Socio-economic differences in receiving care by the over-80s in Germany and England: intensity of care needs as a moderator

Abstract

The growing number of people aged 80 or older living in the community has raised concerns about meeting their care needs and about socio-economic inequalities in their care use. The study examines socio-economic status (SES) patterns in informal and formal care use, as well as unmet care needs, of people aged 80 or older living in the community in Germany and England. We propose that SES patterns in care use change with the intensity of care needs. The analyses use data from the Survey of Quality of Life and Well-Being of the Very Old in North Rhine-Westphalia and the English Longitudinal Study of Ageing. Despite the differences in the long-term care systems (LTCSs) and cultural norms around filial obligations, we find a consistent pattern of association between socio-economic status (SES) and care use for older people with only few care needs in both countries. In this group, people with a higher SES have the highest likelihood of experiencing unmet care needs. For older people with many care needs, we find country-specific SES patterns that we link to cultural differences and the design of the LTCSs. In Germany, SES is negatively associated with using informal care and positively with using formal care. In England, care use shows little SES variation for older people with many care needs. The findings underscore the importance of considering the intensity of care needs when assessing inequalities in care access.

Keywords: Ageing; Care regimes; Formal care; Inequality; Informal care; Unmet care need.

Fig. 1

Per cent of individuals with at least one ADL need receiving care, by country, type of care and number of care needs: percentages and 95% confidence intervals

Fig. 2

Predicted margins of receiving informal care, formal care or having an unmet need: models with level of education. Note: Country-specific models, controlling for age, number of ADL needs, gender and living arrangements, having a child, level of education, home ownership. Full model estimates are shown in Table 3 and Table A11 in the Online Appendix. Table A14 of the Online Appendix reports significance tests for SES differences in Panel B

Fig. 3

Predicted margins of receiving informal care, formal care or having unmet needs: models with income groups. Note: Country-specific models, controlling for age, number of ADL needs, gender and living arrangements, having a child, income. Full model estimates in Appendix Tables A9 and A12. Table A14 of the Online Appendix gives significance tests for SES differences in Panel B

Fig. 4

Predicted margins of receiving informal care, formal care or having unmet needs: models with wealth groups. Note: Country-specific models, controlling for age, number of ADL needs, gender and living arrangements, having a child, wealth. Full model estimates in Appendix Tables A10 and A13. Table A14 of the Online Appendix gives significance tests for SES differences in Panel B