This study demonstrated that informal care provided by children or grandchildren to their single-living elderly parents substituted for formal home care (e.g., provided by the institutionalized health and social care systems in Europe), but complemented physician visits and nights in hospital. The relationship between informal care and formal home care varied across Europe, and was less evident in central Europe. The findings have important implications for policy makers as the availability of informal caregivers is predicted to decline with a resulting direct impact on the demand for formal caregiving.

Background: This study examined the relationship between informal and formal care among the singledwelling elderly in Europe and whether living in a northern, central or southern European country affected the relationship. The rationale for this analysis is that some studies have found a relationship between the amount of care and assistance an elderly person receives from family or friends (i.e., informal care) and the amount of formal care (i.e., provided by the health care system) he or she utilizes. Given the aging population and the demographic and socio-economic trends that are expected to decrease the availability of informal care (e.g., increased participation of women in the labour force; decline in average number of children per female; lower marriage rates, etc.), examining for a relationship between informal and formal home care is important, particularly among the single-dwelling elderly that are without the support of a spouse.

Methods: This study focused on the care received by elderly individuals who had at least one child and lived alone because they were divorced or widowed. Countries analysed included those in northern Europe (Denmark and Sweden), central Europe (Austria, France, Germany, Switzerland, Belgium, the Netherlands), and southern Europe (Spain, Italy, Greece). Statistical analysis was used to examine relationships between the amount of informal care provided by children and four types of formal health care. Informal care was provided by children and comprised self-reported number of hours of personal care, practical household help, and help with paperwork. Formal care was provided by the institutionalized health or social care systems and was defined as a recipient of home care (yes or no), and number of GP visits, specialist visits, and nights in hospital. A European database of roughly 22,000 Europeans aged 50 or older was used for the analysis.

Findings: The results suggest that as the amount of informal care increases, utilisation of formal home care services tends to decline (i.e., they are substitutes). This relationship varied to some extent across regions in Europe: the substitution effect was not as strong in central Europe (meaning that even with receipt of informal care, the use of formal home care did not decline as much) compared to those living in southern Europe, while no differences were observed between those living in the North relative to the South.

The results also suggest that the number of informal care hours received over a one-year time period complements (i.e., adds to) the number of physician visits over the same time period. Similarly, informal care was found to complement the number of nights spent in hospital over a one-year time period. No differences by European region were observed for the relationship between informal care and use of physician or hospital services.

Conclusions: While based on self-reported data, this study revealed that informal care substitutes for formal home care in Europe. It is important for policy makers to be aware that if current trends persist and the availability of informal care declines, as predicted, the findings of this study suggest that individuals will require more formal home care. This is particularly important for the single-dwelling elderly population since they lack the support of a spouse, and for policy makers tasked with home care planning for an elderly population. The policy implication of the finding that informal care complements utilisation of physician visits and nights spent in hospital is unclear: the higher utilisation rates may be interpreted as contributing to higher health care costs although on the flip side, the additional physician and hospital visits may be of a preventive nature, thereby leading to lower future costs.

Reference: Bolin K, Lindgren B, Lundborg P. Informal and Formal Care Among Single-Living Elderly in Europe. Health Economics. 2007; DOI 10.1002/hec.1275.

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