Introduction
The world population aged 65 years and older reached 258 million in 1980 and is expected to reach 994 million by 2030 and 1.6 billion by 2050, accounting for nearly 12 and 16 per cent, respectively, of the global population (United Nations, 2022). Among these, the growth rate of the population aged 80 years and over, who are more likely to have social care needs, will be even faster, rising from 155 million in 2021 to 459 million in 2050 (Wilmoth et al., Reference Wilmoth, Bas, Mukherjee and Hanif2023). As many countries experience an ageing population, they have strengthened public long-term care (LTC) services in response to growing care needs and increased awareness of social responsibility. Alongside strengthening state efforts in LTC, fiscal sustainability issues have become more prominent, and attention to ageing in place for care recipients has led to further expansion of in-home services (Wittenberg, Reference Wittenberg, Gori, Fernández and Wittenberg2016).
In this context, informal care still plays a vital role in supporting older adults, regardless of the care regime determining the national framework for LTC policies (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). Among the 19 member countries of the Organisation for Economic Co-operation and Development (OECD) examined, around 60 per cent of the older adults reported exclusively relying on informal care (Rocard and Llena-Nozal, Reference Rocard and Llena-Nozal2022). Informal care can negatively impact informal caregivers as it is often associated with kinship obligations and a sense of responsibility for the care recipient’s life, in addition to the general nature of care that involves physical and emotional labour (Twigg and Atkin, Reference Twigg and Atkin1994). It may result in informal caregivers being burdened with excessive support responsibilities, limiting their labour market participation, or encountering a range of physical and mental health problems (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011).
To address these issues, many countries have recognised the support of informal caregivers as a policy agenda and have implemented various support policies (Courtin et al., Reference Courtin, Jemiai and Mossialos2014; Zigante, Reference Zigante2018). Nevertheless, informal caregiver support policies can alleviate or increase the burden of informal care depending on the ideology and emphasised values inherent in each country (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). This is because perspectives on informal caregivers are formed differently under different care regimes, and these perspectives can shape the direction and implementation of support policies (Riedel and Kraus, Reference Riedel and Kraus2011; Zigante, Reference Zigante2018). Hence, to develop support policies that effectively relieve the care burden and improve the quality of life for informal caregivers of older adults, it is crucial to analyse the policy’s content and consider the care regime’s impact.
Care regimes consider the cultural, social, and institutional contexts shaping each country’s caregiving approach. This concept helps explain why some countries prioritise formal LTC services while others focus on informal care (Giordano, Reference Giordano2022). The care regime concept illustrates how countries perceive and value informal caregivers. This perspective aids in analysing how policies are designed to support, compensate, or potentially replace informal care, depending on the role assigned to caregivers within each regime. Care regimes are grounded in ideologies that influence the design and implementation of informal caregiver support policies (Lightman, Reference Lightman2021). By examining care regimes, we can better understand how they affect informal caregiver support policy. This understanding can benefit policymakers looking to adapt or reform informal caregiver support systems to better align with their unique societal contexts and caregiving needs.
However, it is important to recognise that most previous studies have overlooked the impact of the care regime and have been limited by a lack of policy-specific analysis. Instead, they have focused on understanding the care burden of informal caregivers (Zigante, Reference Zigante2018; Barczyk and Kredler, Reference Barczyk and Kredler2019; Rexhaj et al., Reference Rexhaj, Nguyen, Favrod, Coloni-Terrapon, Buisson, Drainville and Martinez2023), the personal and social consequences of informal care (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011; Bauer and Sousa-Poza, Reference Bauer and Sousa-Poza2015; Bleijlevens et al., Reference Bleijlevens, Stolt, Stephan, Zabalegui, Saks, Sutcliffe, Lethin, Soto and Zwakhalen2015; Kaschowitz and Brandt, Reference Kaschowitz and Brandt2017; Ciccarelli and Van Soest, Reference Ciccarelli and Van Soest2018; Bom et al., Reference Bom, Bakx, Schut and van Doorslaer2019; European Commission, Directorate-General for Employment, Social Affairs and Inclusion, 2021), and the need for and effectiveness of particular interventions (Janse et al., Reference Janse, Huijsman, de Kuyper and Fabbricotti2014; Zmora et al., Reference Zmora, Statz, Birkeland, McCarron, Finlay, Rosebush and Gaugler2021; Kraun et al., Reference Kraun, De Vliegher, Vandamme, Holtzheimer, Ellen and van Achterberg2022). Although there are studies analysing policies to support informal caregivers across countries (Da Roit and Le Bihan, Reference Da Roit and Le Bihan2010; Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011; Courtin et al., Reference Courtin, Jemiai and Mossialos2014; Zigante, Reference Zigante2018; Rocard and Llena-Nozal, Reference Rocard and Llena-Nozal2022; Wieczorek et al., Reference Wieczorek, Evers, Kocot, Sowada and Pavlova2022), these are either outdated or have not focused on the specifics of the policies.
Therefore, we aim to examine in more detail and compare informal caregiver support policies of countries with a socially responsible approach to LTC for older adults, focusing on those that alleviate the burden of informal caregivers and improve their quality of life. To be specific, three research questions are addressed: (1) What roles are assigned to informal caregivers across different care regimes? (2) What are the differences and similarities in support policies for informal caregivers across different care regimes? (3) What policy directions can complement the limitations of informal caregiver support policies? To achieve this, South Korea, the United Kingdom, and Sweden were selected for a comparative case analysis of informal caregiver support policies. Each country has developed unique support policies to relieve the negative impact of informal caregiving based on different care regimes within a structured LTC system.
The following section will explore the link among care regimes, the roles of informal caregivers, and informal caregiver support policies. After analysing the policies of these three countries, we will discuss how informal caregiver support policies should be developed. This study could shape future policy development to reduce the adverse outcomes of informal caregiving for older adults and provide appropriate support.
Care regimes and informal caregiving
The differences in informal caregiver support policies across care regimes have blurred due to socio-environmental changes. Nevertheless, many countries still maintain the framework of their initially designed LTC system, as the operation of each policy is shaped by the ideology and emphasised values that guide their policy choices (Wieczorek et al., Reference Wieczorek, Evers, Kocot, Sowada and Pavlova2022). In this respect, each country has “the institutional and spatial arrangements for the provision and allocation of care”, which can be described as a care regime (Kofman and Raghuram, Reference Kofman and Raghuram2009). The concept includes countries’ regulations, policies, and general arrangements for dealing with care responsibilities (Degavre and Nyssens, Reference Degavre and Nyssens2012). It explains how domestic and caregiving responsibilities are distributed among various parties through national implicit or explicit regulations (Giordano, Reference Giordano2022).
