Met or unmet need for long-term care: Formal and informal care in southern Europe

Abstract

Southern European countries share many common traits but there are differences among them that can justify different levels of need and of unmet need for social long-term care (LTC). In our study, we quantify met and unmet need for LTC for older people, in the four southern European countries – Portugal, Spain, Italy, and Greece – and we analyse their determinants, using multinomial logits and data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). We analyse the association between several demographic and socio-economic factors and the chances of having needs, and of receiving or not different types of care. Although most of the effects of the explanatory variables are valid in all the countries, some factors are more important in some countries than in others. Portugal stands out as the country where people aged fifty or older have more care needs and, as a result, a higher risk of having people with unmet social care needs, compared to the other countries. Also, there is evidence that Portuguese women are especially penalized. In Greece and Portugal, people with the same characteristics have a higher probability of receiving exclusively informal care. Curiously, despite its suboptimal LTC system, the Greek reliance on informal care leads to superior performance in terms of unmet needs of people with ADL limitations. Italy and Spain show similar traits, particularly concerning the probabilities of having care needs and experiencing unmet needs. However, in Spain, receiving exclusively informal care is much less probable. Our findings suggest caution in the treatment of southern European countries as a uniform cluster and the need to take the differences into consideration when defining a policy to promote disability-free ageing or to guarantee that support is provided when needed.