Abstract

The ‘ageing in place’-policy in Swedish eldercare has led to a downsizing of residential care, driven by measures of cost containment. Today, Sweden has the lowest per capita hospital bed rate in Europe and every fourth bed in nursing homes has disappeared since year 2000. As a result, an increasing number of older persons with extensive and complex health and social care needs are cared for at home. As health and social care services generally are fragmented, many family members try to coordinate them, and to provide other types of help to compensate service decline.

The aim of this paper is to analyse the meaning of gender for the extent, content and consequences of informal caregiving among middle-aged persons in Sweden today. A mixed methods approach is used, combining a nationally representative postal survey on persons aged 45-66 years from 2013 (response rate 61%, n=3630), with an ongoing interview study with so far 15 adult children of older persons with extensive and complex health and social care needs.

The survey shows that 28% of the middle-aged population are caregivers, defined as providing care at least once a week. Almost 80% of the caregivers assist an older person (65+), most often a frail parent. Caregiving is more common and intensive among women. They are also more frequently negatively affected by caregiving in their well-being, work situation and labour force participation.

To handle contacts with health and social care services is a common task for caregivers, and as common among men as among women. Women’s well-being and work situation are however more frequently affected by providing this kind of help. For women, but not for men, it increases the risk of being negatively affected almost as much as providing personal care.

The interviews confirm that female caregivers are more strained by handling contacts with health and social care services, especially if many service providers are involved and contacts concern complaints. While only female caregivers say that they do not want to be a nuisance (‘a troublesome daughter’); only male caregivers say they are used to make complaints and ‘make things happen’ in their professional role.

Most interviewees are very critical to home care services. Too many people coming and going, not knowing when, who or if they are coming, and if so, if they will do their job. The visits are too short, and time is not enough to provide proper care. Health care services receive much less criticism. Although frail older persons are discharged from hospital care ‘quicker and sicker’, it is not framed as a health care problem, rather as a social care problem. Most interviewees do not regard home care services as a reliable solution after discharge and think that residential care is too hard to get.

Conclusion: the realization of ‘ageing in place’-policy in Swedish eldercare has high costs, primarily regarding the well-being of frail older persons, but also regarding the well-being and labour force participation of middle-aged women, which also threaten financing of services.