Accordingly, the view of informal caregivers varies across different care regimes (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). Informal caregivers can be perceived as a resource, co-workers, co-clients, or to be replaced with formal care (Twigg and Atkin, Reference Twigg and Atkin1994). Based on these views, roles are assigned to informal caregivers, and support for them is provided in a way that reinforces these assigned roles through societal policies, including regulations or financial (dis-)incentives within the care regime (United Nations Economic Commission for Europe, 2019; Cahill et al., Reference Cahill, Bielsten and Zarit2023). In response to this, advocacy activities and grassroots movements by caregivers, while influenced by existing care regimes, have responded to the limited support policies resulting from these prevailing perceptions (Yeandle et al., Reference Yeandle, Kröger and Cass2012; Cahill et al., Reference Cahill, Bielsten and Zarit2023). These efforts have gradually contributed to the development of the policies by seeking to transform the perceptions of informal caregivers (Crossdale and Buckner, Reference Crossdale and Buckner2023).
Viewing informal caregivers as a resource leads to prioritising informal care over formal care, which is taken for granted as a natural given (Twigg and Atkin, Reference Twigg and Atkin1994). Social care is mainly provided when informal care is unavailable. In addition, support for informal caregivers is rarely considered in policy (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). The distinction between formal and informal care is transcended by considering informal caregivers as co-workers, perceiving them as contributors. Thus, the care burden of informal caregivers is partly recognised by prioritising support for providing informal care, assuming that informal caregivers want to provide care (Twigg and Atkin, Reference Twigg and Atkin1994). Considering informal caregivers as co-clients means treating them as clients in need and providing support to protect their rights and ensure choice. Supporting policies assume that informal care is a risk-taking behaviour and provide support to alleviate the care burden and promote the well-being of informal caregivers based on their needs (Twigg and Atkin, Reference Twigg and Atkin1994). The idea of replacing informal caregivers is not to support informal care but to substitute it with formal care, thereby enhancing the care recipient’s independence and alleviating the care burden on informal caregivers (Twigg and Atkin, Reference Twigg and Atkin1994).
The distinction offers a clear lens for evaluating each country’s policies. Twigg and Atkin’s (Reference Twigg and Atkin1994) typology is applicable across different national care systems. Schneider et al. (Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016) analysed the content of support policies based on the roles of informal caregivers in LTC systems. The study also examined how the roles are shaped differently according to care regimes in Europe. In the study by Cahill et al. (Reference Cahill, Bielsten and Zarit2023), an earlier version (Twigg, Reference Twigg1989) of Twigg and Atkin’s (Reference Twigg and Atkin1994) typology served as an analytical framework to assess the roles of informal caregivers within the long-term care systems of Sweden, Ireland, and the United States. Furthermore, in a study that analysed informal caregivers’ self-perceived roles within the Canadian healthcare system, this typology was used to categorise roles based on the caregivers’ experiences (Law et al., Reference Law, Ormel, Babinski, Kuluski and Quesnel-Vallée2021). Examining the roles of informal caregivers within the LTC systems of South Korea, the United Kingdom, and Sweden will provide insight into how different care regimes influence informal caregiving and determine the extent of their support.
Policy support for informal caregivers
Support policies for informal caregivers of older adults vary depending on the perception of informal caregivers shaped by each country’s care regime. In particular, diverse support policies can be implemented from the perspectives of co-worker and co-client, which position informal caregivers both as key providers of care and as subjects of policy interventions (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). The distinct differences in policy direction based on these two perspectives become evident in the three major challenges that informal caregivers face in the caregiving process.
Informal caregiving may induce psychological problems and deteriorate health, exacerbated by isolation and insufficient support (Bleijlevens et al., Reference Bleijlevens, Stolt, Stephan, Zabalegui, Saks, Sutcliffe, Lethin, Soto and Zwakhalen2015; Kaschowitz and Brandt, Reference Kaschowitz and Brandt2017; Bom et al., Reference Bom, Bakx, Schut and van Doorslaer2019). Hence, policy interventions are important to improve informal caregivers’ physical and mental well-being. These can be delivered through direct services such as needs assessment, information, counselling, and training, as well as by providing services that allow informal caregivers to take a break (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011). When viewing caregivers as co-workers, direct services are provided to improve the quality of care, while respite care is primarily provided to sustain informal caregiving (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). However, when caregivers are viewed as co-clients, information and counselling services are provided to inform informal caregivers about their legal rights and self-care. Similarly, education and training services are provided to empower the caregiver. With this perspective, respite care is provided to enhance their health and quality of life (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016).
Informal caregiving is associated with a higher risk of poverty. High-intensity care may result in reduced employment rates and working hours for working-age people, leading to a trade-off between informal caregiving and income (Ciccarelli and Van Soest, Reference Ciccarelli and Van Soest2018). The disproportionate share of unpaid work between men and women has a more significant negative impact on women’s labour market participation (Carrino et al., Reference Carrino, Nafilyan and Avendano2023). Since informal caregivers’ financial situation is likely to deteriorate, it may also adversely affect their ability to pay social security contributions that cover future unemployment, illness, pensions, and so forth (European Commission, Directorate-General for Employment, Social Affairs and Inclusion, 2021). Policy support can be provided to compensate them and socially recognise informal care work (Zigante, Reference Zigante2018). This can be delivered through financial assistance, either directly to the informal caregiver or indirectly through the care recipient (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011). With the perspective that regards caregivers as co-workers, cash benefits are provided to encourage informal care or support the stability of informal care arrangements (Zigante, Reference Zigante2018). Conversely, when regarding caregivers as co-clients, cash benefits are underdeveloped in order to avoid encouraging informal care and are implemented either as tax allowances or as benefits paid to care recipients (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016) with strict regulations (Zigante, Reference Zigante2018).
Furthermore, informal caregiving can impact employment decisions and the continuity of one’s career. Informal caregiving can be demanding, with unpredictable intensity levels (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011). Available jobs may not have flexible working hours or leave options to accommodate caregiving responsibilities (European Commission, Directorate-General for Employment, Social Affairs and Inclusion, 2021). Therefore, informal caregivers are more prone to absenteeism or are generally incompatible with a full-time job, limiting them to temporary work (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011). Care leave or flexible working arrangements can be provided to address these issues and reconcile employment and informal care (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011). From the perspective that regards caregivers as co-workers, support for reconciling employment and care is not a policy priority. However, full-time or extended care leave support can be provided when needed (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). When regarding caregivers as co-clients, this support aims to protect the right to choose informal care while protecting informal caregivers’ financial security and career opportunities. Eligibility may be restricted to end-of-life care, and support may be limited to short-term leave or part-time work arrangements (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016).
