Skip to main content Accessibility help

Residential care and care to community-dwelling parents: out-selection, in-selection and diffusion of responsibility



Research suggests that adult children are less likely to provide care to community-dwelling parents when beds in residential care settings are more widely available. The underlying mechanisms are not well understood. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE) on 1,214 impaired parent–child dyads from 12 countries, we find that adult children are less likely to provide care in countries where beds in residential care settings are more widely available because (a) parents’ care needs are less severe in such countries (out-selection hypothesis) and (b) adult children and impaired parents are less likely to share a household in such countries (in-selection hypothesis). Finally (c), after taking these two factors into account, adult children remain less likely to provide care in countries where beds in residential care settings are more widely available (diffusion of responsibility hypothesis). Plausibly, being able to rely on residential care undermines adult children's sense of urgency to step in and provide care to their parents.


Corresponding author

Address for correspondence: Thijs van den Broek, London School of Economics and Political Science, Department of Social Policy, Houghton Street, London WC2A 2AE, UK E-mail:


Hide All
Amato, P. R. and James, S. 2010. Divorce in Europe and the United States: commonalities and differences across nations. Family Science, 1, 1, 213.
Andersen, R. M. 1995. Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36, 1, 110.
Andersen, R. M. and Newman, J. F. 1973. Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly, 51, 1, 95124.
Blomgren, J., Breeze, E., Koskinen, S. and Martikainen, P. 2012. Help from spouse and from children among older people with functional limitations: comparison of England and Finland. Ageing & Society, 32, 6, 905–33.
Börsch-Supan, A., Brandt, M., Hunkler, C., Kneip, T., Korbmacher, J., Malter, F., Schaan, B., Stuck, S. and Zuber, S. 2013. Data resource profile: the Survey of Health, Ageing and Retirement in Europe (SHARE). International Journal of Epidemiology, 42, 4, 9921001.
Börsch-Supan, A., Brugiavini, A., Jürges, H., Kapteyn, A., Mackenbach, J., Siegrist, J. and Weber, G. 2008. First Results from the Survey of Health, Ageing and Retirement in Europe 2004–2007. Starting the Longitudinal Dimension. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany.
Brandt, M., Haberkern, K. and Szydlik, M. 2009. Intergenerational care and help in Europe. European Sociological Review, 25, 5, 581601.
Broese van Groenou, M., Glaser, K., Tomassini, C. and Jacobs, T. 2006. Socio-economic status differences in older people's use of informal and formal help: a comparison of four European countries. Ageing & Society, 26, 5, 745–66.
Chappell, N. and Blandford, A. 1991. Informal and formal care: exploring the complementarity. Ageing & Society, 11, 3, 299317.
Choi, N. G. 2003. Coresidence between unmarried aging parents and their adult children. Research on Aging, 25, 4, 384404.
Da Roit, B. and Le Bihan, B. 2010. Similar and yet so different: cash-for-care in six European countries’ long-term care policies. Milbank Quarterly, 88, 3, 286309.
Darley, J. M. and Latané, B. 1968. Bystander intervention in emergencies: diffusion of responsibility. Journal of Personality and Social Psychology, 8, 4, 377–83.
Dykstra, P. A. 2015. Aging and social support. In Ritzer, G. (ed.), The Blackwell Encyclopedia of Sociology. Blackwell, Oxford, 8893.
Dykstra, P. A. and Komter, A. E. 2012. Generational interdependencies in families: the MULTILINKS research programme. Demographic Research, 27, 18, 487506.
Forder, J. and Fernandez, J.-L. 2011. What works abroad? Evaluating the funding of long-term care: international perspectives. Report commissioned by Bupa Care Services. PSSRU Discussion Paper 2794, Personal Social Services Research Unit, Canterbury, UK.
Freedman, V. A., Wolf, D. A., Soldo, B. J. and Stephen, E. H. 1991. Intergenerational transfers: a question of perspective. The Gerontologist, 31, 5, 640–7.
Greene, V. L. 1983. Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care, 21, 6, 609–19.
Greene, V. L. and Ondrich, J. I. 1990. Risk factors for nursing home admissions and exits. A discrete-time hazard function approach. Journal of Gerontology: Social Sciences, 45, 6, S250–8.
Grootegoed, E., Duyvendak, J. W. and Van Barneveld, E. 2015. What is customary about customary care? How Dutch welfare policy defines what citizens have to consider ‘normal’ care at home. Critical Social Policy, 35, 1, 110–31.
Grundy, E. and Jitlal, M. 2007. Socio-demographic variations in moves to institutional care 1991–2001: a record linkage study from England and Wales. Age and Ageing, 36, 1, 424–30.
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.
Hochschild, A. R. 1995. The culture of politics: traditional, postmodern, cold-modern, and warm-modern ideals of care. Social Politics, 2, 3, 331–46.
Howe, A. L., Jones, A. E. and Tilse, C. 2013. What's in a name? Similarities and differences in international terms and meanings for older peoples’ housing with services. Ageing & Society, 33, 4, 547–78.
Huber, M., Rodrigues, R., Hoffmann, F., Gasior, K. and Marin, B. 2008. Facts and Figures on Long-term Care. Europe and North America. European Centre for Social Welfare Policy and Research, Vienna.
Keck, W. and Saraceno, C. 2011. MULTILINKS Database on Intergenerational Policy Indicators. Methodological Report. Version 2.1, WZB Social Science Research Center, Berlin.
