Home and Community Care Digest
Methods: The data was obtained from a European multi-disciplinary survey in 2004, which included 7,329 people aged 65 years and older from nine European countries. Two types of formal home care were analyzed: nursing care, which comprised nursing and personal care provided by professionals, and paid domestic help, which consists of professional or paid home help in carrying out tasks such as doing housework or shopping for groceries. The respondents were asked to report the number of weeks and the average number of hours per week they received either skilled or unskilled formal home care during the 12 months preceding the survey. The measure of home care utilization was expressed as the average number of hours received per month. Findings: Informal care was found to decrease or substitute for unskilled formal home care, while it is a complement for skilled formal home care. The relationship between formal and informal care is sensitive to the needs of the elderly. More specifically, the substitution effect vanishes for the elderly suffering from significant disability.
Conclusions: This study highlighted the complexity of the relationship between formal and informal care. One common recommendation to limit the expected increase in long-term care expenditures is to encourage informal care provided by families, as an alternative for more costly formal care. The effectiveness of such policies depends on the degree of substitutability between informal and formal care. This study suggested that informal care is an effective substitute for long-term care as long as the needs of the elderly are low and require unskilled. Any policy encouraging informal care to decrease long-term care expenditures should take into account the potentially limiting role of informal care where the elderly report greater disability or where they need skilled care.
Bonsang E. Does informal care from children to their elderly parents substitute for formal care in Europe? Journal of Health Economics. 2009; 28: 143-154.
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