Based on the framework developed by Colombo et al. (Reference Colombo, Llena-Nozal, Mercier and Tjadens2011), the analytical framework for this study includes an analysis of informal caregiver support by policy type. Colombo et al. (Reference Colombo, Llena-Nozal, Mercier and Tjadens2011) offer a structured approach to categorising informal caregiver support policies into three main types: (1) improving physical and mental well-being, (2) compensation and recognition, and (3) employment and care reconciliation. It allows for systematic policy analysis.
This classification complements Twigg and Atkin’s (Reference Twigg and Atkin1994) typology, which focuses on the various roles that can be assigned to informal caregivers under different care regimes. While Twigg and Atkin’s framework explains the roles of informal caregivers, Colombo et al.’s categorisation compares policy interventions supporting informal caregivers in different national contexts. Furthermore, the framework has been validated through an international study on informal caregiving (Wieczorek et al., Reference Wieczorek, Evers, Kocot, Sowada and Pavlova2022), enhancing its credibility for research methodology.
Methods
This study employs a comparative case study method to examine the roles of and support policies for informal caregivers of older adults within the LTC systems of South Korea, the United Kingdom, and Sweden. Comparative case studies aim to analyse and synthesise the differences and similarities across two or more cases that have a common focus or objective (Goodrick, Reference Goodrick2014). This approach enables the generation of a holistic view of established policies within specific contexts and facilitates the interpretation of those differences and similarities to guide further implementation (Goodrick, Reference Goodrick2014). Accordingly, by selecting cases with different care regimes – familistic (South Korea), liberal (United Kingdom), and social-democratic (Sweden) – this study examines how variations in welfare structures influence the roles and burdens of informal caregivers. Based on this analysis, it explores the distinctive and shared features of each country’s support policies for informal caregivers and synthesises these findings to propose directions for the development of more effective and context-sensitive support policies.
The inclusion criteria for case selection were: (1) representativeness of distinct care regimes (familial, liberal, and social-democratic regimes); (2) availability of robust and comparable data; and (3) the presence of established informal caregiver support policies as a recognised component of the LTC system. Based on these criteria, South Korea, the United Kingdom, and Sweden were selected. South Korea’s strong familial caregiving culture (Lee and Ku, Reference Lee and Ku2007) provides a unique perspective compared to the United Kingdom and Sweden. The United Kingdom was chosen to represent a liberal, market-oriented LTC model, while Sweden exemplifies a social-democratic, publicly funded Scandinavian model (Kraus et al., Reference Kraus, Riedel, Mot, Willemé, Röhrling and Czypionka2010). Each country’s LTC system aligns with a distinct care regime, providing a foundation for comparing and understanding these policies (Zigante, Reference Zigante2018; Ministry of Health and Welfare [MOHW], 2023). We assessed the inclusion criteria for these cases through a literature review of government documents, institutional reports, books, journal articles, and relevant websites, ensuring that the selected countries met the standards for representativeness and data accessibility. This multilingual approach, incorporating Korean, English, and Swedish sources, allowed us to integrate diverse perspectives and achieve a contextually rich analysis of the selected cases.
Previous studies comparing countries across care regimes have reported distinct differences in the policy characteristics of each regime (Bartha and Zentai, Reference Bartha and Zentai2020; Lightman, Reference Lightman2021; Lightman, Reference Lightman2024). However, a limitation of previous research is that country comparisons have centred on Europe or North America. To address this gap and underscore the importance of our work, we have selected countries representative of each care regime, including South Korea, an Asian country with good access to data, for a more inclusive comparative study.
Building on this foundation, this study employs the analytical framework developed by Twigg and Atkin (Reference Twigg and Atkin1994) to examine the roles assigned to informal caregivers of older adults within different care regimes. Their typology categorises informal caregivers as resources, co-workers, co-clients, or replacements for formal care, and provides a structured lens for evaluating how each country perceives and supports them. In addition, this study applies the framework proposed by Colombo et al. (Reference Colombo, Llena-Nozal, Mercier and Tjadens2011), which classifies informal caregiver support policies into three key dimensions: improving physical and mental well-being, compensation and recognition, and employment and care reconciliation. This study systematically examines how informal caregiver roles influence policy design and implementation across the selected countries by integrating these two frameworks. An overview of the analytical framework adopted in this study is presented in Figure 1.
Analytical framework.
Results
Roles of informal caregivers
South Korea
South Korea maintains a strong familial caregiving culture while promoting defamilialisation through market-based mechanisms, mainly via its compulsory Long-Term Care Insurance (LTCI) system (Saraceno, Reference Saraceno2016). Introduced in 2008, the LTCI system is managed by the MOHW and operated by the National Health Insurance Service (NHIS) (NHIS, 2023). Despite the growing role of formal care, South Korea keeps LTC spending relatively low (OECD, 2023), and co-payment support is limited to low-income care recipients (NHIS, 2023), resulting in a high reliance on informal care. This care regime primarily reflects the characteristics of welfare regimes found in conservative or Southern European countries (Lee and Ku, Reference Lee and Ku2007) while also incorporating elements of liberal ones (Cho, Reference Cho2001). Within this framework, informal caregivers are primarily perceived as resources, expected to continue providing care alongside formal services. However, to mitigate the negative impacts of informal caregiving, they are also regarded as co-clients, and support policies have been implemented accordingly. The government has mainly supported informal caregivers through restricted financial assistance policies with various regulatory conditions and, in particular, has allowed family members to work as formal care workers under specific conditions. However, informal caregivers’ legal rights and well-being are not comprehensively protected. Current legislation only protects the right of family caregivers to receive information, guidance, and counselling on LTC benefits from the NHIS (MOHW, 2023). Furthermore, in the context of a strong familistic culture, advocacy movements supporting informal caregivers have remained weak, often integrated into broader women’s movements rather than forming independent, caregiver-led initiatives (Women in Development Europe, 2009; Lee, Reference Lee2011). Instead of being led by caregiver groups, they have primarily focused on securing social recognition and economic compensation for informal caregiving while advocating for stronger public LTC provisions (Lee, Reference Lee2011). The Third Basic Plan for Long-Term Care (2023–2027) proposes strengthening informal caregiver support through enhanced well-being measures and care leave policies, suggesting a gradual policy shift towards recognising caregivers’ needs beyond financial compensation (MOHW, 2023). Nevertheless, the country’s continued reliance on familial caregiving reinforces gendered caregiving burdens and economic inequalities.
