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. 2021 Jan 1;76(1):121-132.
doi: 10.1093/geronb/gbaa139.

Socioeconomic Inequalities in Home-Care Use Across Regional Long-term Care Systems in Europe

Ginevra Floridi, Ludovico Carrino  1 , Karen Glaser  1
Affiliations

Socioeconomic Inequalities in Home-Care Use Across Regional Long-term Care Systems in Europe

Ginevra Floridi et al. J Gerontol B Psychol Sci Soc Sci. .

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.

Keywords: Long-term care; Multilevel models; SHARE; Socioeconomic status.

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Figures

Figure 1.
Figure 1.
Percentages of care recipients receiving each type of care by LTC beds tertile group. LTC beds tertiles calculated over the sample of regions (n = 136). Note: LTC = long-term care; The percentages receiving any home-care in each group of regions are: 20.61% (low beds); 20.54% (medium beds); 16.62% (high beds).
See this image and copyright information in PMC

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