Abstract

Objectives: There are growing concerns in Europe that long-term care systems are over-reliant on informal care provision for older dependent people. In some countries, often described as familialistic care regimes, care provision is primarily seen as the responsibility of families, who provide the bulk of needed care while formal service or support to informal carers are far from generous. However, as increasing formal services and support for carers is likely a more effective way to care for an ageing population, it is important to understand how system characteristics and public policies can impact the care mix (i.e. whether informal care, formal care or a combination of both is used). Our study aims to understand the patterns and determinants of the care-mix in two familialistic regimes, similar in many cultural, social and welfare dimensions, but differing in their level of support for informal care provision. Austria provides an example of supported familialism, with strong policies that support informal carers as the main providers of care (e.g. cash benefits, more generous care leave schemes) while Slovenia is an example of familialism by default, with minimal welfare state support for caring families.

Methods: We use data from the most recent wave of the Survey of Health, Ageing and Retirement in Europe, collected in 2015, in Austria and Slovenia. The sample includes individuals aged 50 and above in both countries who have used either formal care (home based care services), informal care or a combination of both, in the year previous to the survey. We account for socio-economic status, health status, household and regional characteristics and focus on the different position of lower and higher income households in both countries and their patterns of utilisation of formal care and care mix.

Results: Early results indicate that the lower availability of formal care services and the lack of cash-benefits in Slovenia lead to lower utilization of both formal and informal care for older dependent individuals. Furthermore, less older individuals in Slovenia use a combination of care types, suggesting there is more choice for specific care-mixes in supported familialistic regimes. In both countries lower income families are more limited in their access to formal and mixed care, with respect to higher income households. Final results from the analysis will be available in summer 2018.

Conclusions: The degree of familialization in policies for long-term care, and in particular the availability of cash-for-care benefits and of formal care services, has a significant impact on access to care but also on choices regarding the care-mix. This raises important concerns related to equity and fairness in access to care in countries where system characteristics restrict user choice and do not provide sufficient support for informal care provision.