United Kingdom
The United Kingdom’s LTC system reflects a mixed approach, combining public and private resources under a liberal welfare model (Kraus et al., Reference Kraus, Riedel, Mot, Willemé, Röhrling and Czypionka2010). Care services are provided through means-tested assessments, prioritising cost-efficiency and targeting the greatest need (National Health Service [NHS], 2022a). Informal caregivers are recognised as both co-workers and co-clients, viewed as key contributors to care provision while simultaneously being acknowledged as individuals in need of support (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). The United Kingdom has institutionalised informal caregiver support by providing personalised carer’s assessments through local authorities, which determine eligibility for various services, such as counselling, training, and respite care (Age UK, 2024a). However, regional disparities in service provision persist due to the decentralised nature of the system. Many informal caregivers rely on Carer’s Allowance as their primary source of financial aid; yet, eligibility criteria restrict access to some extent (Age UK, 2024b). Advocacy organisations such as Carers UK have played a crucial role in shaping policies through active government lobbying and advocacy campaigns (Clements, Reference Clements2010). Notably, they led the campaign for the 1999 National Carers Strategy and collaborated with the government in 2007–2008 to revise the strategy (Yeandle et al., Reference Yeandle, Kröger and Cass2012). In addition, they engage members through research, online forums, and local carer centres (Yeandle et al., Reference Yeandle, Kröger and Cass2012). As issues surrounding informal care and labour market participation gained prominence, these organisations actively pushed for policies beyond financial compensation, advocating for stronger labour rights for informal caregivers to help them maintain their existing economic activities (Yeandle, Reference Yeandle2016). This has led to policy developments such as the Carer’s Leave Act 2023, which grants employees the right to unpaid caregiving leave (UK Parliament, 2023). However, the increasing privatisation and marketisation of care services have heightened reliance on informal caregiving, especially for individuals unable to access formal care due to stringent eligibility criteria (Kraus et al., Reference Kraus, Riedel, Mot, Willemé, Röhrling and Czypionka2010).
Sweden
Sweden represents a social-democratic model, highlighting publicly funded LTC services and defamilialisation to reduce reliance on informal care, ensuring independence and equity (Kraus et al., Reference Kraus, Riedel, Mot, Willemé, Röhrling and Czypionka2010). Most LTC is funded from public sources (about 90 per cent), primarily through municipal taxes, and municipalities are responsible for providing LTC services (Johansson and Schön, Reference Johansson and Schön2017). In this context, Sweden tends to replace informal caregivers with public services (Bettio and Plantenga, Reference Bettio and Plantenga2004) while recognising them as co-clients (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016), with emphasis on the voluntariness of informal caregiving (Socialutskottet, 2009; Regeringskansliet, 2022). Accordingly, support for informal caregivers underscores the importance of direct services to promote their physical and mental well-being (Regeringskansliet, 2022), yet discourages monetary compensation to prevent overburdening them (Magnusson et al., Reference Magnusson, Hansson, Skoglund, Ilett, Sennemark, Barbabella and Gough2016; Socialstyrelsen, 2021). Informal caregivers are recognised under Sweden’s Social Services Act (Socialtjänstlag, SoL), which mandates support (Socialutskottet, 2009). Furthermore, the National Strategy for Informal Caregivers (Nationell anhörigstrategi) was introduced in 2022 to standardise municipal support, ensure individualised assistance tailored to their needs, and incorporate their perspectives into care planning and follow-up (Regeringskansliet, 2022). Building on this initiative, support areas that should be continuously monitored have been identified, and evaluation scales have been proposed (Socialstyrelsen, 2023). The informal caregiver movement has historically been less prominent due to the tradition of extensive public care service provision (Cahill et al., Reference Cahill, Bielsten and Zarit2023). However, since the late 1980s, informal caregiver advocacy groups have begun to emerge, and organisations for care service users and pensioners’ organisations have also been actively advocating for informal caregivers (Johansson et al., Reference Johansson, Long and Parker2011).
Improving informal caregivers’ physical and mental well-being
South Korea
In South Korea, staff at local government LTCI operation centres under the NHIS provide education on care and information, as well as referrals to professional counselling agencies and local resources, to families of care recipients who receive home care benefits for 6 h or more per week (MOHW and NHIS, 2023). However, it does not provide a needs assessment for informal caregivers. Since the NHIS is the support operator, identical services are provided throughout all municipalities. Participation is free of charge, but there is a qualifying examination process, except for families of care recipients with dementia (MOHW and NHIS, 2023). In most cases, the staff will provide information about the support during counselling sessions after the care recipient’s benefit level has been determined. The service expanded from 65 to 227 centres nationwide from August 2023 (MOHW, 2023).
Respite care is available to LTC recipients for up to 9 days per service use at an LTC institution, with the possibility of extension up to four times per year in special cases (MOHW and NHIS, 2024). For level 1 and 2 benefit recipients or those with dementia, institutional respite care is available for up to 11 days per year, or they can opt for in-home respite care, allowing up to 12 h per use and a maximum of 22 uses per year (MOHW, 2024). To apply for the service, applicants must contact the LTC institution directly, following the same process as other LTC services. For co-payments, both the cost of facility-based and in-home respite care is determined based on the LTC benefit level, with a 15 per cent co-payment rate (MOHW and NHIS, 2024).
United Kingdom
The United Kingdom conducts a carer’s assessment to understand the needs of informal caregivers and tailor support services to them. The assessment is arranged when the caregiver requests it from their local council’s social service department. The assessor will advise them on the benefits to which they are entitled. Though a carer’s assessment usually takes place alongside a needs assessment for the care recipient, a carer can get one regardless of whether the person they care for has their needs assessed (NHS, 2022b).
In the United Kingdom, local authorities provide information on caring, local support groups, and equipment for caring (Age UK, 2024a). In addition to government support, caregiver organisations and charities offer various services to assist informal caregivers, such as training and counselling (Age UK, 2024c). While these interpersonal services aim to ensure that informal caregivers get informed, some conditions may vary between local authorities. Regarding respite care, local councils only fund informal caregivers with assessments who qualify. Applicants who do not qualify must seek charity grants or pay for themselves. Caregivers must search the NHS website for care homes or charities to arrange the care service (NHS, 2022c). The primary types of respite care are a short stay in a care home and home care from paid caregivers. The length of respite care will depend on the care recipient’s unique personal care needs (NHS, 2022c). Respite care agencies are monitored by the Care Quality Commission (England), the Care Inspectorate (Scotland and Wales), and the Regulation and Quality Improvement Authority (Northern Ireland) (Care Quality Commission, n.d.).
