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Informal and formal home-care use among older adults in Europe: can cross-national differences be explained by societal context and composition?


Cross-national comparisons employed welfare state classifications to explain differences in care use in the European older population. Yet these classifications do not cover all care-related societal characteristics and limit our understanding of which specific societal characteristics are most important. Using the Survey of Health, Ageing and Retirement (second wave, 2006–07), the effect of societal determinants relating to culture, welfare state context and socio-economic and demographic composition on informal and formal care use of older adults in 11 European countries was studied. Multinomial multi-level regression analyses showed that, in addition to individual determinants, societal determinants are salient for understanding care use. In countries with fewer home-based services, less residential care, more informal care support and women working full time, older adults are more likely to receive informal care only. Older adults are more likely to receive only formal home care or a combination of formal and informal care in countries with more extensive welfare state arrangements (i.e. more home-based services, higher pension generosity), whereas the odds of receiving a combination of informal and formal care are also larger in countries that specify a legal obligation to care for parents. We tentatively conclude that the incorporation of societal determinants rather than commonly used welfare state classifications results in more understanding of the societal conditions that determine older adults’ care use.

Corresponding author
Address for correspondence: Bianca Suanet, Department of Sociology, Faculty of Social Sciences, VU University Amsterdam, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands. E-mail:
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Andersen, R. and Newman, J. F. 2005. Societal and individual determinants of health care Utilization in the United States. Millbank Quarterly, 83, 4, 128.
Anttonen, A. and Sipilä, J. 1996. European social care services: is it possible to identify models? Journal of European Social Policy, 6, 2, 87100.
Azjen, I. 1991. The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 2, 179211.
Bettio, F. and Plantenga, J. 2004. Comparing care regimes in Europe. Feminist Economics, 10, 1, 85113.
Blackman, T. 2000. Defining responsibility for care: approaches to the care of older people in six European countries. International Journal of Social Welfare, 9, 3, 181–90.
Bolin, K., Lindgren, B. and Lundborg, P. 2008. Informal and formal care among single-living elderly in Europe. Health Economics, 17, 3, 393409.
Bonsang, R. 2009. Does informal care from children to their elderly parents substitute for formal care in Europe. Journal of Health Economics, 28, 1, 143–54.
Börsch-Supan, A. and Jürges, H. 2005. The Survey of Health, Ageing and Retirement in Europe – Methodology. Mannheim Institute for Economics of Aging, Mannheim, Germany.
Brandt, M., Haberkern, K. and Szydlik, M. 2009. Intergenerational help and care. European Sociological Review, 25, 5, 585601.
Broese van Groenou, M. I., Glaser, K., Tomassini, C. and Jacobs, T. 2006. Socio-economic status differences in the use of informal and formal help: a comparison of four European countries. Ageing & Society, 26, 5, 745–66.
Daatland, S. and Herlofson, K. 2006. Filial norms and family support in a comparative cross-national context: evidence from the OASIS study. Ageing & Society, 26, 2, 202–23.
Dautzenberg, M. G. H., Diederiks, J. P. M., Philipson, H., Stevens, F. C. J., Tan, F. E. S. and Vernooij-Dassen, M. J. F. J. 2000. The competing demands of paid work and parent care: middle-aged daughters providing assistance to elderly parents. Research on Ageing, 22, 2, 165–87.
De Boer, A., Broese van Groenou, M. I. and Timmermans, J. 2009. Mantelzorg. Een overzicht van de steun van en aan mantelzorgers in 2007 [Volunteer Aid. An Overview of Support from and to Carers]. The Netherlands Institute for Social Research, The Hague.
Esping-Andersen, G. 1990. The Three Worlds of Welfare Capitalism. Polity Press, Oxford.
Eurobarometer 2004. Social Capital. Available online at [Accessed 12 April 2009].
Eurofamcare 2005. Supporting Family Carers of Older People in Europe – The Pan-European Background Report. LIT-Verlag, Münster, Germany.
Eurostat 2009 a. Expenditure on Pensions – Current Prices (% of GDP). Available online at [Accessed 12 April 2009].
Eurostat 2009 b. Proportion of Population Aged 65 and Over – (% of Total Population). Available online at [Accessed 12 April 2009].
Evandrou, M. and Glaser, K. 2004. Family, work and quality of life: changing economic and social roles through the lifecourse. Ageing & Society, 24, 5, 771–91.
Ferrera, M. 1996. The Southern model of welfare in social Europe. Journal of European Social Policy, 6, 1, 1737.
Glaser, K. 1997. The living arrangements of older people. Reviews in Clinical Gerontology, 7, 1, 6372.
