Socio-economic inequalities in home-care use across regional long-term care systems in Europe

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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.
Original languageEnglish
Pages (from-to)121–132
Number of pages12
JournalJournals of Gerontology Series. B, Psychological Sciences and Social Sciences
Volume76
Issue number1
Early online date30 Sept 2020
DOIs
Publication statusPublished - 1 Jan 2021

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