personal assistance at home have been implemented since the start of the local care system [18]. Although these strategies have shown positive results related to the autonomy of individuals, the cost associated with the implementation of the strategy is a concern. In this context, other strategies should also be implemented to cover the needs of adults with disabilities, especially those who are cared for by someone from outside their family.

The results of this study also reveal that an important percentage of adults with disabilities provide care and support to other members of the household. Caregivers with disabilities are more likely to have higher levels of education, are more likely to be working in addition to providing care, and are more likely to be women, relative to adults with disabilities who do not provide care. This finding is important, given that adults with disabilities, especially women with disabilities who provide care, are usually invisible within care systems. Currently, the local care system in Bogota does not implement services or programmes specifically for caregivers with disabilities, nor does it provide guidelines or processes to adapt general services for caregivers to the needs of those with disabilities. At the same time, traditional disability and social policies more widely do not consider the specific needs of caregivers with disabilities. Globally, there is limited data on caregivers with disabilities, with only one study in the US finding that women with disabilities were more likely to provide care than women without disabilities [19]. While our findings cannot reach the same conclusion, the results provide important evidence on the role of adults with disabilities as caregivers.

Finally, a small percentage of respondents reported that either themselves or their caregiver accessed the care services provided by the district municipality. This finding highlights the gap in service provision for adults with disabilities and caregivers in the city. It is fundamental that care and disability public services and programmes increase their outreach, aiming to reach people with different types and severities of functional difficulties. Increasing access to public services could improve the lives of both people with disabilities and their caregivers, while promoting equal participation in society.

Under a human rights framework, the provision of care and support is fundamental for the inclusion of people with disabilities in society. This framework recognises the need of supporting people with disabilities in different activities, as well as understanding that people with disabilities receive but also provide care. The results of this study identified that people with disabilities present different characteristics that increase their socioeconomic vulnerability and that an important percentage of the population have unsatisfied care needs. Therefore, it is fundamental that care and support services play a central role in social inclusion policies for people with disabilities. In addition, this group should be recognised as a subject of rights that receive and provide care and policies aiming to support caregivers should implement strategies for caregivers with disabilities.

Limitations

The results of this study provide fundamental evidence on the increased probability of unsatisfied care needs among adults with disabilities in Bogota. However, key limitations should be considered. First, the study relies on a small sample surveyed in one of the largest neighbourhoods of the city (Kennedy). However, data collection was not possible in the entire metropolitan region of Bogota. Thus, results are not representative at the city level. Given the small sample size, analysis by type of disability was underpowered, and therefore, disaggregated analysis was not conducted. Secondly, this study did not interview or collect data on the care and support needs of children with disabilities. Given the difficulties with identifying children with functional difficulties, the research team decided not to include them in the study and to focus only on adults with disabilities. Finally, given the small sample size; it is not possible to conduct disaggregated analysis by type of disability.

5. Conclusions

This paper finds that 66.3% of adults with disabilities had unsatisfied care needs, either because they need more care than they receive or because they do not receive care even though they require it. Additionally, 34.0% of adults with disabilities in the study provided care to other household members. These findings reveal that adults with disabilities need local programmes and strategies to address their care and support needs both as care recipients and care providers. Addressing the needs of people with disabilities should be a fundamental objective of care systems, including in Bogota. In addition, care programmes should align with social policies to guarantee the fulfilment of the rights of people with disabilities. The joint provision of care, education, and employment programmes can help guarantee that people with disabilities enjoy the same opportunities to participate in society.