Availability Of Informal Care Research Articles

Willingness to provide informal care to older adults in Germany: a discrete choice experiment

As the German population is continually aging and the majority of older adults still wish to ‘age in place’, the need for informal care provided by family and friends will correspondingly continue to increase. In addition, while the need for formal (professional) care services is also likely to increase, the supply already does not meet the demand in Germany today. The aim of our study is the elicitation of people’s willingness to provide informal care by means of a discrete choice experiment. The self-complete postal survey was disseminated to a random sample of the German general population in Lower Saxony. Data cleansing resulted in a final sample size of 280 participants. A conditional logit and a latent class model were estimated. All attributes were judged as highly relevant by the respondents. The results revealed that an increase in the care hours per day had the greatest negative impact overall on the willingness to provide informal care in our sample. The marginal willingness-to-accept for 1 h of informal care was €14.54 when having to provide informal care for 8 h in reference to 2 h per day. This value is considerably higher than the national minimum wage of €9.82. A three-class latent class model revealed preference heterogeneity. While a monetary compensation is often discussed to increase the willingness and availability of informal care in a country, our results show that this statement could not be generalized within our entire sample.

(In)Decent work conditions and quality care: an issue for long-term care policy

AbstractThe availability of informal care will remain a key factor influencing future demand for formal services and the analysis cannot be dissociated from formal care. Based on the ‘unpaid care work–paid work–paid care work circle’, proposed by the International Labour Office, this paper focuses on the individual, interpersonal and organisational determinants that most influence quality care. This paper is based on 40 semi-structured interviews with care workers, in 16 Portuguese care homes, in one council in the metropolitan area of Lisbon. In spite of social change processes in the care worker profession in Portuguese nursing homes, in the last decade, in terms of numbers, age and education, the interviews allowed me to unveil qualitatively what the numbers hid: precarious working conditions, insufficient staffing, excessive workloads and long working hours, high rotation and insufficient skills. All these determinants have consequences not only on the quality of the care that these care workers can offer, but also on their physical and mental health, job satisfaction and work environment. The high demand of care needs due to the ageing of the population, calls for continued efforts in improving working conditions, and a national strategy to promote recruitment of a diverse, younger and more-qualified workforce. The professionalisation of care work must be integrated with migration and employment policies (improvement of job quality and working conditions).

Is the Availability of Informal Care Associated with a Lower Uptake in Formal Home Care? An Application to Personal Care in the Netherlands

Context: Long-term care (LTC) costs within member countries of the Organisation for Economic Co-operation and Development (OECD) are rising steeply, thereby presenting a challenge to the financial sustainability of most LTC systems. A seemingly attractive policy measure is to decrease the use of (expensive) publicly financed LTC and to increase the provision of informal care. Objectives: This paper assesses how 1) the use of publicly financed LTC and 2) the uptake of entitled LTC care are related to the availability of informal care. Our study only considers personal care as it might be more easily replaced by informal care than other more complex types of care. Personal care includes tasks like bathing, toileting, dressing, and helping with eating. Methods: We have access to unique Dutch nationwide data from 2013, which contain information on care entitlement, care use, potential informal caregivers, and clients’ characteristics. Craggit regression analyses were used to analyse the data. Findings: Only 58% of the maximal amount of entitled hours for formal personal care was used. A lower uptake is observed when children moved out. Also, individuals with a healthy partner use about 19% less formal personal care than the average of 11.5 hours per month. Moreover, individuals with an unhealthy partner use about 7% more formal care. Limitations: We had access to data on availability of informal care and not on the actual informal care provided. Implications: Older individuals use less publicly financed personal care than expected based on their needs and the relatively low uptake of entitled care can partially be explained through informal care.

Investigating factors influencing quality-of-life effects of home care services in Austria, England and Finland: A comparative analysis

European countries have developed a range of long-term care (LTC) policy responses to support the increasing share of older people. However, little is known about the effectiveness of LTC services and benefits, particularly their impact on older peoples’ quality of life (QoL). This paper investigates the role of personal, care service and environmental characteristics on the effects of home care services on QoL across England, Finland and Austria. We used data from surveys conducted in England, Finland and Austria. In total, 811 older adults were included in the analysis. OLS regression including main effects and country-specific interactions was used to explore variation in gains in long-term care service-related quality-of-life (LTC-QoL). Explanatory variables were derived from the production of welfare framework and comprised home care service user socio-demographics, needs indicators, social support and environmental variables and characteristics of home care service provision. In all three countries, LTC-QoL gains increased with needs, indicating that home care services perform well, with additional gains declining the higher the needs. Also, better process quality contributed to LTC-QoL improvements in all three countries. In addition, the availability of informal care, social contact, financial household situation and living alone, were associated with changes in LTC-QoL only in one or two of the countries. Home care services increased service users’ QoL in all three European countries. The increase in QoL, however, varied across the countries. The results also provide insights into the benefits and limits of home care service provision and areas for future improvements. JEL: I31, I38, J14

