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How equitable is Sweden's changing care-mix? Linking individual and regional characteristics over time

  • ADAM DAVEY (a1), JYOTI SAVLA (a2), GERDT SUNDSTRÖM (a3), STEVEN H. ZARIT (a2) and BO MALMBERG (a3)...
Abstract
ABSTRACT

Given its relative ethnic and socio-economic homogeneity, Sweden is an ideal nation for the study of variations in formal and informal care as a function of gender, disability and advanced age. This paper reports an analysis of the relationships between gender, disability and age and the formal care delivered to more than 1,200 people aged 75 or more years in Sweden in 1994 and 2000. In municipalities that provided above-average home-help hours per recipient, and that had high institutional placement rates, women were relatively less likely to have been receiving informal assistance alone, those with greater disability were more likely to have been receiving all forms of assistance, the oldest-old were less likely to have been receiving either informal or formal help alone, and rates of formal assistance and of no informal care were relatively low. In municipalities with high rates of institutional placement, the oldest-old were relatively more likely to have been receiving both formal and informal assistance. Sweden's system of old-age care appears broadly equitable although the quality of care could not be fully assessed. Although home and community-based service provision (HCBS) has recently decreased, variations in the volume and mix of delivered formal services reflect differences in need.

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Corresponding author
Address for correspondence: Adam Davey, College of Health Professions, 1700 N. Broad Street, Suite 313, Temple University, Philadelphia, PA 19122, USA. E-mail: adavey@temple.edu
References
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Berg S., Branch L. G., Doyle A. and Sundström G. 1993. Local variations in old-age care in the welfare-state: the case of Sweden. Health Policy, 24, 2, 175–86.
Berg S. and Sundström G. 1988. Kommunal och regional variation inom aldreomsorgen [Municipal and Regional Variations in Old Age Care]. Report 70, Institutet för Gerontologi, Jönköping, Sweden.
Bergmark Å., Parker M. G. and Thorslund M. 2000. Priorities in care and services for elderly people: a path without guidelines? Journal of Medical Ethics, 26, 5, 312–8.
Chappell N. L. and Blandford A. 1991. Informal and formal care: exploring the complementarity. Ageing & Society, 11, 3, 299315.
Chappell N. L. 1992. Informal Support and Aging. Butterworths, Toronto.
Daatland S. O. 1997. Welfare policies for older people in transition? Emerging trends and comparative perspectives. Scandinavian Journal of Social Welfare, 6, 2, 153–61.
Davey A., Femia E. E., Zarit S. H., Shea D. G., Sundström G., Berg S., Smyer M. A. and Savla J. 2005. Life on the edge: patterns of formal and informal help to older adults in the United States and Sweden. Journal of Gerontology: Social Sciences, 60B, 5, 5281–8.
Davey A., Johansson L., Malmberg B. and Sundström G. 2006. Unequal but equitable: an analysis of variations in old-age care in Sweden. European Journal of Ageing, 3, 1, 3440.
Denton M. 1997. The linkages between informal and formal care of the elderly. Canadian Journal on Aging, 16, 1, 3050.
Edelman P. 1986. The impact of community care to the homebound elderly on provision of informal care. The Gerontologist, 26, Suppl. 1, 263–74.
Edelman P. and Hughes S. 1990. The impact of community care on provision of informal care to homebound elderly persons. Journal of Gerontology: Social Sciences, 45, 1, S7484.
Esping-Andersen G. 1990. The Three Worlds of Welfare Capitalism. Princeton University, Princeton, New Jersey.
Esping-Andersen G. 1999. Social Foundations of Post-industrial Economies. Oxford University Press, Oxford.
George L. K. 1987. Easing caregiver burden: the role of informal and formal supports. In Ward R. A. and Tobin S. S. (eds) Health in Aging: Sociological Issues and Policy Directions. Springer Publishing Company, New York, 133–58.
Greene V. L. 1983. Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care, 21, 6, 609–19.
Hanley R., Wiener J. M. and Harris K. M. 1991. Will paid home care erode informal support? Journal of Health Politics, Policy, and Law, 16, 3, 507–21.
Jeths A.v.d.B. and Thorslund M. 1994. Will resources for elder care be scarce? Hastings Center Report, 24, 1, 610.
Johansson L., Sundström G. and Hassing L. B. 2003. State provision down, offspring's up: the reverse substitution of old-age care in Sweden. Ageing & Society, 23, 3, 269–80.
Johansson L. and Thorslund M. 1992. Care needs and sources of support in a nationwide sample of elderly in Sweden. Zeitschrift für Gerontologie, 25, 1, 5762.
Larsson K. 2006. Care needs and home-help services for older people in Sweden: does improved functioning account for the reduction in public care? Ageing & Society, 26, 3, 413–29.
Larsson K. and Thorslund M. 2002. Does gender matter? Differences in patterns of informal support and formal services in a Swedish urban elderly population. Research on Aging, 24, 3, 308–36.
