No abstract

Much attention has been paid to the care workforce and care home residents during the COVID-19 crisis, whereas the impact on informal caregivers has remained speculative. In Austria, like in other European countries, informal care is carried out overwhelmingly by (non-cohabiting) relatives. Limited care services available during the crisis, social-distancing, economic uncertainty and competing care needs within households may have changed the profile of informal caregiving and/or increased the psychological strain experienced by caregivers. Focusing on Austria, this study aims to empirically analyse the following research questions: how has the pandemic affected the incidence and intensity of informal caregiving? How has the psychological wellbeing during the first wave of the pandemic compared across different groups of informal caregivers, depending on their gender and parental status? We use a novel representative survey carried out in Austria after the implementation of lockdown measures (June 2020, N=2000). Bivariate and multivariate statistical analysis is applied to a set of survey items dedicated to respondent’s informal caregiving before and after the start of the pandemic and psychological wellbeing. Findings suggest a tightening of care networks, with new carers likely to have stepped in to provide low intensity care to relatively autonomous people. Overall, both prevalence and intensity of informal care did not change significantly (compared to pre-crisis levels). Caregiving was associated with poor psychological outcomes, especially among those without children. Findings are discussed in relation to the emerging literature on the impact of the pandemic and to the policy measures implemented in Austria.

Increased demand for long‐term care (LTC) services alongside precarious working conditions has resulted in labour shortages in the LTC sector, which has led to an increasing share of workers of migrant origin filling these jobs. Previous research on migrant care workers has also highlighted the seeming gap in working conditions relative to native workers. However, lack of disaggregated data on migrant and native care workers, alongside single‐case studies, may have concealed potential disadvantages faced by certain groups and insufficiently accounted for differences in migration regimes and organisation of LTC sectors. To address these gaps, we carried out a comparative study on various working conditions of migrant and native LTC workers in Austria and Sweden. Using the international Nordcare survey on care sector working conditions, carried out in Austria in 2017 (n = 792) and in Sweden in 2015 (n = 708), we employed t‐tests and multivariate logistic regressions to compare the working conditions of migrant and native carers in home and residential care in each country. We found that worse working conditions in Sweden compared to Austria may be explained by differences in training requirements of the LTC workforce and the relatively large for‐profit private sector. Country of origin also plays a paramount role in the differences in working conditions experienced by migrants compared to native care workers, with non‐European migrants being more likely to face a number of precarious working conditions. Our findings highlight the need to continue addressing precarious working conditions across the sector, particularly during the COVID‐19 pandemic where poor working conditions have been linked to increased COVID‐related deaths in nursing homes. Our findings also emphasise the importance of policies that consider the various challenges experienced by different migrant groups in the LTC sector, who may particularly be at risk of presenteeism during the COVID‐19 pandemic.

Background Many patients experienced restricted access to healthcare during the Coronavirus Disease 2019 (COVID-19) pandemic. This study is among the first to provide systematic evidence on the existence of subjective unmet needs (SUN) in different population groups during the pandemic. Methods Using data on individuals aged 20–64 and living in Austria from the AKCOVID survey (June 2020) and the ‘European Social Survey’ (2015), SUN were compared between 2015 and 2020, either related to the pandemic (fear of infection, provider closed or treatment postponed) or not (barriers related to knowledge, affordability, time and reachability). Multinomial logistic regression models identified determinants of SUN during the pandemic, adjusting for socio-demographics, socio-economic status and self-reported health. Results Shares of the population with SUN in 2020 substantially exceeded SUN in 2015. Excess unmet needs were mostly attributable to the pandemic. Postponed treatments and closed providers were the most important reasons for SUN in June 2020. Older age groups (50–64 years), inactive and retired people were most likely to report pandemic-related SUN. We did not find socio-economic differences in pandemic-related SUN. Conclusions The pandemic resulted in a supply-side shock to healthcare, with vulnerabilities emerging especially among older people, people with poor health and/or people no longer active on the labour market. Further research could focus on health system resilience and the possibilities to improve management of healthcare services during pandemics without widening inequalities while maintaining population health.

