Convenor: Marjolein Broese van Groenou, Vrije Universiteit Amsterdam

Ageing societies and recent reforms to long-term care (LTC) in many countries are likely to make informal care by kin and nonkin increasingly critical for fulfilling the care needs of older people. To date, it is unknown whether informal care falls disproportionately on disadvantaged populations. The IN-CARE project (a collaboration of Dutch, British, German research teams; http://in-care.fk12.tu-dortmund.de/) examines if and how LTC reforms exacerbate existing social disparities in care use and provision in older age, which fits nicely into the TCC theme of Time and Temporality in Care. To this end, this project compares the socioeconomic status (SES) gradient in formal and informal care across Europe over time. A particular effort is made to include macro-level indicators of LTC systems in cross-level analyses across countries and operationalize these according to the typology of (de)familialization of Saraceno. The first paper presented in this symposium concerns a description of the macro-level database and how it may be used in exploring the macro-micro link in studies on care use. In the second paper, the UK team studied SES-inequality in care receipt across European nations with different care systems; the third paper presented by the German team studied the same question but now among caregivers, and the fourth paper by the Dutch team studies SES-inequalities in care use within the Netherlands over time (1995-2015). The symposium will start off with a short description of the IN-CARE project (2019-2022). Tine Rostgaard will be our discussant.

Individual abstracts

• APPLYING THE TYPOLOGY OF (DE)FAMILIALIZATION TO MACRO-LEVEL INDICATORS OF LONG TERM CARE POLICIES

Ellen Verbakel, Radboud University

This presentation describes the newly created database on long-term care (LTC) indicators created by the IN-Care project and available to other researchers. Following the theoretical contribution of Saraceno (2016), we argue it is important to use more fine-grained distinctions of familism and defamilisation in LTC policies, because the consequences for inequality in care use and provision may differ. In particular, we study supported familism (e.g., informal caregiver support), supported defamilisation through the market (e.g., in-cash benefits for care users), and defamilisation through public provision (e.g., availability of beds in residential care). We constructed indicators for each type of LTC support policy. This presentation (1) outlines the theoretical ideas on the impact of LTC policies on SES inequality in care; (2) describes the LTC indicator dataset created by the IN-Care team, which will become available to other researchers; (3) presents basic descriptive information on the LTC indicators.

• SOCIOECONOMIC INEQUALITIES IN CARE RECEIPT AT OLDER AGES: A COMPARATIVE EUROPEAN STUDY

Ginevra Floridi, Ludovico Carrino & Karen Glaser, King’s College London

As the prevalence of LTC rises in European societies, it is important to evaluate the consequences of different forms of care for the wellbeing of care recipients. Crucially, if the consequences of care for wellbeing vary by socio-economic status (SES), this may lead to greater inequalities in health among adults with care needs. In this study we examine the longitudinal associations between different types of home-care (informal, formal and mixed) and subsequent wellbeing (quality of life and depression) among physically-impaired individuals aged 50 and above. We propose a theoretical model of SES inequalities in the consequences of care for wellbeing, and empirically assess SES differences in the longitudinal associations using data from the SHARE survey. On average, we do not find evidence that informal, formal or mixed care are associated with changes in wellbeing. However, informal and formal care are linked with better outcomes among wealthier – relative to poorer – individuals.

• SOCIOECONOMIC INEQUALITIES IN INFORMAL CARE PROVISION AND ITS CONSEQUENCES FOR THE WELLBEING OF INFORMAL CAREGIVERS ACROSS EUROPE

Nekehia Quashie, Judith Kaschowitz, Christian Deindl & Martina Brandt – TU Dortmund University

We assess socioeconomic inequalities in informal care provision and its consequences for the wellbeing of informal caregivers. The literature states that a lower socio economic status (SES) is linked to a higher probability to give care (at higher intensities) which then leads to a higher caregiving burden. People with lower SES additionally have fewer resources to alleviate caregiving pressures. Thus, they are likely to experience decreased wellbeing compared to those with higher SES. Our analyses based on data from SHARE and ELSA confirm, that individuals with lower SES are indeed more likely to provide care all over Europe. They also report a lower wellbeing than people with higher SES, even if controlling for further important influences. In the next step we investigate longitudinally, if taking over care responsibilities leads to a wellbeing decline and if this decline is more pronounced for people with lower SES.

• SOCIOECONOMIC INEQUALITY IN LONG-TERM CARE: A COMPARISON OF THREE TIME PERIODS IN THE NETHERLANDS

Jens Abbing, Bianca Suanet & Marjolein Broese van Groenou, Vrije Universiteit Amsterdam

This study aims at investigating to what extent inequalities in the use of formal, informal and privately paid care have changed over time. Data from the Longitudinal Aging Study Amsterdam (LASA) was used from three points in time (1995, 2005 and 2015) that capture distinct periods in the recent development of the Dutch long-term care system. In particular, the reforms of 2007 and 2015 might have impacted care uses. All participants (N = 1810) were living at home and between the age of 75 and 85 at measurement. The results indicate that, adjusted for health and partner status, formal, informal and privately paid care have decreased over time. Socioeconomic differences in informal care use have increased over time, but no change was found for privately paid or formal care use. These findings suggest that changes in the LTC system and long-term care resources in particular benefit lower socioeconomic groups.