Sweden
In Sweden, informal caregivers are entitled to an individualised needs assessment of the support required under Chapter 4 of the SoL (Socialutskottet, 2009). Through an investigation, the caseworker (handläggare) can determine whether action is needed and assess which intervention can best meet the needs (Socialstyrelsen, 2016).
Family consultants in each municipality provide counselling, information services, and referrals to various activities and self-help groups (Socialstyrelsen, 2021). No needs assessment is required for participation (Johansson and Schön, Reference Johansson and Schön2017), and participation is often free of charge (Takter, Reference Takter2020). In addition to municipal staff, information about these services is also provided through brochures and the municipal website (Winqvist et al., Reference Winqvist, Magnusson, Beijer, Göransson, Takter, Tomazic and Hanson2016), which usually includes contact details and specific programme schedules (Göteborgs stads, n.d.; Malmö stad, n.d.; Uppsala kommun, 2024). The intensity, content, and quality of support can vary across municipalities (Johansson and Schön, Reference Johansson and Schön2017).
Respite care is divided into in-home respite care (avlösning i hemmet), short-term institutional respite care (korttidsboende), and rotational care (växelvård), which alternates between institutional care and informal care (Socialstyrelsen, 2016). The application process is the same as for other LTC benefits, with a comprehensive needs assessment carried out by a care manager (biståndshandläggare) after applying (Socialstyrelsen, 2016). Co-payments for the services are determined individually, considering income and housing costs, but do not exceed the maximum charge for each service (Socialstyrelsen, 2016). In some municipalities, in-home respite care is free up to a specific time and does not require additional decisions (Nationellt kompetenscentrum anhöriga [Nka], 2021). For example, up to 16 h in Stockholm (Stockholms stad, 2020) and 12 h in Malmö (Malmö stad, 2024) are free of charge per month. The dates and duration of respite care availability will vary by municipality, and the care manager will coordinate the decisions of service providers (Nka, 2021). However, it has been reported that the implementation of the service is governed by municipal regulations, which makes it difficult to fully consider the date or duration required by the caregiver (Socialstyrelsen, 2021).
Compensation and recognition of informal caregivers
South Korea
South Korea provides a family care allowance of £125.62Footnote 1 per month to eligible recipients of LTC benefits as follows: First, if the recipient lives in regions with a significant shortage of LTC institutions, such as islands and remote areas. Second, if it is difficult for the recipient to use services provided by LTC institutions due to natural disasters or other reasons. Third, if the recipient needs to receive LTC from a family member or other person for reasons prescribed by presidential decrees, such as physical, mental, or personality issues. Despite the name, the family care allowance is not limited to family members (MOHW, 2024c). In addition to these qualification criteria, the government has defined specific cases that qualify for the benefit. To receive the allowance, an applicant must apply to the NHIS, and the NHIS will pay directly to the recipient (MOHW and NHIS, 2023). Home and institutional care benefits are unavailable when receiving the family care allowance (MOHW, 2024b).
Family caregivers can receive financial compensation if they have a certification as formal care workers and do not work more than 160 h per month. After being employed by an LTC institution, they will receive the equivalent payment as formal care workers based on the hours of care provided. However, only 60 min a day for 20 days a month can be considered for salary calculation. In cases where the caregiver is aged 65 years or older and provides home care benefits to their spouse, the care recipient exhibits problematic behaviours such as violence or paranoia, or the care recipient has been diagnosed with dementia, the recognised care hours can exceed 20 days per month, with up to 90 min per day being acknowledged (MOHW, 2025). Despite being unable to receive the equivalent compensation as formal care workers, the number of family caregivers has increased from 2,621 in 2008 to 65,297 in 2019 (Kim et al., Reference Kim, Yang and Kim2021).
United Kingdom
Informal caregivers might get a personal budget from the council based on their needs assessment. This can be a direct payment, allowing them to maintain interests outside caregiving (NHS, 2022b). Attendance Allowance (AA) assists with extra costs if a person has a severe disability and needs someone’s help (UK Government, n.d.a.). Applicants must have reached the state pension age and require assistance for at least 6 months to qualify for the allowance. They must also have resided in the United Kingdom for at least 2 of the last 3 years, be habitually resident, and not be subject to immigration control. The allowance is paid either £73.90 or £110.40 a week, depending on the level of assistance required (UK Government, n.d.a). Allowance recipients must report changes in circumstances and be reassessed. Applicants can claim the allowance by submitting the claim form to the Department for Work and Pensions with help from the helpline, and the benefit is paid directly into their accounts (UK Government, n.d.a.).
Informal caregivers who meet specific eligibility requirements can receive a weekly Carer’s Allowance of £83.30 directly into their account (UK Government, n.d.b.). The requirements include being at least 16 years old, caring for 35 h a week or more, not being in full-time education for more than 21 h a week, not being subject to immigration control, and earning at most £196 per week after tax and National Insurance contributions. Importantly, they should be UK residents who have lived in the country for at least 2 of the last 3 years, except for refugees or those with humanitarian protection status (UK Government, n.d.b.). Informal caregivers must also report any changes in their circumstances and may be reassessed for the allowance. The process is available online and offline, and they can seek independent advice from charities to navigate this process (UK Government, n.d.b.). There is additional support for those who receive the allowance. The carer element of Universal Credit provides an extra £201.68 a month and the Carer’s Premium, which is means-tested, provides £46.40 a week (Carers UK, n.d.a.). Furthermore, pension credit ensures a minimum income for those over state pension age. It offers extra support for AA and Carer’s Allowance recipients, in addition to the standard guaranteed amount (UK Government, n.d.c).
Carer’s Credit is a national insurance credit that assists with gaps in informal caregivers’ national insurance records. It allows informal caregivers to concentrate on caring without affecting their eligibility to qualify for the pension. To be eligible for this credit, informal caregivers must be aged 16 years or older, under the pension age, caring for one or more persons for at least 20 h a week, and the person(s) they care for must receive a benefit because of their illness or disability. Even if they have a break from caring for up to 12 weeks in a row, they can still get Carer’s Credit. To apply for the credit, caregivers must complete a claim form and send it to the Carer’s Allowance Unit (UK Government, n.d.d.). Moreover, an informal caregiver who provides care for at least 35 h a week and lives with a care recipient who receives AA but is not their partner could be entitled to discounts on their council tax bill for 25 or 50 per cent, excluding Northern Ireland (Carers UK, n.d.b.).
