Informal and formal home-care use among older adults in Europe: can cross-national differences be explained by societal context and composition?

Abstract

Cross-national comparisons employed welfare state classifications to explain differences in care use in the European older population. Yet these classifications do not cover all care-related societal characteristics and limit our understanding of which specific societal characteristics are most important. Using the Survey of Health, Ageing and Retirement (second wave, -), the effect of societal determinants relating to culture, welfare state context and socio-economic and demographic composition on informal and formal care use of older adults in  European countries was studied. Multinomial multi-level regression analyses showed that, in addition to individual determinants, societal determinants are salient for understanding care use. In countries with fewer home-based services, less residential care, more informal care support and women working full time, older adults are more likely to receive informal care only. Older adults are more likely to receive only formal home care or a combination of formal and informal care in countries with more extensive welfare state arrangements (i.e. more home-based services, higher pension generosity), whereas the odds of receiving a combination of informal and formal care are also larger in countries that specify a legal obligation to care for parents. We tentatively conclude that the incorporation of societal determinants rather than commonly used welfare state classifications results in more understanding of the societal conditions that determine older adults' care use.KEY WORDS -informal and formal care use, cross-national comparison, welfare state, culture, demographic composition. IntroductionRapid population ageing has made older adults' care a major policy topic across Europe. In , approximately  per cent of the European . These studies showed that variation in older adult's formal and informal care use between European countries is pervasive. On one side of the spectrum, in the Scandinavian countries as well as the Netherlands and Belgium, relatively many older adults receive formal home care, whether or not in combination with informal care. In contrast, in Mediterranean countries like Spain and Greece, and to a lesser extent, in Germany, many older adults receive informal care only. In Austria and France, the percentage of older adults receiving informal care only and formal care only are roughly equal and more often a combination of formal and informal care is used.Previous studies showed that cross-national variation in care use is only in part explained by older adults' individual characteristics (e.g. MotelKlingebiel, Tesch-Roemer and von Kondratowitz ; Pommer, Woittiez and Stevens ). Recently more attention has been devoted to the effects of societal conditions on older adults care use. Studies on intergenerational solidarity in Europe have shown that societal characteristics relating to culture and welfare state policies are important for explaining patterns of help between parents and children. In more familialistic cultures, for ...

Interpersonal Relationships and Subjective Well-being among Older Adults in Sheltered Housing

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“…From the beginning of the 1990s onwards policies aiming to increase ageing in place were implemented, which was translated into providing formal care to older adults in their own homes. While other countries stimulated the development of informal care, the Netherlands aimed at offering more home-based care, and made a transition from public care provision to more private provision of formal care (Pavolini & Ranci, 2008;Suanet et al, 2012). More recently, the Dutch government took measures which limit the possibility to move into a care-facility to people who need intensive care and assistance (Homan, 2012).…”

Delegating home care for the elderly to external caregivers? An empirical study on Italian data

“…It has now been recognised that cultural factors and the societal context may also affect households' decisions. In Europe a "north-south gradient" has been identified, with Nordic countries favouring State support and generous home care services, resulting in a considerable degree of formal care, while a mix of formal and informal care prevails in Continental Europe, and Mediterranean countries remain largely dependent on informal care (Suanet et al, 2012).…”

“…A second contribution is that while several studies have incorporated societal values and cultural factors in the analysis of care provision, and have proven important at the national level (Bolin, 2008;Suanet et al, 2012;Di Novi et al 2013), cultural views at the household level can be equally relevant but tend to be overlooked owing to a lack of adequate information. We, on the contrary, are able to take advantage here of a unique survey that includes questions reflecting both households' views on the best way to organise and finance LTC services, and the strength of family ties.…”

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“…Suanet et al, 2012) together with welfare system characteristics, cultural factors and socioeconomic and demographic contextual factors as they may contribute to variability in care arrangements in a systematic way.…”