Live-in care, provided by mainly female migrants, has developed as a do-it-yourself welfare mechanism—hardly regulated, with undefined working times, singular labour relations and widely untraceable cash flows. Migrant carers are isolated, working in a ‘grey’ area, torn between the family in which they are working and the individual person in need of care, and very often they are also dependent on brokering agencies. The aim of this contribution is therefore to describe and analyse how the pandemic has made hidden inequalities more visible in connection with the specificities of live-in migrant care in Austria, Italy and Spain. Findings are based on a brief scoping review, including national media coverage. Results are described in terms of national caveats and strategies to respond to challenges triggered by the pandemic. Mitigating short-term strategies were implemented under pressure and at short notice, mainly influenced by the national framework conditions of live-in migrants in the respective countries. In spite of upcoming political debates regarding the regularisation of live-in care, including issues of wages and working conditions, the visibility of migrant live-in care remains tightly connected to the further development of care regimes and the acknowledgement of unpaid work as a precondition for gender equality and equal opportunities in a European and subsequently in a global dimension.

Old age disabilities are more common among women than men, and adverse socioeconomic conditions are associated with a higher prevalence of disabilities among older adults. The goal of this study was to complete a mapping review of the available evidence assessing the extent to which the observed sex differences in older adults’ disabilities can be attributed to sex differences in socioeconomic status. We searched three databases for articles published between 2009 and 2019, and after screening and looking at eligibility criteria, 6 articles were included in the review. For those studies that did not directly analyse the contribution of socioeconomic conditions, we used the ‘difference method’ to estimate the proportion of the sex gap in disabilities among older adults that could be attributed to socioeconomic conditions. Our review demonstrated that women generally have a higher prevalence of disabilities than men. In several studies, these differences could be partly attributed to sex differences in the distribution of socioeconomic conditions. We also find great elasticity in the magnitude of both the sex gap in disabilities and in the proportion that could be attributed to differences in socioeconomic conditions.

Objectives We present a dynamic view of gender patterns in informal caregiving across Europe in a context of socio-demographic transformations. It aims to answer the following research questions: i) has the gender gap in informal caregiving changed; ii) if so, is this due to changes among women and/or men; iii) has the gender care gap changed differently across care regimes? Methods Multilevel growth curve models are applied to gendered trajectories of informal caregiving of a panel sample of 50+ Europeans, grouped into 5-year cohorts and followed across 5 waves of the SHARE survey, stratified by sex and adjusted for several covariates. Results For men in cohorts born more recently there is a decrease in the prevalence of informal care outside the household, while cohort trajectories for women are mostly stable. Prevalence of care inside the household has increased for later born cohorts for all without discernible changes to the gender care gap. Gender care gaps overall widened among later born cohorts in the Continental cluster, while they remained constant in Southern Europe, and narrowed in the Nordic cluster. Discussion We discuss the cohort effects found in the context of gender differences in employment and care around retirement age, as well as possible demographic explanations for these. The shift from care outside to inside the household, where it mostly consists of spousal care, may require different policies to support carers, whose age profile and possible care burden seems to be increasing.

Background Most countries in Europe require out-of-pocket payments (OPPs) for nursing homes based on users’ income and often assets. This was also the case in Austria until 2018 when asset-based contributions to residential care —denoted the ‘Pflegeregress’ – were abolished, leaving a shortfall in revenue. We aim to determine how the Pflegeregress was distributed across different groups in Austria prior to 2018, what the distributional consequences of its abolishment were, and what the distributional impact of different financing alternatives would be. Methods Circumventing data availability issues, we construct a micro-simulation model using a matched administrative dataset on residential care users receiving the Austrian care allowance (Pflegegeldinformation, PFIF, HVB, and Pflegedienstleistungsstatistik, Statistik Austria) and survey data (SHARE, wave 6). Using this model, we estimate the expected duration of residential care and OPPs under the Pflegeregress of a representative sample of older people aged 65 + in Austria, as well as OPPs under budgetary neutral financing alternatives to the abolished asset-based contribution, namely an inheritance tax and a social insurance scheme. The distributional impact of abolishing the Pflegeregress and these alternative scenarios is assessed through a number of measures, such as ability to pay, Concentration Indices (CI) and a needs-standardized measure. Results We find that lower income individuals and homeowners disproportionately contributed to asset-based OPPs for residential care prior to 2018, due in large part to their higher use of residential care and the low asset-exemption thresholds. These groups were therefore the largest beneficiaries of its abolishment. The alternative financing scenarios tested would result in a more progressive distribution of payments (i.e. concentrated on more affluent individuals). Conclusion Our findings indicate the limited ability of asset-based OPPs to target those with higher assets, thus questioning the fairness of these instruments for financing residential care facilities for older people in Austria. Findings also suggest that the parameterization of such OPPs (such as asset exemption thresholds) and patterns of residential care use are key variables for assessing the distribution of asset-based OPPs for residential care use. Policy alternatives that decouple payments from use would entail greater transfers from healthy to less healthier individuals.