Older parents and filial support obligations: a comparison of family solidarity norms between native and immigrant populations in Italy

AbstractAlthough older migrants in Southern Europe are increasing in number, relatively little attention has been paid to their care needs and resources. The availability of informal care is an important determinant of wellbeing in later life and norms regulating filial obligations have an important role in affecting the quality and quantity of support received. Using data from a qualitative survey conducted in Italy, this article sheds light on the social norms regulating filial obligations towards older parents among natives and three groups of immigrants: Maghrebis, Chinese and Filipinos. The results indicate a number of commonalities between the four different groups considered, such as: the principle of delayed reciprocity at the basis of filial support obligations; a gender bias in attributing the most psychologically, physically and time-demanding caring obligations to adult daughters and daughters-in-law; and a preference for intergenerational residential autonomy shared by Italian, Filipinos and, to a lesser extent, Maghrebi respondents. At the same time, numerous differences emerge between natives and immigrants, and between immigrant groups. The most significant differences are observed regarding: the possibility of resorting to a paid care-giver, which is more common among Italians and, to a lesser extent, Filipino respondents; and a stronger gender bias among the Chinese and Maghrebi groups, i.e. they attribute the majority of personal care responsibilities to daughters and daughters-in-law.

A set of efficient heuristics for a home healthcare problem

Nowadays, the aging population and the little availability of informal care are two of the several factors leading to an increased need for assisted living support. Hence, home healthcare (HHC) operations including a set of nurses and patients have been developed recently by both academia and health practitioners to consider elderlies’ preferences willing to receive their cares at their homes instead of hospitals or retirement homes. Commonly, different services, e.g., nursing, physiotherapy, housekeeping and cleaning, for an HHC system are performed by nurses at patients’ homes after scheduling and routing the nurses by decision makers. Due to the difficulty of the problem, recent studies show a great deal of interest in applying various metaheuristics and heuristics to solve this problem. To alleviate the drawbacks of previous works and make HHC more practical, this paper develops not only a new mathematical formulation considering new suppositions in this research area but also a lower bound based on Lagrangian relaxation theory has been employed. As such, three new heuristics and a hybrid constructive metaheuristic are utilized in this study to solve the proposed model. Finally, the performance of the proposed algorithms is validated by the developed lower bound and also analyzed by different criteria and also the efficiency of developed formulation is probed through some sensitivity analyses.

Modelling and (re-)planning periodic home social care services with loyalty and non-loyalty features

The aging population alongside little availability of informal care are two of the several factors leading to an increased need for assisted living support. In this work, we tackle a home social care service problem, motivated by two real case studies where a new loyalty scheme must be considered: within a week, patient-caregiver loyalty should be pursued but, between weeks, the caregivers must rotate among patients (non-loyalty). In addition, a common situation in this kind of service is also addressed: the need of a constant re-planning caused by the leaving of patients and the arrival of new ones. This new plan should be such that minimum disturbance is caused to the visiting hours of current patients, the caregivers’ travelling time between visits is minimized, and the workload is balanced among caregivers. A multi-objective optimization approach based on mixed-integer models is developed. Results on the two real case studies show that both institutions can efficiently re-plan their activities without much disturbance on the visits of their patients, and with a patient-caregiver loyalty scheme suiting their needs.

Family Transfers with Retirement-Aged Adults in the United States: Kin Availability, Wealth Differentials, Geographic Proximity, Gender, and Racial Disparities

