Public expenditure on care for older people has been rising along with the increasing number of senior citizens, and is expected to rise even more as population ageing continues. Attempts to constrain expenditures have largely focused on enabling older people to live independently longer and stressing the importance of informal caregivers as an alternative to public care. But to what extent and under which conditions can this idea actually be feasible? This question is examined in a new study by Niels Schenk and colleagues, who use the Netherlands as an example.
In the Netherlands public care is provided when care-needs cannot be met by close family. Physically and mentally capable household members are expected to provide a dependent older adult with social participation support and temporary personal care, especially when the need for personal care is expected to last no longer than three months. Generally unskilled forms of care, like housekeeping or running errands, are much more likely to be provided by family members than forms of care that require professional training.
Different family members, different tasks
Results show that older people with a partner are considerably less likely to receive public care. Interestingly though, this holds especially true for older men. Whilst many women actually provide care for their partners, male partners only complement public care. As a consequence, older women with a partner are more dependent on public care than older men with a partner.
Moreover, the authors found no association between informal care provided by children and public care receipt. Having a male partner or receiving care from a child did not lower the odds of receiving public care versus skilled care as compared to having no partner. Results therefore clearly show that female partners serve as the only actual alternative to public care, and especially so for unskilled types of care. Though the likelihood of receiving household help from adult children and male partners is high in the Netherlands, their help does not render public care unnecessary.
Research provides different explanations for these gender differences in caregiving: Apparently women are much less likely then men to indicate that they are overburdened by the care needs of their partners. Another possibility might be that the processing of public care requests is gender biased. Officials might be inclined to view women as being more able than men to provide the care needed. This seems strange given that women tend to use health services more frequently and have higher morbidity. But as men are on average older than their female partners, this might offset the overall gender differences found in health service use and morbidity. However, in their study the authors were not able to control for the health of the partner or the age difference between partners.
Policy implications: Empowering Men
Schenk and colleagues suggest that much might be gained in terms of public care costs by addressing the possible gender bias in processing public care requests. Another option might be that male partners are trained in, or are convinced of, their skills to care for their spouse, at least in cases where their own health is not the limiting factor. A greater reliance on male partners is called for given the expected trends in living arrangements at advanced ages. Recent projections indicate that in 30 years the proportion of women living with a partner will sharply increase, whereas the proportion of men who are part of a couple will remain relatively unchanged.
The data used is limited to the Netherlands, so therefore it remains unclear to what degree these results can be applied to other western countries. There are as many policy measures as there are countries and results are for a large part determined by these measures. Moreover, not many elder care policies are as generous as the Dutch. In countries with less generous arrangements, informal care by family members other than the (female) partner plays a more important role in substituting for public care.
*This PopDigest has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 320116 for the research project FamiliesAndSocieties.
FamiliesAndSocieties (www.familiesandsocieties.eu) has the aim to investigate the diversity of family forms, relationships and life courses in Europe, to assess the compatibility of existing policies with these changes, and to contribute to evidence-based policy-making. The consortium brings together 25 leading universities and research institutes in 15 European countries and three transnational civil society organizations