Socioeconomic Inequalities in Home-Care Use Across Regional Long-term Care Systems in Europe

Abstract

Objectives We examine whether socioeconomic inequalities in home-care use among disabled older adults are related to the contextual characteristics of long-term care (LTC) systems. Specifically, we investigate how wealth and income gradients in the use of informal, formal, and mixed home-care vary according to the degree to which LTC systems offer alternatives to families as the main providers of care (“de-familization”). Method We use survey data from SHARE on disabled older adults from 136 administrative regions in 12 European countries and link them to a regional indicator of de-familization in LTC, measured by the number of available LTC beds in care homes. We use multinomial multilevel models, with and without country fixed-effects, to study home-care use as a function of individual-level and regional-level LTC characteristics. We interact financial wealth and income with the number of LTC beds to assess whether socioeconomic gradients in home-care use differ across regions according to the degree of de-familization in LTC. Results We find robust evidence that socioeconomic status inequalities in the use of mixed-care are lower in more de-familized LTC systems. Poorer people are more likely than the wealthier to combine informal and formal home-care use in regions with more LTC beds. SES inequalities in the exclusive use of informal or formal care do not differ by the level of de-familization. Discussion The results suggest that de-familization in LTC favors the combination of formal and informal home-care among the more socioeconomically disadvantaged, potentially mitigating health inequalities in later life.

Discrimination against the elderly in health‐care services: a systematic review

“…Our investigation identified pro‐poor inequality among the elderly in high‐, middle‐, and low‐income countries. Similar disparities have been discussed in the context of home care service for the elderly in Europe 5 …”

“…Regional reports describe inequalities in senior citizens' access to health care and long‐term care 5–8 . Analysis of survey data among elderly people with disabilities in 12 European countries indicated that a 10% increase in wealth is related to a 0.01–0.02% decrease in the reception of informal care 5 .…”

Do Standard Classifications Still Represent European Welfare Typologies? Novel Evidence from Studies on Health and Social Care

“…Second, our study suggests that enhancing the specificity of welfare classifications might be relevant for future comparative empirical research, which often have to rely on general classifications of countries welfare systems while studying specific policy areas, due to data limitations (e.g., Carrieri et al, 2017;Floridi et al, 2021). Our findings show that broad classifications might underestimate the hybridisation of countries welfare systems in specific policy areas.…”

Influence of socio-economic profile of neighbourhoods on the selection of home care strategies for older dependants

“…The importance of the context in care-giving decisions Much of the research published on factors behind care-giving decisions has focused on the characteristics of dependants, their homes, the preferences and availability of their relatives, and what financial and human resources the dependants have at their disposal (Sergeant and Ekerdt, 2008;Fernández-Carro, 2016). Some studies have shown that the household's socio-economic level affects the probability of dependants being cared for by someone other than a family member, but the evidence is sometimes inconclusive (Floridi et al, 2021). Some researchers report that dependants living in lower-income households receive less care from their relatives, friends or neighbours (Jang and Kawachi, 2019).…”