This paper examines transfers of time and money between retirees and their children. It uses data from the Panel Study of Income Dynamics to test whether numbers of children, parent-child wealth differentials, geographic proximity, and gender contribute to racial and ethnic differences in transfers of time and money between retirement-aged adults and their children. Critical components of the analysis include measuring kin availability, the spatial and social embeddedness of family networks, supply as well as demand for transfers, and gender. Key limitations are that we exclude those who have no living family members with whom they could transfer, and we do not examine the role of non-familial transfers. The paper found that: -There are large racial disparities in family transfers; non-White older adults are less likely to give either time or money transfers to their children than White older adults. Non-White older adults are also less likely to receive time transfers from their children, but they are more likely to receive money transfers from them. -Having more children is associated with marginal declines in the likelihood of transfer with each child, but an overall increase in the likelihood of transfer with any child. -Parents who live closer to their children tend to provide more time to them and receive more time from them, while those in the same family provide more money. -Parents who are relatively wealthier than their children are more likely to give them money and are less likely to receive time or money from them. -Racial disparities in transfers appear to be growing across parental birth cohorts. The policy implications of these findings are: -Challenges regarding retiree financial security and the availability of informal care from family members are likely to grow because adults with fewer children receive less overall support than those with many children, and historical declines in birth rates mean that more older adults increasingly have fewer children. -Older adults may be more likely to receive instrumental care, but not financial support, from their children in the future, because people are increasingly likely to live close to their children, and closer children are more likely to provide such care. -There may be especially large unmet financial and instrumental needs for female and non-White population subgroups of retirees.

Can resources moderate the impact of levels of frailty on adverse outcomes among (pre-) frail older people? A longitudinal study

BackgroundHigher levels of frailty result in higher risks of adverse frailty outcomes such as hospitalisation and mortality. There are, however, indications that more factors than solely frailty play a role in the development of these outcomes. The presence of resources, e.g. sufficient income and good self-management abilities, might slow down the pathway from level of frailty to adverse outcomes (e.g. mortality). In the present paper we studied whether resources (i.e. educational level, income, availability of informal care, living situation, sense of mastery and self-management abilities) moderate the impact of the level of frailty on the adverse outcomes mortality, hospitalisation and the development of disability over a two-year period.MethodsLongitudinal data on a sample of 2420 community-dwelling pre-frail and frail older people were collected. Participants filled out a questionnaire every six months, including measures of frailty, resources and outcomes. To study the moderating effects of the selected resources their interaction effects with levels of frailty on outcomes were studied by means of multiple logistics and linear regression models.ResultsFrail older participants had increased odds of mortality and hospitalisation, and had more deteriorating disability scores compared to their pre-frail counterparts. No moderating effects of the studied resources were found for the outcomes mortality and hospitalisation. Only for the outcome disability statistically significant moderating effects were present for the resources income and living situation, yet these effects were in the opposite direction to what we expected. Overall, the studied resources showed hardly any statistically significant moderating effects and the directions of the trends were inconsistent.ConclusionsFrail participants were more at risk of mortality, hospitalisation, and an increase in disability. However, we were unable to demonstrate a clear moderating effect of the studied resources on the adverse outcomes associated with frailty (among pre-frail and frail participants). More research is needed to increase insight into the role of moderating factors. Other resources or outcome measures should be considered.

THE ACTUAL AND EXPECTED AVAILABILITY OF INFORMAL CARE: CHILDLESS ELDERLY PEOPLE AND PARENTS

As people get older, they face the question of who will provide them with care if they ever need it. Current estimates indicate that approximately 87% of Americans who receive long-term care receive it from informal caregivers. However, the supply of family caregivers is unlikely to keep pace with future demand, and increasing childlessness rates represent an additional challenge. Using data from the HRS, the present study analyzes how childlessness affects the probability that disabled individuals receive informal care, and nondisabled individuals anticipate future informal care. In contrast to most previous research, the childless are not treated as an homogeneous group; different types of and pathways to childlessness are distinguished. In general, the results do not hold up the claim that in the US non-parents face significant support deficits in old age. The probability of receiving support is substantially lower only for those who survived their children, whereas the weak negative effect observed for those who never had natural nor step-children is not statistically significant. Compared to natural parents, step-parents receive more support from their partners but get less help from their children. The analysis of support expectations reveals that parents as well as childless people tend to overestimate the availability of informal care in case of need.

Evaluating Long-Term-Care Policy Options, Taking the Family Seriously*

We propose a dynamic non-cooperative framework for long-term-care (LTC) decisions of families and use it to evaluate LTC policy options for the U.S. We first document the importance of informal caregiving and economic determinants of care arrangements. We then build a heterogeneous-agents model with imperfectly-altruistic overlapping generations to account for the patterns we find. A key innovation is the availability of informal care (IC), which is determined through intra-family bargaining. This opens up a new margin in response to policy and allows for informal insurance through home-production of care. Our calibrated model captures the observed care arrangements well. We study the implications of non-means-tested IC and formal care (FC) subsidies as well as changes to means-tested Medicaid. We find that IC responds strongly to these policies. An IC subsidy substantially reduces reliance on Medicaid, while the reduction of tax revenues due to lower labour supply by caregivers is modest. There are large welfare gains from a combination of IC and FC subsidies, even when combined with a reduction of the Medicaid program.