Kohler, U., Karlson, K. B. and Holm, A. 2011. Comparing coefficients of nested nonlinear probability models. Stata Journal, 11, 3, 420–38.
Le Bihan, B. and Martin, C. 2012. Diversification of care policy measures supporting older people: towards greater flexibility for carers? European Journal on Ageing, 9, 2, 141–50.
Leopold, T., Raab, M. and Engelhardt, H. 2014. The transition to parent care: costs, commitments, and caregiver selection among children. Journal of Marriage and Family, 76, 2, 300–18.
Litwak, E. 1985. Helping the Elderly: The Complementary Roles of Informal Networks and Formal Systems. Guilford Press, New York.
Mandemakers, J. J. and Dykstra, P. A. 2008. Discrepancies in parent's and adult child's reports of support and contact. Journal of Marriage and Family, 70, 2, 495506.
Meijer, A., Van Kampen, C. and Kerkstra, A. 2000. A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands. Journal of Advanced Nursing, 32, 3, 554–61.
Messeri, P., Silverstein, M. and Litwak, E. 1993. Choosing optimal support groups: a review and reformulation. Journal of Health and Social Behavior, 34, 2, 122–37.
Nadler, A. 2012. From help-giving to helping relations. Belongingness and independence in social interactions. In Deaux, K. and Snyder, M. (eds), The Oxford Handbook of Personality and Social Psychology. Oxford University Press, Oxford, 394418.
Ogg, J. and Renaut, S. 2006. The support of parents in old age by those born during 1945–1954: a European perspective. Ageing & Society, 26, 5, 723–43.
Österle, A. and Rothgang, H. 2010. Long-term care. In Castles, F. G., Leibfried, S., Lewis, J., Obinger, H. and Pierson, C. (eds), The Oxford Handbook of the Welfare State. Oxford University Press, Oxford, 378–90.
Pavolini, E. and Ranci, C. 2008. Restructuring the welfare state: reforms in long-term care in Western European countries. Journal of European Social Policy, 18, 3, 246–59.
Perrow, C. B. 1984. Normal Accidents: Living with High-risk Technologies. Basic Books, New York.
Pfau-Effinger, B. 2005. Culture and welfare state policies: reflections on a complex interrelation. Journal of Social Policy, 34, 1, 320.
Pickard, L. 2012. Substitution between formal and informal care: a ‘natural experiment’ in social policy in Britain between 1985 and 2000. Ageing & Society, 32, 7, 1147–75.
Reher, D. S. 1998. Family ties in Western Europe: persistent contrasts. Population and Development Review, 24, 2, 203–34.
Ribbe, M. W., Ljunggren, G., Steel, K., Topinkova, E., Hawes, C., Ikegami, N., Henrard, J.-C. and Jónnson, P. V. 1997. Nursing homes in 10 nations: a comparison between countries and settings. Age and Ageing, 26, supplement 2, 312.
Robertson, R., Gregory, S. and Jabbal, J. 2014. The Social Care and Health Systems of Nine Countries. The King's Fund, London.
Rodrigues, R., Huber, M. and Lamura, G. (eds) 2012. Facts and Figures on Healthy Ageing and Long-term care. Europe and North America. European Centre for Social Welfare Policy and Research, Vienna.
Ross, M. M., Carswell, A. and Dalziel, W. B. 2001. Family caregiving in long-term care facilities. Clinical Nursing Research, 10, 4, 347–63.
Rostgaard, T. 2002. Caring for children and older people in Europe. A comparison of European policies and practice. Policy Studies, 23, 1, 5168.
Rostgaard, T. (ed.) 2011. Livindhome – Living Independently at Home: Reforms in Home Care in 9 European Countries. SFI Danish National Centre for Social Research, Copenhagen.
Sagan, S. D. 2004. Learning from normal accidents. Organization and Environment, 17, 1, 1519.
Saraceno, C. and Keck, W. 2010. Can we identify intergenerational policy regimes in Europe. European Societies, 12, 5, 675–96.
Saraceno, C. and Keck, W. 2011. Towards an integrated approach for the analysis of gender equity in policies supporting paid work and care responsibilities. Demographic Research, 25, 11, 371406.
Silverstein, M. 1995. Stability and change in temporal distance between the elderly and their children. Demography, 32, 1, 2945.
Smits, A., Van Gaalen, R. I. and Mulder, C. H. 2010. Parent–child coresidence: who moves in with whom and for whose needs? Journal of Marriage and Family, 72, 4, 1022–33.
Sobel, M. E. 1982. Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology, 13, 1, 290312.
Stoller, E. P. and Earl, L. L. 1983. Help with activities of everyday life: sources of support for the noninstitutionalized elderly. The Gerontologist, 23, 1, 6470.
Ulmanen, P. and Szebehely, M. 2015. From the state to the family or to the market? Consequences of reduced residential eldercare in Sweden. International Journal of Social Welfare, 24, 1, 8192.
Van den Broek, T., Dykstra, P. A. and Van der Veen, R. J. 2015. Care ideals in the Netherlands: shifts between 2002 and 2011. Canadian Journal on Aging/La revue canadienne du viellisement, 34, 3, 268–81.
Van Gaalen, R. I., Dykstra, P. A. and Flap, H. 2008. Intergenerational contact beyond the dyad: the role of the sibling network. European Journal of Ageing, 5, 1, 1929.
Vlachantoni, A., Shaw, R. J., Evandrou, M. and Falkingham, J. 2015. The determinants of receiving social care in later life in England. Ageing & Society, 35, 2, 321–45.
Walker, A. J., Pratt, C. C. and Eddy, L. 1995. Informal caregiving to aging family members. A critical review. Family Relations , 44, 4, 402–11.
Willis, R., Glaser, K. and Price, D. 2010. Applying the Andersen behavioural model to informal support among Britain's ethnic minorities. Generations Review, 20, 3. Available online at [Accessed 30 May 2014].


Related content

Powered by UNSILO

Residential care and care to community-dwelling parents: out-selection, in-selection and diffusion of responsibility



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.