Revisiting the Nordic long-term care model for older people—still equal?

Abstract

With the extensive long-term care services for older people, the Nordic countries have been labelled ‘caring states’ as reported (Leira, Welfare state and working mothers: the Scandinavian experience, Cambridge University Press, Cambridge, 1992). The emphasis on services and not cash benefits ensures the Nordics a central place in the public service model (Anttonen and Sipilä, J Eur Soc Policy 6:87–100, 1996). The main feature of this ideal model is public social care services, such as home care and residential care services, which can cover the need for personal and medical care, as well as assistance with household chores. These services are provided within a formally and professionally based long-term care system, where the main responsibility for the organization, provision and financing of care traditionally lays with the public sector. According to the principle of universalism (in: Antonnen et al. (eds), Welfare state, universalism and diversity, Elgar, Cheltenham, 2013), access to benefits such as home care and residential care is based on citizenship and need, not contributions nor merit. Also, care services should be made available for all and generally be used by all, with no stigma associated. Vabø and Szebehely (in: Anttonen (ed), Welfare State, universalism and diversity, Edward Elgar Publishing, London, 2012)) further argue that the Nordic service universalism is more than merely issues of eligibility and accessibility, in that it also encompasses whether services are attractive, affordable and flexible in order to meet a diversity of needs and preferences. However, recent decades have seen a continuous tendency towards prioritization of care for the most frail, contributing to unmet need, informalization of care and privatization in the use of topping up with market-based services. These changes have raised questions about increasing inequalities within Nordic long-term care systems. We investigate in the article what effect changes have for equality across social class and gender, for users and informal carers. The article is based on analysis of comparable national and international statistics and a review of national research literature and policy documents.

Will your child take care of you in your old age? Unequal caregiving received by older parents from adult children in Sweden

“…When the overall coverage reduces, and the eligibility thresholds are relatively strict, older adults must have quite severe health problems to qualify for formal care. Consequently, the adult children of parents with less-severe health problems but who still need care will be affected (Rostgaard et al 2022 ). However, this study shows that even when accounting for formal care received by parents, care received from children still vary depending on their gender and social class combined.…”

“…publicly funded care for older adults should be available to all as needed, regardless of an individual’s financial or family resources (Sipilä 2019 ). However, care provided by the state has undergone a process of deinstitutionalisation and marketisation, having various implications for the lives of older adults and their families (Rostgaard et al 2022 ). Older adults needing care appear to arrange their care provision depending on their socioeconomic status, especially if they do not qualify for formal services.…”

Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China

“…At the same time, local governments with a social democratic orientation may be more inclined to allocate excessive public resources to the LTC system than those with a liberal capitalist orientation [ 9 ]. Recent research has also found that local governments’ differential prioritization of LTC systems in overall social security policy and differential emphasis on institutional and family services have contributed to significant differences in the geographic distribution of existing LTC systems [ 10 , 11 ]. These differences can hardly be explained by the changes in the population size and needs of the elderly, but the results all lead to the inequality and unfairness of LTC.…”

Long-term care use among people living with dementia: a retrospective register-based study from Sweden

“…Due to different systems of LTC, given a certain level of care needs, the use of services varies across countries [ 10 , 11 ]. In the Nordic countries LTC is largely publicly financed with the goal of an equitable allocation of care on the basis of universalism [ 12 ], e.g., access to LTC is needs-tested rather than means-tested. Although aging-in-place, e.g., to assist older people in their own homes, is promoted in all Nordic countries [ 13 , 14 ], the use of LTC depends on the country-specific welfare system.…”

“…Although aging-in-place, e.g., to assist older people in their own homes, is promoted in all Nordic countries [ 13 , 14 ], the use of LTC depends on the country-specific welfare system. Although several European countries impose legal obligation to family members to provide care support to older adults [ 15 ], in the Nordic countries, there is no formal obligation nor strong norms for the family to care for older parents [ 12 , 16 ].…”