Careful in the Crisis? Determinants of Older People's Informal Care Receipt in Crisis-Struck European Countries.

Macroeconomic downturns can have an important impact on the receipt of informal and formal long-term care, because recessions increase the number of unemployed and affect net wealth. This paper investigates how the market for informal care changed during and after the Great Recession in Europe, with particular focus on the determinants of care receipt. We use data from the Survey of Health, Ageing and Retirement in Europe, which includes a rich set of variables covering waves before and after the Great Recession. We find evidence of an increase in the availability of informal care after the economic downturn when controlling for year and country fixed effects. This trend is mainly driven by changes in care provision of individuals not cohabiting with the care recipient. We also find evidence of several determinants of informal care receipt changing during the crisis - such as physical needs, personal wealth, and household structures. Copyright © 2016 John Wiley & Sons, Ltd.

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers.

Background: The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods: This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results: The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion: The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic- and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-makers.

Determinants of Unmet Needs among Slovenian Old Population.

BackgroundPopulation ageing has significant effects on societies. The organization of care for dependent old people is one of the key issues for ageing societies. The majority of care for homebound dependent old people in Slovenia is still performed by informal carers, even though the use of formal services has been increasing over the last 20 years. The proportion and characteristics of people with unmet needs are important for the development of long term care social policy.MethodThe SHARE (Survey of Health, Ageing and Retirement in Europe) survey was used to assess the determinants of care arrangements and of unmet needs of the aging population in Slovenia. Multinomial regression analysis was used to evaluate individual and contextual determinants of care arrangements and unmet needs.ResultsThe proportion of older people with unmet needs is 4%. As expected, “needs” (Functional impairment OR=4.89, P=0.000, Depression OR=2.59, P=0.001) were the most important determinant, followed by the predisposing factor “age” (age OR 1.15, P=0.000) and two enabling factors, namely:”community setting and “availability of informal care within household” (Urban areas OR=.47, P=0.021; Household size 3+ OR=2.11, P=0.030).ConclusionThis study showed that there are a proportion of older people in Slovenia with severe needs for care, which are being unmet. As shown by the importance of enabling factors, social policy should encourage the development of formal services in rural areas and elaborate policy measures for informal carers.

Economic Analysis of Formal Care, Informal Care, and Productivity Losses in Primary Care Patients who Screened Positive for Dementia in Germany

The majority of people with dementia (PwD) live at home and require professional formal care and informal care that is generally provided by close relatives. To determine the utilization and costs of formal and informal care for PwD, indirect costs because of productivity losses of caregivers, and the associations between cost, socio-demographic and clinical variables. The analysis includes the data of 262 community-dwelling PwD and their caregivers. Socio-demographics, clinical variables, and the utilization of formal care were assessed within the baseline assessment. To evaluate informal care costs, the Resource Utilization in Dementia (RUD) questionnaire was used. Costs were calculated from a social perspective. Associations were evaluated using multiple linear and logistic regression models. Formal care services were utilized less (26.3%) than informal care (85.1%), resulting in a cost ratio of one to ten(1,646 €; 16,473 €, respectively). In total, 29% of caregivers were employed, and every seventh (14.3%) experienced productivity losses, which corresponded to 1,258 € annually. Whereas increasing deficits in daily living activities were associated with higher formal and higher informal costs, living alone was significantly associated with higher formal care costs and the employment of a caregiver was associated with lower informal care costs. Informal care contributes the most to total care costs. Living alone is a major cost driver for formal costs because of the lower availability of potential informal care. The availability of informal care is limited and productivity losses are increased when a caregiver is employed.

Caring for adults in the EU: Work–life balance and challenges for EU law

Unpaid carers of adults, as a group, have, until recently, been largely neglected by the EU. While a number of provisions of EU law – including anti-discrimination measures and protections for part time workers – may benefit (some) carers of adults in the workplace, the existing package of work–life balance regulation falls well short of a coherent approach to addressing the needs of this group. Growing concern about a crisis in social care across member states, linked to an ageing demographic, has recently focussed attention on inadequacies in the formal care sector; on the vital economic contribution of unpaid care; and on a projected rise in the need for care coupled with a decline in the availability of informal care as the population ages and family structures change. It has prompted interest both in the need to develop the formal care sector, with the opportunities this may present to create employment, and in the need to support ‘informal’ carers in the workplace. This paper explores the various policy drivers for EU regulation to support informal carers in the workplace and consider the potential difficulties in establishing a coherent legal response.