Glaser, K., Tomassini, C. and Grundy, E. 2004. Revisiting convergence and divergence: support for elderly people in Europe. European Journal of Ageing, 1, 1, 6472.
Goldstein, H. 1995. Multilevel Statistical Models. Edward Arnold, London.
Gori, C. 2000. Solidarity in Italy's policies towards the frail elderly: a value at stake. International Journal of Social Welfare, 9, 4, 261–69.
Haberkern, K. and Szydlik, M. 2010. State care provision, societal opinion and children's care of older parents in 11 European countries. Ageing & Society, 30, 2, 299323.
Jowell, R. and the Central Co-ordinating Team 2005. European Social Survey 2004/2005: Technical Report. Centre for Comparative Social Surveys, City University, London.
Kalmijn, M. and Saraceno, C. 2008. A comparative perspective on intergenerational support: responsiveness to parental needs in individualistic and familialistic countries. European Societies, 10, 3, 479508.
Litwin, H. and Attias-Donfut, C. 2009. The inter-relationship between formal and informal care: a study in France and Israel. Ageing & Society, 29, 1, 7191.
Lowenstein, A., Katz, R. and Gur-Yaish, N. 2009. Cross-national variation in elder care: antecedents an outcomes. In Szinovacz, M. E. and Davey, A. (eds), Care Giving Contexts. Cultural, Familial and Societal Implications. Springer, New York, 93112.
Motel-Klingebiel, A., Tesch-Roemer, C. and von Kondratowitz, H. J. 2005. Welfare states do not crowd out the family: evidence for mixed responsibility from comparative analyses. Ageing & Society, 25, 6, 863–82.
Neidhardt, F. 1986. Kultur und Gesellschaft. In Neidhardt, F., Lepsius, R. M. and Weiβ, J. (eds), Kultur und Gesellschaft Sonderheft 27 der Kölner Zeitschrift für Soziologie und Sozialpsychologie. Westdeutscher Verlag, Opladen, Germany, 1018.
Organisation for Economic Cooperation and Development 2005. Long Term Care for Older People. Organisation for Economic Cooperation and Development, Paris.
Pfau-Effinger, B. 2005. Culture and welfare state policies: reflections on a complex interrelation. European Journal of Social Policy, 34, 1, 320.
Pommer, E., van Gameren, E., Stevens, J. and Woittiez, I. 2007. Verschillen in verzorging. De verzorging van ouderen in negen EU-landen. Social and Cultural Planning Office, The Hague.
Pommer, E., Woittiez, I. and Stevens, J. 2007. Comparing Care. The Care of the Elderly in Ten EU-Countries. Social and Cultural Planning Office, The Hague.
Reher, D. S. 1998. Family ties in Western Europe: persistent contrasts. Population and Development Review, 24, 2, 203–34.
Rostgaard, T. 2002. Caring for children and older people in Europe – a comparison of European policies and practice. Policy Studies, 23, 1, 5168.
Scharlach, A., Gustavson, K. and Dal Santo, T. 2007. Assistance received by employed caregivers and their care recipients: who helps care recipients, The Gerontologist, 47, 6, 752–62.
Silverstein, M., Bengtson, V. L. and Litwak, E. 2003. Theoretical approaches to problems of families, ageing and social support in the context of modernization. In Biggs, S., Lowenstein, A. and Hendricks, J. (eds). The Need for Theory: Critical Approaches to Social Gerontology. Baywood, New York, 181–99.
Snijders, T. and Bosker, R. 1999. Multi-level Analysis: An Introduction to Basic and Advanced Multilevel Modelling. Sage Publications, London.
Sörensen, S., Pinquart, M. and Duberstein, P. 2002. How effective are interventions with caregivers? An updated meta-analysis. The Gerontologist, 42, 3, 356–72.
Sundström, G., Malmberg, B., Castiello, M. S., Del Barrio, E., Castejon, P., Tortosa, M. A. and Johansson, L. 2009. Family care for elders in Europe: policies and practices. In Szinovacz, M. E. and Davey, A. (eds), Caregiving Contexts. Cultural, Familial and Societal Implications. Springer, New York, 235–67.
Uhlenberg, P. and Cheuk, M. 2009. Demographic change and the future of informal caregiving. In Szinovacz, M. E. and Davey, A. (eds), Caregiving Contexts. Cultural, Familial and Societal Implications. Springer, New York, 935.
United Nations 2002. World Population Ageing 1950–2050. Department of Economic and Social Affairs, Population Division, New York.
Van Houtven, C. H. and Norton, E. C. 2004. Informal care and health care use of older adults. Journal of Health Economics, 23, 6, 1159–80.
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Ageing & Society
  • ISSN: 0144-686X
  • EISSN: 1469-1779
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