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

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)121–132
Number of pages12
JournalJournals of Gerontology Series. B, Psychological Sciences and Social Sciences
Issue number1
Early online date30 Sep 2020
Accepted/In press10 Aug 2020
E-pub ahead of print30 Sep 2020
Published1 Jan 2021

Bibliographical note

Funding Information: This work was supported by the Economic and Social Research Council (ESRC) (grant number: ES/S01523X/1). Publisher Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.


King's Authors


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”).

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.

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.

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.

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