Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-19T04:24:40.182Z Has data issue: false hasContentIssue false
  • English
  • Français

Substitution between formal and informal care: a ‘natural experiment’ in social policy in Britain between 1985 and 2000

Published online by Cambridge University Press:  17 October 2011

LINDA PICKARD
LINDA PICKARD*
Affiliation:
LSE Health and Social Care, London School of Economics & Political Science, London, UK.
*
Address for correspondence: Linda Pickard, Department of Social Policy, London School of Economics & Political Science, Houghton Street, London WC2 2AE, UK. E-mail: l.m.pickard@lse.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper is concerned with the issue of substitution between formal and informal care in Britain between 1985 and 2000. This period provides the conditions for a ‘natural experiment’ in social policy. During the late 1980s/early 1990s, there was an increase in long-stay residential care for older people, which came to an end around the mid-1990s. The paper examines whether this increase in formal services led to a decline in informal care, and whether this was subsequently reversed. The focus is on provision of intense informal care by adult children to their older parents, trends in which are identified using General Household Survey data. The paper shows that there was a decline in provision of intense and very intense co-resident care for older parents between 1985 and 1995, which came to an end in the mid-1990s. These trends in intergenerational care were negatively related to changes in long-stay residential care. In particular, controlling for age and disability, there was evidence of substitution between nursing home/hospital care and very intense co-resident care for older parents. A key policy implication is that an expansion of very intense formal services for older people could bring about a decline in very intense intergenerational care. The paper relates these findings to the current debate on reform of the long-term care system in England.

