Abstract

Objectives and Methods: In this paper we address both health and social LTC services and identify the socio-economic factors that drive or hinder their use among the Estonian elderly aged 60 and above. Using Survey of Health, Ageing and Retirement in Europe (SHARE) data collected in 2015, we analyse determinants of utilization of informal care and three types of publicly-provided LTC services – social home care, inpatient care and rehabilitation. When estimating the relationship between informal care and formal home care, we control for endogeneity of the informal care variable and apply the new approach to instrumental variable method proposed by Lewbel (2012). To analyse the relationship between various socioeconomic factors and amount of institutional care received we use zero-inflated negative binomial model and compare the results with the two-part hurdle model.

Results: We find that it is important to distinguish between informal care provided by household members, by other relatives (not living together with an elderly) and non-relatives, because the same socioeconomic factor might affect the propensity to use these kinds of care in different directions. For example, persons with higher education and ethnic minorities are found to have greater chances to receive informal care within own households, at the same time these factors are not important when care provided by relatives not living together with an elderly is analysed. While care provided by relatives within and outside the household is strongly related not only to objective limitations in mobility and everyday activities, but also to subjective health status, the latter is not found to increase chances of getting the assistance from non-relatives in case of need. Other parameters being equal, wealthier Estonians and those living in rural areas receive help from non-relatives more often than the others.

Estonian legislation stipulates that closest relatives - spouses, adult ascendants and descendants related to the first and second degree - are required to provide care to their family members in need; siblings are not included into this list, and empirical results indicate that having siblings (contrast to spouses, children and grandchildren) is not found to have a statistically significant effect on probability of receiving care from relatives living separately, however, this factor has negative effect on probability and amount of care provided by non-relatives, signalling that non-relatives have lower motivation to provide domestic help to someone who has (any) relatives.

Estimation results indicate that informal care complements formal home care; however, when splitting the informal care variable by nature of the relationship between caregivers and recipients, the complementary effect remains only for assistance provided by non-relatives.

Conclusion: The results suggest that currently defined LTC policy in Estonia ensures the absence of financial, language and urban/rural barriers to utilization of formal home care provided by local governments.