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Transitions in formal and informal care utilisation amongst older Europeans: the impact of national contexts

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Abstract

The objective of this study was to explore how long-term care systems, and in particular the incorporation of needs-based entitlements to care services or benefits, influence formal and informal care utilisation dynamics. We used the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 1 and 2 data, restricting the sample to persons 65+ from 9 European countries (N = 6,293). The effects of changes in health and household composition on formal and informal care transitions were estimated using logistic regression, allowing these effects to vary across countries. The results indicated that, in all countries, formal and informal care were more often complements than substitutes. The likelihood of becoming a formal or informal care user varied significantly between countries. In the Scandinavian countries and in several continental European countries with needs-based entitlements, the transition to formal care was strongly related to informal support being or becoming unavailable. We found little evidence of country differences in the effect of health variables on the transition to formal care. The analysis suggested that, whilst rates of formal care utilisation continue to differ considerably between European countries, formal care allocation practices are not very dissimilar across Northern and continental European welfare states, as we found evidence for all countries of targeting of older persons living alone and of the most care-dependent older people.

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References

  • Aday LA, Andersen RM (1974) A framework for the study of access to medical care. Health Ser Res 9(3):208–220

    Google Scholar 

  • Albertini M, Kohli M, Vogel C (2007) Intergenerational transfers of time and money in European families: common patterns–different regimes? J Eur Soc Policy 17(4):319–334

    Article  Google Scholar 

  • Andersen RM (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 36(1):1–10

    Article  Google Scholar 

  • Andersen RM (2008) National health surveys and the behavioral model of health services use. Med Care 46(7):647–653

    Article  Google Scholar 

  • Andersen R, Newman JF (1973) Societal and individual determinants of medical care utilization in the United States. Milbank Q 51(1):95–124

    Google Scholar 

  • Armi F, Guilley E, Lalive d’Epinay CJ (2008) The interface between formal and informal support in advanced old age: a ten-year study. Int J Ageing Later Life 3(1):5–19

    Article  Google Scholar 

  • Brandt M, Haberkern K, Szydlik M (2009) Intergenerational help and care in Europe. Eur Sociol Rev 25(5):585–601

    Article  Google Scholar 

  • Bravell ME, Berg S, Malmberg B (2008) Health, functional capacity, formal care, and survival in the oldest old: a longitudinal study. Arch Gerontol Geriatr 46(1):1–14

    Article  Google Scholar 

  • Broese van Groenou M, Glaser K, Tomassini C, Jacobs T (2006) Socio-economic status differences in older people’s use of informal and formal help: a comparison of four European countries. Ageing Soc 26(5):745–766

    Article  Google Scholar 

  • Calsyn RJ, Winter JP (2000) Predicting different types of service use by the elderly: the strength of the behavioral model and the value of interaction terms. J Appl Gerontol 19(3):284–303

    Article  Google Scholar 

  • Colombo F, Llena-Nozal A, Mercier J, Tjadens F (2011) Help wanted? Providing and paying for long-term care. OECD Health Policy Studies. OECD Publishing, Paris

    Google Scholar 

  • Comas-Herrera A, Wittenberg R (eds) (2003) European study of long-term care expenditure. PSSRU discussion paper 1840. London School of Economics, London

  • Costa-Font J (2010) Devolution, diversity and welfare reform: long-term care in the ‘Latin Rim’. Soc Policy Adm 44(4):481–494

    Article  Google Scholar 

  • Da Roit B, Le Bihan B (2010) Similar and yet so different: cash-for-care in six European countries’ long-term care policies. Milbank Q 88(3):286–309

    Article  Google Scholar 

  • Daatland SO, Herlofson K (2003) ‘Lost solidarity’ or ‘changed solidarity’: a comparative European view of normative family solidarity. Ageing Soc 23(5):537–560

    Article  Google Scholar 

  • Declercq A, Demaerschalk M, Vanden Boer L, Bronselaer J, De Witte N, Verté D, Molenberghs G (2009) De invloed van individuele en gemeentelijke kenmerken op het formele en informele zorggebruik van Vlaamse ouderen. In: Vanderleyden L, Callens M, Noppe J (red) De sociale staat van Vlaanderen 2009. Studiedienst van de Vlaamse Regering, Brussel, pp 381–399