Keywords

substitutioninformal careintergenerational carelong-stay residential careolder people
Type
Articles
Information
Ageing & Society , Volume 32 , Issue 7 , October 2012 , pp. 1147 - 1175
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Academy of Medical Sciences 2009. Rejuvenating Ageing Research. A Report by the Academy of Medical Sciences. The Academy of Medical Sciences, London.Google Scholar
Audit Commission 1997. The Coming of Age. Improving Care Services for Older People. Audit Commission, London.Google Scholar
Bajekal, M. 2002. Health Survey for England 2000: Characteristics of Care Homes and Their Residents. The Stationery Office, London.Google Scholar
Bebbington, A. and Darton, R. 1996. Healthy Life Expectancy in England and Wales: Recent Evidence. PSSRU Discussion Paper No. 1205, Personal Social Services Research Unit, University of Kent, Canterbury, UK.Google Scholar
Bell, D. and Bowes, A. 2006. Financial Care Models in Scotland and the UK: A Review of the Introduction of Free Personal Care for Older People in Scotland. Joseph Rowntree Foundation, York, UK.Google Scholar
Challis, D., Godlove Mozley, C., Sutcliffe, C., Bagley, H., Price, L., Burns, A., Huxley, P. and Cordingley, L. 2000. Dependency in older people recently admitted to care homes. Age and Ageing, 29, 255–60.CrossRefGoogle ScholarPubMed
Daatland, S. O. and Herlofson, K. 2003. ‘Lost solidarity’ or ‘changed solidarity’: a comparative European view of normative family solidarity. Ageing & Society, 23, 537–60.CrossRefGoogle Scholar
Darton, R. and Wright, K. 1992. Residential and nursing homes for elderly people: one sector or two? In Laczko, F. and Victor, C. R. (eds), Social Policy and Elderly People. Avebury, Aldershot, UK, 216–45.Google Scholar
Darton, R. and Wright, K. 1993. Changes in the provision of long-stay care, 1970–1990. Health and Social Care in the Community, 1, 11–25.CrossRefGoogle Scholar
Davies, B., Fernandez, J. and Saunders, R. 1998. Community Care in England and France: Reforms and the Improvement of Equity and Efficiency. Ashgate, Aldershot, UK.Google Scholar
Department of Health 2001 a. Community Care Statistics. 2000 Edition, The Stationery Office, London.Google Scholar
Department of Health 2001 b. Community Care Statistics. 2001 Edition, The Stationery Office, London.Google Scholar
Department of Health 2002. Community Care Statistics 2002. Home Care Services for Adults, England. Department of Health, London.Google Scholar
Department of Health and Social Security 1992. Health and Personal Social Services Statistics for England. 1992 Edition, HMSO, London.Google Scholar
Dickinson, H. and Glasby, J. 2006. Free personal care in Scotland. In Wanless, D. (ed.), Securing Good Care for Older People: Taking a Long-term View. Kings Fund, London, Appendix.Google Scholar
Estrin, S. and Pérotin, V. 1988. Privatisation by default? Old age homes in Britain and France. STICERD Welfare State Programme Research Note No. 11, London School of Economics, London.Google Scholar
Evandrou, M. and Glaser, K. 2002. Changing economic and social roles: the experience of four cohorts of mid-life individuals in Britain, 1985–2000. Population Trends, 110, 19–30.Google Scholar
Grundy, E. 1996. Elderly people in complex and non-private (institutional) households: changes in England and Wales 1971–1991. In House of Commons Health Committee, Long-term Care: Future Provision and Funding. Volume II, Minutes of Evidence and Appendices, HC 59-II, HMSO, London, 81–9.Google Scholar
Grundy, E. 2008. Transitions from independent households to supported environments over three decades in England and Wales: changing roles of family and state? Paper to the Population Association of America 2008 Annual Meeting, 17–19 April, New Orleans, Louisiana.Google Scholar
Grundy, E. and Glaser, K. 1997. Trends in, and transitions to, institutional residence among older people in England and Wales, 1971–1991. Journal of Epidemiology and Community Health, 51, 531–40.CrossRefGoogle Scholar
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, 4, 424–30.CrossRefGoogle ScholarPubMed
Hanley, R. J., Alecxih, L. M. B., Wiener, J. M. and Kennell, D. L. 1990. Predicting elderly nursing home admissions results from the 1982–1984 National Long-term Care Survey. Research on Aging, 12, 2, 199–228.CrossRefGoogle ScholarPubMed
Hanley, R. J., Wiener, J. M. and Harries, K. M. 1991. Will paid home care erode informal support? Journal of Health Politics, Policy and Law, 16, 3, 507–21.CrossRefGoogle ScholarPubMed
Her Majesty's Government (HMG) 2008. Carers at the Heart of 21st-century Families and Communities. ‘A Caring System on Your Side. A Life of your Own.’. The Stationery Office, London.Google Scholar
Her Majesty's Government (HMG) 2009. Shaping the Future of Care Together. Cm 7673, The Stationery Office, London.Google Scholar
Her Majesty's Government (HMG) 2010 a. Building the National Care Service. Cm 7854, The Stationery Office, London.Google Scholar
Her Majesty's Government (HMG) 2010 b. The Coalition: Our Programme for Government. Available online at http://www.cabinetoffice.gov.uk/sites/default/files/resources/coalition_programme_for_government.pdf [Accessed December 2010].Google Scholar
Her Majesty's Government (HMG) 2010 c. Recognised, Valued and Supported: Next Steps for the Carers Strategy. The Stationery Office, London.Google Scholar
Hirst, M. 2001. Trends in informal care in Great Britain during the 1990s. Health and Social Care in the Community 9, 6, 348–57.CrossRefGoogle ScholarPubMed
House of Commons Health Committee 1995. Long-term Care: NHS Responsibilities for Meeting Continuing Health Care Needs. Volume 1, Session 1995–1996, HC 19–1, HMSO, London.Google Scholar
Information Centre 2010. Survey of Carers in Households in England 2009/10. Provisional Results. The NHS Health and Social Care Information Centre, Leeds, UK.Google Scholar