Does informal care reduce public care expenditure on elderly care? Estimates based on Finland’s Age Study

BackgroundTo formulate sustainable long-term care policies, it is critical first to understand the relationship between informal care and formal care expenditure. The aim of this paper is to examine to what extent informal care reduces public expenditure on elderly care.MethodsData from a geriatric rehabilitation program conducted in Finland (Age Study, n = 732) were used to estimate the annual public care expenditure on elderly care. We first constructed hierarchical multilevel regression models to determine the factors associated with elderly care expenditure. Second, we calculated the adjusted mean costs of care in four care patterns: 1) informal care only for elderly living alone; 2) informal care only from a co-resident family member; 3) a combination of formal and informal care; and 4) formal care only. We included functional independence and health-related quality of life (15D score) measures into our models. This method standardizes the care needs of a heterogeneous subject group and enabled us to compare expenditure among various care categories even when differences were observed in the subjects’ physical health.ResultsElder care that consisted of formal care only had the highest expenditure at 25,300 Euros annually. The combination of formal and informal care had an annual expenditure of 22,300 Euros. If a person received mainly informal care from a co-resident family member, then the annual expenditure was only 4,900 Euros and just 6,000 Euros for a person living alone and receiving informal care.ConclusionsOur analysis of a frail elderly Finnish population shows that the availability of informal care considerably reduces public care expenditure. Therefore, informal care should be taken into account when formulating policies for long-term care. The process whereby families choose to provide care for their elderly relatives has a significant impact on long-term care expenditure.

Use of informal and formal care among community dwelling dependent elderly in Spain

Faced with increased public spending for care, knowledge of the determinants of the choices between informal and formal care is of particular importance for estimating the need for care in the future. Using a representative sample of Spanish dependent elderly from the Disabilities, Independence and Dependency Situations Survey (DIDSS) 2008, we compare the factors associated with the reception of informal, formal and mixed care. The study included 10 703 dependent persons living at home aged ≥ 65 years. Overall, the percentage of those receiving only informal care was high in Spain, 47.5%. Formal care was most often received in combination with informal care (9.8%) than alone (4.9%). Five out of the seven factors analysed were found to influence the reception of all types of care: age, gender, income, self-rated health and suffering a chronic condition. There is a high coincidence among how factors affect the reception of care although some differences can be noted. Curiously, a high income level and the availability of informal care (as measured by living with a partner) can negatively affect the reception of only formal care. Living in a capital can also have an impact on the type of care a dependent elderly person receives.

Does availability of informal care within the household impact hospitalisation?

This study assesses the effect of having informal support available at home on inpatient care use in Switzerland. The main contributions are to consider the availability of care regardless of its source, measured by multiple-adult living arrangements, and to examine this effect by type of inpatient care and source of potential support. A two-part model with region and time fixed effects is estimated to determine the impact of informal care availability on the likelihood of hospitalisation and length of stay, conditional on hospitalisation. The analysis is conducted on a sample of individuals aged 18+ from four waves of the Swiss Household Panel survey (2004-2007). Overall, availability of informal care has no impact on the likelihood of hospitalisation but does significantly reduce length of stay by 1.9 days. Available support has no effect on the shortest stays (up to 10 days), but has a significant impact on acute care stays up to 30 days and longer stays. Additionally, the effect does not significantly vary whether the source of informal support is a spouse only, a spouse and other adults, or other adults only. These results indicate that social changes leading to an expansion in the proportion of one-person households may increase future inpatient care use.

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Public expenditures on long-term care are a matter of concern for Korea as in many other countries. The expenditure is expected to accelerate and to put pressure on public budgets, adding to that arising from insufficient retirement schemes and other forms of social spending. This study tried to foresee how much health care spending could increase in the future considering demographic and non-demographic factors as the drivers of expenditure. Previous projections of future long-term expenditure were mainly based on a given relation between spending and age structure. However, although demographic factors will surely put upward pressure on long-term care costs, other non-demographic factors, such as labor cost increase and availability of informal care, should be taken into account as well. Also, the possibility of dynamic link between health status and longevity gains needs to be considered. The model in this study is cell-base and consists of three main parts. The first part estimated the numbers of elderly people with different levels of health status by age group, gender, household type. The second part estimated the levels of long-term care services required, by attaching a probability of receiving long-term care services to each cell using from the sample from current year. The third part of the model estimated long-term care expenditure, along the demographic and non-demographic factors' change in various scenarios. Public spending on long-term care could rise from the current level of 0.2~0.3% of GDP to around 0.44~2.30% by 2040.