Lawton M. P. and Brody E. M. 1969. Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 3, 179–86.
Litwak E. 1985. Helping the Elderly: The Complementary Roles of Informal Networks and Formal Systems. Guilford, New York.
Litwak E. and Szelenyi I. 1969. Primary group structures and their functions. American Sociological Review, 34, 2, 465–81.
Messeri P., Silverman M. and Litwak E. 1993. Choosing optimal support groups: a review and formulation. Journal of Health and Social Behaviour, 34, 2, 122–37.
Moscovice I., Davidson G. and McCaffrey D. 1988. Substitution of formal and informal care for the community-based elderly. Medical Care, 26, 10, 971–81.
Muramatsu N. and Campbell R. T. 2002. State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. Journal of Health and Social Behavior, 43, 1, 107–24.
Noelker L. S. and Bass D. M. 1989. Home care for elderly persons: linkages between formal and informal caregivers. Journal of Gerontology: Social Sciences, 44, 1, S6370.
O'Connor J. S. 1993. Gender, class and citizenship in the comparative analysis of welfare state regimes: theoretical and methodological issues. British Journal of Sociology, 44, 3, 501–18.
Orloff A. S. 1993. Gender and the social rights of citizenship: the comparative analysis of gender relations and welfare states. American Sociological Review, 58, 3, 303–28.
Patsios D. and Davey A. 2005. Formal and informal community care for older adults. In Johnson M., Bengtson V. L., Coleman P. and Kirkwood T. (eds) The Cambridge Handbook of Age and Ageing. Cambridge University Press, Cambridge, 597604.
Raudenbush S. W. and Bryk A. S. 2002. Hierarchical Linear Models: Applications and Data Analysis Methods. Second edition, Sage, Thousand Oaks, California.
Shea D. G., Davey A., Femia E. E., Zarit S. H., Sundstrom G., Berg S. and Smyer M. A. 2003. Exploring Assistance in Sweden and the United States. The Gerontologist, 43, 5, 712721.
Socialstyrelsen 1994. Hemma På Äldre Da'r [Ageing at Home: Technical Report]. Socialstyrelsen, Stockholm, Sweden.
Socialstyrelsen 2000. Hemma På Äldre Da'r 2000 [Ageing at Home 2000: Technical Report]. Socialstyrelsen, Stockholm, Sweden.
Soldo B. J., Agree E. and Wolf D. 1989. Balance between formal and informal care. In Ory M. and Bond K. (eds) Aging and Health Care. Routledge, New York, 193216.
Statistiska Centralbyrån (2003). Undersökning om levnadsförhållanden [Level of Living]. Data file, Statistics Sweden, Stockholm.
Stoller E. P. and Pugliesi K. L. 1988. Informal networks of community based elderly: changes in composition over time. Research on Aging, 10, 4, 499516.
Stuart M. and Weinrich M. 2001. Home- and community-based long-term care: lessons from Denmark. The Gerontologist, 41, 4, 474–80.
Sundström G. and Berg S. 1990. Ensamboende Bland de Äldre: En Analys av Kommunala Variationer och Deras Effekter på Äldreomsorgen. PM Utarbetat för Socialdepartementet [Solitary Living Among Elderly People: An Analysis of Municipal Variations and Their Effects on Public Old Age Care: Memorandum for the Ministry of Social Affairs]. Mimeo, Institutet för gerontologi, Jönköping, Sweden.
Sundström G., Johansson L. and Hassing L. B. 2002. The shifting balance of long-term care in Sweden. The Gerontologist, 42, 3, 350–5.
Sundström G. and Malmberg B. 1996. The long arm of the welfare state shortened. Scandinavian Journal of Social Welfare, 5, 1, 6975.
Sundström G., Malmberg B. and Johannson L. 2006. Balancing family and state care: neither, either or both? The case of Sweden. Ageing & Society, 26, 5, 767–82.
Tennstedt S. L., Crawford S. L. and McKinlay J. B. 1993. Is family care on the decline? A longitudinal investigation of the substitution of formal long-term care services for informal care. Milbank Quarterly, 71, 4, 601–24.
Tennstedt S., Harrow B. and Crawford S. 1996. Informal care vs. formal services: changes in patterns of care over time. Journal of Aging and Social Policy, 7, 1, 7191.
Tennstedt S., Sullivan L., McKinlay J. and D'Agostino R. 1990. How important is functional status as a predictor of service use by older people. Journal of Aging and Health, 2, 4, 439–61.
Thorslund M., Bergmark Å. and Parker M. G. 1997. Difficult decisions on care and services for elderly people: the dilemma of setting priorities in the welfare state. Scandinavian Journal of Social Welfare, 6, 3, 197206.
Trydegård G.-B. and Thorslund M. 2001. Inequality in the welfare state? Local variation in the care of the elderly: the case of Sweden. International Journal of Social Welfare, 10, 3, 174–84.
Zarit S. H., Johansson B. and Malmberg B. 1995. Changes in functional competency in the oldest old: a longitudinal study. Journal of Aging and Health, 7, 1, 323.
Zarit S. H., Johansson B. and Berg S. 1993. Functional impairment and co-disability in the oldest old: a multidimensional approach. Journal of Aging and Health, 5, 3, 291305.
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Ageing & Society
  • ISSN: 0144-686X
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