Jette, A. M., Tennstedt, S. and Crawford, S. 1995. How does formal and informal community care affect nursing home use? Journals of Gerontology: Social Sciences, 50, 1, S4–12.CrossRefGoogle ScholarPubMed
Johansson, L., Sundstrom, G. and Hassing, L. B. 2003. State provision down, offspring's up: the reverse substitution of old-age care in Sweden. Ageing & Society, 23, 269–80.CrossRefGoogle Scholar
Keith, L. and Morris, J. 1996. Easy targets: a disability right perspective on the ‘children as carers’ debate. In Morris, J. (ed.), Encounters with Strangers. Feminism and Disability. The Women's Press, London, 89–115.Google Scholar
Lafortune, G., Balestat, G. and the Disability Study Expert Group Members 2007. Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications. Organisation for Economic Co-operation and Development, Paris.Google Scholar
Laing and Buisson 2002. Care of Elderly People. Market Survey 2002. Laing and Buisson, London.Google Scholar
Lewis, J. and Glennerster, H. 1996. Implementing the New Community Care. Open University Press, Buckingham, UK.Google Scholar
Lingsom, S. 1997. The Substitution Issue. Care Policies and Their Consequences for Family Care. NOVA Rapport 6/1997, NOVA, Oslo.CrossRefGoogle Scholar
Lo Sasso, A. T. and Johnson, R. W. 2002. Does informal care from adult children reduce nursing home admissions for the elderly? Inquiry, 39, 3, 279–97.CrossRefGoogle ScholarPubMed
Martin, J., Meltzer, H. and Elliot, D. 1988. The Prevalence of Disability Among Adults. HMSO, London.Google Scholar
McNamee, P. 2006. Effects of free personal care policy in Scotland. Examination of trends in the use of informal and formal care at home and in residential care. In Wanless, D. (ed.), Securing Good Care for Older People: Taking a Long-term View. Kings Fund, London, Appendix.Google Scholar
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, 863–82.CrossRefGoogle Scholar
National Assembly for Wales 2002. Health Statistics Wales 2001. National Assembly for Wales, Cardiff.Google Scholar
Netten, A., Darton, R., Bebbington, A. and Brown, P. 2001. Residential or nursing home care? The appropriateness of placement decisions. Ageing & Society, 21, 3–23.CrossRefGoogle Scholar
Office for National Statistics (ONS) 2010. Life expectancy at birth and at age 65 by local areas in the United Kingdom, 2007–09. Statistical Bulletin, 19 October.Google Scholar
Parker, G. 1998. Trends in caring 1985–1995. In Rowlands, O. (ed.), Informal Carers. An Independent Study Carried Out by the Office for National Statistics on Behalf of the Department of Health as Part of the 1995 General Household Survey. The Stationery Office, London, 39–48.Google Scholar
Patsios, D. 2008. The impact of the National Health Service and Community Care Act (NHSCCA) 1990 on the ‘typologies of care’ of older people with functional dependencies living at home in Britain (1980–2001). Radical Statistics, 96, 1–12.Google Scholar
Penning, M. J. 2002. Hydra revisited: substituting formal for self- and informal in-home care among older adults with disabilities. The Gerontologist, 42, 1, 4–16.CrossRefGoogle ScholarPubMed
Pezzin, L., Kemper, P. and Reschovsky, J. 1996. Does publicly provided home care substitute for family care? Experimental evidence with endogenous living arrangements. The Journal of Human Resources, 31, 3, 650–76.CrossRefGoogle Scholar
Pickard, L. 2002. The decline of intensive intergenerational care of older people in Great Britain, 1985–1995. Population Trends, 110, 31–41.Google Scholar
Pickard, L. 2008. Informal care for older people provided by their adult children: projections of supply and demand to 2041 in England. PSSRU Discussion Paper No. 2515, Personal Social Services Research Unit, London.Google Scholar
Pickard, L. Analysing the ‘dual focus of caring’ using large-scale survey data: an innovative approach to the analysis of unpaid care in Britain, forthcoming.Google Scholar
Scottish Executive 2002. Scottish Community Care Statistics 2001. Scottish Executive, Edinburgh.Google Scholar
Stuart, M. and Weinrich, M. 2001. Home- and community-based long-term care: lessons from Denmark. The Gerontologist, 41, 4, 474–80.CrossRefGoogle Scholar
Tennstedt, S., Harrow, B. and Crawford, S. 1996. Informal care vs. formal services: changes in patterns of care over time. Journal of Social Policy and Aging, 7, 3/4, 71–91.CrossRefGoogle ScholarPubMed
The Commission on Funding of Care and Support 2010. Call for Evidence on the Future Funding of Care and Support. Available online at http://www.dilnotcommission.dh.gov.uk/ [Accessed December 2010].Google Scholar
Twigg, J. 1996. Issues in informal care. In Organisation for Economic Co-operation and Development (ed.), Caring for Frail Elderly People: Policies in Evolution. Social Policy Studies No. 19, Organisation for Economic Co-operation and Development, Paris, 81–92.Google Scholar
Van Houtven, C. H. and Norton, E. C. 2004. Informal care and health care use of older adults. Journal of Health Economics, 27, 1159–80.CrossRefGoogle Scholar
Van Houtven, C. H. and Norton, E. C. 2008. Informal care and Medicare expenditures: testing for heterogeneous treatment effects. Journal of Health Economics, 27, 134–56.CrossRefGoogle ScholarPubMed
Wanless, D. (ed.) 2006. Securing Good Care for Older People: Taking a Long-term View. King's Fund, London.Google Scholar
Welsh Office 1991. Health and Personal Social Services Statistics for Wales. 1990 Edition, Welsh Office, Cardiff.Google Scholar
Welsh Office 1994. Health and Personal Social Services Statistics for Wales. 1993 Edition, Welsh Office, Cardiff.Google Scholar
Welsh Office 1997. Health Statistics for Wales. 1996 Edition, Welsh Office, Cardiff.Google Scholar
Wittenberg, R., Pickard, L., Comas-Herrera, A., Davies, B. and Darton, R. 1998. Demand for Long-term Care: Projections of Long-term Care Finance for Elderly People. Personal Social Services Research Unit, University of Kent, Canterbury, UK.Google Scholar