    Google Scholar 

  • Evers A, Svetlik I (eds) (1991) New welfare mixes in care for the elderly. European Centre for Social Welfare Policy and Research, Vienna

    Google Scholar 

  • Fontaine R, Gramain A, Wittwer J (2007) Les configurations d’aide familiales mobilisées autour des personnes âgées dépendantes en Europe. Economie et Statistique 303–404:97–115

    Article  Google Scholar 

  • Geerlings S, Pot AM, Twisk JWR, Deeg DJH (2005) Predicting transitions in the use of informal and professional care by older adults. Ageing Soc 25(1):111–130

    Article  Google Scholar 

  • Geerts J (2009) Gebruik van formele en informele zorg door ouderen. Vlaanderen/België in Europees vergelijkend perspectief. In: Cantillon B, Van den Bosch K, Lefebure S (red) Ouderen in Vlaanderen en Europa. Tussen vermogen en afhankelijkheid. Acco, Leuven, pp 155–189

  • Geerts J (2010) Dynamieken en determinanten van long-term caregebruik. Doctoral dissertation, Universiteit Antwerpen

  • Gutiérrez MF, Jiménez-Martín S, Vegas Sánchez R, Vilaplana C (2010) The Spanish long-term care system. ENEPRI Research Report No.88, http://www.ceps.eu/book/long-term-care-system-elderly-spain

  • Huber M, Rodrigues R, Hoffmann F, Gasior K, Marin B (2009) Facts and figures on long-term care. European Centre, Vienna

    Google Scholar 

  • Jamieson A (ed) (1991) Home care for older people in Europe. A comparison of policies and practices. Oxford University Press, Oxford

    Google Scholar 

  • Kadushin G (2004) Home health care utilization: a review of the research for social work. Health Soc Work 29(3):219–232

    Article  Google Scholar 

  • Kalmijn M, Saraceno C (2006) Responsiveness to parental needs in individualistic and familialistic countries. Netspar discussion paper, 2006-022, Tilburg

  • Kraus M, Riedel M, Mot E, Willemé P, Röhrling G, Czypionka T (2010) A typology of systems of long-term care in Europe—results of work package 1 of the ANCIEN project. Institut für Höhere Studien, Wien, http://www.ancien-ongtermcare.eu/sites/default/files/Typology%20Report_Final%20Version_07.09.2010_postIHS2.pdf

  • Larsson K (2004) According to need? Predicting use of formal and informal care in a Swedish urban elderly population. Doctoral dissertation, Stockholm University

  • Litwin H, Attias-Donfut C (2009) The inter-relationship between formal and informal care: a study in France and Israel. Ageing Soc 29(1):71–91

    Article  Google Scholar 

  • Lyons KS, Zarit SH (1999) Formal and informal support: the great divide. Int J Ger Psych 14(3):183–192

    Article  Google Scholar 

  • Morel N (2007) From subsidiarity to ‘free choice’: child- and elder-care policy reforms in France, Belgium, Germany and the Netherlands. Soc Policy Adm 41(6):618–637

    Article  Google Scholar 

  • Motel-Klingebiel A, Tesch-Römer C, von Kondratowitz H-J (2005) Welfare states do not crowd out the family: evidence for mixed responsibility from comparative analyses. Ageing Soc 25(6):863–882

    Article  Google Scholar 

  • Muramatsu N, Campbell RT (2002) State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. J Health Soc Behav 43:107–124

    Article  Google Scholar 

  • OECD (2005) Long-term care for older people. OECD, Paris

    Book  Google Scholar 

  • Pacolet J, Lanoye H, Bouten R, Versieck K (1999) Social protection for dependency in old age in the 15 EU Member states and Norway. Office for Official Publications of the European Communities, Luxembourg

    Google Scholar 

  • Pavolini E, Ranci C (2008) Restructuring the welfare state: reforms in long-term care in Western European countries. J Eur Soc Policy 18(3):246–259

    Article  Google Scholar 

  • Pescosolido B, Kronenfeld J (1995) Health, illness, and healing in an uncertain era: challenges from and for medical sociology. J Health Soc Behav 35:5–33