Sweden
Swedish home care allowance (hemvårdsbidrag, anhörigbidrag, or omvårdnadsbidrag) is available after a comprehensive assessment of the level of “dependency” of the care recipient and whether adequate care can be provided through the allowance (Haninge kommun, 2021; Stockholms stad, 2021; Borås stad, 2022; Göteborgs stad, 2023; Nacka kommun, 2024). Some municipalities also require the caregiver and the care recipient to live in the same household (Haninge kommun, 2021; Borås stad, 2022; Nacka kommun, 2024). After the application has been accepted, an individual plan for the care to be carried out by the informal caregiver and the services or support to be provided by the municipality may be developed (Bjurholms kommun, 2021; Göteborgs stad, 2023). Depending on the level of care the recipient needs, the benefit ranges from a minimum of £114.68 to a maximum of £458.73Footnote 2 in Stockholm (Stockholms stad, 2023). However, if the recipient receives other care services simultaneously, the payment will be reduced (Haninge kommun, 2021; Stockholms stad, 2021; Borås stad, 2022; Göteborgs stad, 2023). Reassessments are usually made every year (Haninge kommun, 2021; Borås stad, 2022; Göteborgs stad, 2023; Nacka kommun, 2024), and informal caregivers are obliged to report to the municipality when circumstances arise that require reconsideration, such as a change of caregiver (Borås stad, 2022; Göteborgs stad, 2023; Nacka kommun, 2024), to ensure that the provision of services through cash benefits is adequate. The municipality also ensures continuous support and supervision of the caregiver (Stockholms stad, 2021; Göteborgs stad, 2023).
Carer’s allowance (anhöriganställning), which means that the municipality employs the informal caregiver, is generally only available after a needs assessment if there are special reasons for informal care that cannot be replaced by public care (Johansson and Schön, Reference Johansson and Schön2017) and if the person is deemed to have the same caring capacity as a formal care worker (Värnamo kommun, 2021; Norsjö kommun, 2022; Lidingö stad, 2023). Other requirements may include that the caregiver must live with the care recipient (Värnamo kommun, 2021; Norsjö kommun, 2022) or be fluent in spoken and written Swedish (Värnamo kommun, 2021; Lidingö stad, 2023). After the application is approved, a care plan is established (Värnamo kommun, 2021; Norsjö kommun, 2022; Lidingö stad, 2023), and some municipalities require a reassessment every year (Värnamo kommun, 2021; Norsjö kommun, 2022). The municipality provides a salary and social security similar to that of formal care workers, but not for those over retirement age (Johansson and Schön, Reference Johansson and Schön2017). However, some municipalities stipulate that if care is required for more than a certain number of hours, half of the excess time must be provided by a formal care worker (Lidingö stad, 2023), or if the care needs are lower, only part of a formal care worker’s salary is paid (Norsjö kommun, 2022).
Support for reconciling employment and informal care
South Korea
The Third Basic Plan for Long-Term Care (2023–2027), in cooperation with the Ministry of Employment and Labour intends to strengthen support for care recipients’ families for respite, promoting family leave and facilitating vacations or leaves to take care of family members (MOHW, 2023). To address the needs of informal caregivers currently in the workforce, the Equal Employment Opportunity and Work-Family Balance Assistance Act has introduced short-term care and long-term care leave and reduced working hours. Short-term care leave is unpaid and can be used for up to 10 days per year, with the required application documents to be submitted to the employer on the day of use (Ministry of Government Legislation [MOGL], 2024a). Long-term care leave allows for up to 90 unpaid days per year, with a minimum usage of 30 consecutive days per instance, and requires application submission to the employer at least 30 days in advance (MOGL, 2024b). The reduced working hours policy is generally available for up to 1 year but can be extended to 2 years under reasonable circumstances. It permits working to be adjusted to 15–30 h per week (MOGL, 2024c). Despite such provisions, the utilisation in South Korea remains limited, emphasising the need for greater workplace acceptance (MOHW, 2023).
United Kingdom
The Carer’s Leave Act 2023 aims to provide unpaid leave for employees who need to perform informal care (UK Parliament, 2023). Employees are entitled to take unpaid leave for at least 1 week per year to care for their dependents (UK Government, n.d.e.). They must give their employer notice before the leave and are not required to prove their dependent’s care needs. An employer cannot refuse the leave request but may ask the employee to reschedule to avoid a severe disruption (UK Government, n.d.e.). In addition, informal caregivers can ask their employer for flexible working arrangements to better suit their needs, such as a change in the number of working hours or days, when to start or finish work, and where to work (UK Government, n.d.f.). Applying for flexible working arrangements requires the employee to apply, and the employer should accept or refuse within 2 months. If the employer does not handle the request reasonably, the employee can take legal action (UK Government, n.d.f.).
Sweden
Sweden does have a care leave policy (närståendepenning) that allows informal caregivers to provide care in situations where the care recipient’s illness is life-threatening, such as end-of-life care. With the consent of the care recipient, and if the health condition can be proven by a medical certificate, a written application can be submitted to the Swedish Social Insurance Agency (Försäkringskassan, 2023). If the application is approved, one caregiver can be provided an allowance for 100 days with ~80 per cent of their income (Försäkringskassan, 2023).
Differences and similarities
The findings highlight significant differences in how informal caregiver support policies are designed and implemented across the three care regimes, reflecting how each country perceives the roles assigned to informal caregivers of older adults.
The implementation of the support policies for improving informal caregivers’ physical and mental well-being varied among the three countries. The content and level of services varied across local governments in the United Kingdom and Sweden regarding the direct services provided to informal caregivers. Conversely, South Korea has uniform regulations on the services provided. While Sweden has no barriers to accessing the services, South Korea prioritises certain people with a high level of needs. In the United Kingdom and Sweden, informal caregivers can receive assessments but this is not the case in South Korea. Respite care is based on a needs assessment in Sweden and the United Kingdom. South Korea and the United Kingdom have a process whereby people must contact short-term care facilities directly to access benefits, while Sweden does not require this process.
Sweden restricts access to financial support with eligibility requirements and a strict needs assessment process, while South Korea and the United Kingdom have lower barriers to entry. However, South Korea has stricter support criteria compared to the United Kingdom, while the United Kingdom provides various forms of financial support, including not only cash benefits but also tax reductions and other benefits.
Regarding policies supporting the reconciliation of employment and informal care, Sweden’s support policies are restricted to cases where the recipient has a serious life-threatening illness. In contrast, South Korea and the United Kingdom provide various legal rights to enable informal care while maintaining employment, although in South Korea, usage rates are low, whereas in the United Kingdom, these policies have been introduced relatively recently.
As explained earlier, we found that the level of support and its regulation vary from country to country, primarily reflecting the care regimes inherent in each country. In South Korea, the influence of a strong familistic culture results in a tendency to view informal caregivers primarily as resources. However, to mitigate the negative effects of reliance on informal care, there is also a co-client perspective that recognises the need for support. Accordingly, South Korea provides activity support services aimed at improving the physical and mental well-being of informal caregivers. Despite this, accessibility is restricted as priority is given to certain high-need groups. In the case of respite care, users must independently search for institutions, making access more challenging. Financial support policies are provided without a formal needs assessment process; however, stricter regulations on unrestricted use are in place compared to those in the United Kingdom. Policies supporting the reconciliation of employment and informal care are more diverse than those in Sweden, yet, the strong familistic culture hinders the establishment of an environment conducive to utilising these policies effectively.
In contrast, the United Kingdom holds a mixed perspective on whether informal caregiver support policies should focus on alleviating caregiving burdens to sustain informal care or on ensuring caregivers’ rights and improving their well-being. Consequently, the United Kingdom has implemented some services to enhance informal caregivers’ physical and mental well-being and applies some regulations on financial compensation policies. However, these regulations remain relatively relaxed, and a variety of financial support policies are in place. In addition, in recent years, policies promoting the reconciliation of employment and informal care have been expanding, reinforcing the perspective of viewing informal caregivers as co-clients.
On the other hand, Sweden strongly emphasises reducing the burden on informal caregivers and replacing their role with formal care. As a result, financial compensation policies, which could incentivise informal caregivers, are strictly regulated, and employment-care reconciliation policies are limited to cases where the care recipient has a life-threatening condition. On the contrary, Sweden actively promotes well-being improvement activities, and the direct provision of respite care services ensures relatively high accessibility without requiring caregivers to search for institutions themselves.
Despite these differences, several key commonalities emerge in informal caregiver support policies across the three countries. Although perceptions of informal caregivers vary depending on each care regime, there is a shared policy direction emphasising and promoting the physical and mental well-being of informal caregivers. This reflects the widespread recognition of the negative impact that informal caregiving can have on caregivers’ well-being (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011).
Furthermore, while the level of policy support differs among countries, they have all established financial compensation mechanisms and policies to support the reconciliation of employment and caregiving. This suggests that countries are not only complementing their existing care regime-based policies but also learning from one another in an increasingly globalised era, where the influence of international informal caregiver organisations is expanding. With organisations like Eurocarers and the International Alliance of Carer Organizations playing a growing role, the global alliance of informal caregiver movements is strengthening (Hanson and Champeix, Reference Hanson, Champeix and Charalambous2023). As a result, national policies supporting informal caregivers are increasingly shaped by this trend, prompting efforts to enhance existing policies.
Nevertheless, the fact that the level and scope of support policies vary significantly across countries underscores that policy direction and support levels are shaped by how each country defines the role of informal caregivers (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). That is, whether informal caregivers are seen as resources and co-clients, co-workers and co-clients, or substitutes for formal care and co-clients directly influences policy structures. This highlights the importance of considering care regime typologies when evaluating informal caregiver policies.
Table 1 compares the roles of informal caregivers and the support policies for them in South Korea, the United Kingdom, and Sweden, revealing variations shaped by each country’s care regime.
Comparisons of informal caregiver support policies
Discussion
This comprehensive study analyses how the roles of informal caregivers are assigned within the LTC systems for older adults of South Korea, the United Kingdom, and Sweden under their respective care regimes. It also examines how informal caregiver support policies are shaped based on these roles. Based on the findings, the study will propose policy directions to address the limitations of informal caregiver support policies in each country.
It is crucial to note that the direction of support for informal caregivers may vary depending on the underlying care regimes. Nevertheless, the core of the policies should be providing support that meets informal caregivers’ needs while improving their quality of life. In all three countries, support policies are delivered through various channels. Given the varying needs of informal caregivers, a comprehensive quality control system for delivering support is essential. This includes ensuring that local government officials delivering support policies are aware of the various sources of support and communicating the information to the informal caregivers. It is also important to train local government officials to assess the needs of informal caregivers and match them with appropriate support. Furthermore, to make informal caregivers more visible, mandatory needs assessments for them are required, and these needs assessments should be conducted regularly. The support policies provided to them should also be monitored. Following the direction of South Korea, it may be necessary to establish standards for direct services, such as information, counselling, training, and various activities related to informal caregivers’ well-being. Still, the different service needs of municipalities should be respected when implementing the services. As for respite care, simplifying the application and needs assessment process is of utmost importance. It will ensure that informal caregivers can easily access appropriate services.
Overemphasising the caregiver from a co-worker’s perspective can lead to care burdens, which are likely gendered and class-specific (Kodate and Timonen, Reference Kodate and Timonen2017). Individuals with lower socio-economic status or ethnic minorities tend to prefer financial compensation for informal caregiving over payment for formal care services (Theobald, Reference Theobald2012). Therefore, financial compensation must be evaluated and appropriately regulated to prevent potential negative outcomes. This could include imposing specific circumstantial qualifications for receiving compensation, similar to those in Sweden and South Korea, limiting the hours covered by cash-for-care payments. Implementing an eligibility assessment process for providing financial compensation and introducing shorter benefit reconsideration cycles, as practised in Sweden, would allow for a better understanding of the situation regarding informal caregivers.
Since informal caregiving can have a negative impact on career continuity, strengthening the legal rights to care leave and flexible work arrangements is important for protecting the caregiver’s reconciliation of employment and informal care (Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011). The form can be varied. Nevertheless, the rights should be clearly stated and recognised in the work environment. The burden of informal care can be attributed to perceiving informal caregivers as co-workers (Schneider et al., Reference Schneider, Sundström, Johannson, Tortosa, Gori, Fernández and Wittenberg2016). However, it can also be increased when the coverage and accessibility of formal care are limited (Kodate and Timonen, Reference Kodate and Timonen2017). Ultimately, reinforcing formal care services would alleviate the burden and help ensure voluntariness in informal caregiving.