    Article  Google Scholar 

  • Pescosolido BA, Boyer CA, Lubell KM (1999) The social dynamics of responding to mental health problems: past, present, and future challenges to understanding individuals’ use of services. In: Aneshensel CS, Phelan JC (eds) Handbook of the sociology of mental health. Kluwer Academic/Plenum Publishers, New York, pp 441–459

    Google Scholar 

  • Pfau-Effinger B (2005) Development paths of care arrangements in the framework of family values and welfare values. In: Pfau-Effinger B, Geissler B (eds) Care and social interaction in European societies. Policy Press, Bristol, pp 21–42

    Google Scholar 

  • Pommer E, van Gameren E, Stevens J, Woittiez I (2007) Verschillen in verzorging. De verzorging van ouderen in negen EU-landen. Sociaal en Cultureel Planbureau, Den Haag

    Google Scholar 

  • Rauch D (2008) Central versus local service regulation: accounting for diverging old-age care developments in Sweden and Denmark, 1980–2000. Soc Policy Admin 42(3):267–287

    Article  Google Scholar 

  • Reher D (1998) Family ties in Western Europe: persistent contrasts. Popul Develop Rev 24(2):203–234

    Article  Google Scholar 

  • Schut FT, van den Berg B (2010) Sustainability of comprehensive universal long-term care insurance in the Netherlands. Soc Policy Adm 44(4):411–435

    Article  Google Scholar 

  • Shea D, Davey A, Femia E, Zarit S, Sundström G, Berg S, Smyer M (2003) Exploring assistance in Sweden and the United States. Gerontologist 43(5):712–721

    Article  Google Scholar 

  • TNS Opinion & Social (2007) Health and long-term care, Special Eurobarometer 283, Wave 67.3, Brussels: European Commission, http://ec.europa.eu/public_opinion/archives/ebs/ebs_286_en.pdf

  • Tester S (1996) Community care for older people: a comparative perspective. MacMillan, Basingstoke

    Google Scholar 

  • Ward-Griffin C, Marshall VW (2003) Reconceptualizing the relationship between “public” and “private” eldercare. J Aging Studies 17(2):189–208

    Article  Google Scholar 

  • Willemé P (2010) The long-term care system for the elderly in Belgium. ENEPRI Research Report No. 70, http://www.ceps.eu/book/long-term-care-system-elderly-belgium

Download references

Acknowledgments

This article uses data from SHARE release 2.3.1, as of July 29th 2010. SHARE data collection in 2004–2007 was primarily funded by the European Commission through its 5th and 6th framework programmes (project numbers QLK6-CT-2001-00360; RII-CT-2006-062193; CIT5-CT-2005-028857). Additional funding by the US National Institute on Aging (grant numbers U01 AG09740-13S2; P01 AG005842; P01 AG08291; P30 AG12815; Y1-AG-4553-01; OGHA 04-064; R21 AG025169) as well as by various national sources is gratefully acknowledged (see http://www.share-project.org for a full list of funding institutions). A preliminary version of this article was presented at the 63rd Annual Scientific Meeting of the Gerontological Society of America in November, 2010 in New Orleans. The authors would like to thank the anonymous referees and the guest editor for their helpful suggestions.

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Authors and Affiliations

  1. Federal Planning Bureau, Kunstlaan 47-49, 1000, Brussels, Belgium

    Joanna Geerts & Karel Van den Bosch

  2. University of Antwerp, Research Unit on Welfare and the Welfare State, Sint-Jacobstraat 2, 2000, Antwerp, Belgium

    Joanna Geerts

  3. University of Antwerp, Herman Deleeck Centre for Social Policy, Sint-Jacobstraat 2, 2000, Antwerp, Belgium

    Karel Van den Bosch

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  1. Joanna Geerts
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Correspondence to Joanna Geerts.

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Responsible Editor: D. J. H. Deeg.

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Geerts, J., Van den Bosch, K. Transitions in formal and informal care utilisation amongst older Europeans: the impact of national contexts. Eur J Ageing 9, 27–37 (2012). https://doi.org/10.1007/s10433-011-0199-z

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