Conclusions
This study examined the impact of care regimes in South Korea, the United Kingdom, and Sweden on the roles of and support policies for informal caregivers of older adults by identifying the roles assigned to informal caregivers in each country and comparing the corresponding support policies. Using a comparative case study method, the research analysed the selected countries across four dimensions: the role of informal caregivers, improving physical and mental well-being, compensation and recognition, and employment and care reconciliation. A diverse range of multilingual sources was utilised to integrate diverse perspectives and enhance the accuracy and validity of the analysis. The study found that the roles assigned to informal caregivers vary across care regimes, significantly influencing the design and implementation of support policies.
In South Korea, a strong familistic culture primarily views caregivers as resources; yet, to alleviate the resulting high caregiving burden, support as co-clients is gradually expanding. Nonetheless, well-being support policies remain limited, as they primarily focus on high-need groups, and users must contact institutions directly for respite care, limiting accessibility. Aiming to prevent excessive use, financial support policies impose stricter eligibility criteria than in the United Kingdom, which assigns caregivers the role of co-worker. Employment-care reconciliation policies exist, but workplace environments often make their utilisation challenging.
The United Kingdom assigns informal caregivers both co-worker and co-client roles. Accordingly, it implements well-being improvement policies while also regulating financial support policies. Still, these regulations on financial assistance are relatively more lenient compared to those in other countries, and various financial support programmes are available. In addition, policies supporting the reconciliation of employment and informal caregiving have been actively expanding in recent years.
Sweden considers informal caregivers as substitutes for formal care while also recognising them as co-clients. Support for improving informal caregivers’ physical and mental well-being is actively promoted. On the other hand, financial support and employment-care reconciliation policies are highly restrictive, with strict eligibility criteria.
Despite these differences, all three countries acknowledge the limitations of existing support policies and adjust their systems through international policy learning. This has led to a shared emphasis on informal caregivers’ physical and mental well-being, as well as the establishment of financial support and employment-care reconciliation frameworks. Even so, as each country defines informal caregivers differently, policy direction and support levels vary accordingly, highlighting the need for policy evaluations that consider care regime typologies.
Based on these findings, support policies for informal caregivers of older adults should prioritise meeting caregivers’ needs and improving their quality of life. Therefore, a comprehensive quality control system is essential, ensuring that local authorities not only assess needs but also provide clear information and monitor policies. Moreover, standardising well-being support activities and simplifying access to respite care would enhance overall support. However, overemphasising caregivers as co-workers risks creating gendered and class-specific burdens. Thus, financial aid must be regulated to prevent unintended consequences, with clear eligibility criteria, structured eligibility assessments, and periodic benefit reviews. In addition, strengthening care leave and flexible work rights is key to balancing employment and caregiving. Finally, expanding formal care services would further reduce burdens and ensure caregiving remains voluntary.
Before designing such policies, it is important to understand the care regime of each country and the roles of informal caregivers within these frameworks. Based on the findings, the United Kingdom adopts a mixed perspective, viewing informal caregivers both as co-workers and co-clients. This dual perspective leans towards financial compensation over enhancing the well-being of informal caregivers, indicating that efforts to reduce caregiving burdens may be less emphasised.
For countries that perceive informal caregivers as both co-workers and co-clients, it is important to recognise the potential conflict between expecting them to provide care and addressing their caregiving burdens. Policymaking should prioritise a co-client perspective and simultaneously address the needs of informal caregivers by supporting their co-worker role. This approach could ensure that informal caregivers are regarded as labour resources and individuals whose well-being is safeguarded.
Likewise, in South Korea and Sweden, both of which hold a dual perspective on informal caregivers, efforts to actively support informal caregivers as co-clients have started relatively recently. This is due to South Korea’s strong tradition of perceiving informal caregivers as a resource and Sweden’s long-standing approach of meeting LTC needs primarily through formal caregiving. When multiple roles for informal caregivers are combined, meeting their complex needs can become increasingly challenging. Therefore, designing comprehensive support policies and thoroughly evaluating the outcomes is essential.
The following limitations of the study highlight the challenges of applying the care regimes framework and the need for more detailed analyses of informal caregiver support policies across diverse contexts. The study may be limited by the use of the care regime framework, as it risks oversimplifying countries into fixed categories. Rigid typologies may neglect the cultural and institutional complexities in caregiving policies. Future research should address these complexities for a more comprehensive understanding. By incorporating a wider range of countries, it would be possible to explore the cultural and institutional complexities within the same care regime and gain a deeper understanding of the diversity in informal caregiver support policies.
The study emphasises the need for detailed analysis of caregiver support policies, as prior research has focused mainly on overviews (Courtin et al., Reference Courtin, Jemiai and Mossialos2014). Through this study, it was identified that decentralisation in Sweden and the United Kingdom has led to regionally diverse informal caregiver support policies, highlighting the importance of examining the specific content and level of these policies in each locality. Moreover, further research should explore a broader range of countries, assess the outcomes and effectiveness of various support policies, and identify appropriate financial support levels to avoid adverse impacts.
This study compares and systematically analyses informal caregiver support policies in South Korea, the United Kingdom, and Sweden, addressing the existing gap in cross-national policy comparisons. While previous research has focused on examining changes in caregiving support policies within individual countries (Da Roit and Le Bihan, Reference Da Roit and Le Bihan2010; Colombo et al., Reference Colombo, Llena-Nozal, Mercier and Tjadens2011; Courtin et al., Reference Courtin, Jemiai and Mossialos2014; Zigante, Reference Zigante2018; Rocard and Llena-Nozal, Reference Rocard and Llena-Nozal2022; Wieczorek et al., Reference Wieczorek, Evers, Kocot, Sowada and Pavlova2022), this study provides new policy insights by investigating how different care regimes influence the roles and burdens of informal caregivers of older adults.
In addition, this study expands the applicability of the care regimes framework by applying it to the analysis of support policies for informal caregivers of older adults. While previous research has primarily used the care regimes framework to explain welfare state typologies (Bartha and Zentai, Reference Bartha and Zentai2020; Lightman, Reference Lightman2021; Lightman, Reference Lightman2024), this study applies it at the policy level to examine the specific mechanisms through which different welfare models shape support for informal caregivers. By doing so, this study offers a more refined comparison of how national welfare models affect informal caregivers of older adults and the policy responses that arise from these structures.
Open access
