Gender composition and care-giving to ageing parents

Informal care, in the context of parental care-giving, is seen as a way of preventing institutionalisation and enabling ageing parents to remain at home by providing them with the necessary support, such as meal preparation, housekeeping, financial management and the continuous supervision of parents (Horowitz, Reference Horowitz1985; European Commission et al., 2018).

A child's gender is a crucial determinant of informal care-giving to ageing parents. Continuous economic change and demographic change have occurred over the past few decades (Maume, Reference Maume2016), and progress has been made towards gender equality, which compels men to do more family care work. However, a significant amount of recent research has documented that daughters remain the primary parental care-givers compared with sons (Ingersoll-Dayton et al., Reference Ingersoll-Dayton, Neal, Ha and Hammer2003; Connidis and Kemp, Reference Connidis and Kemp2008; Kalmijn and Saraceno, Reference Kalmijn and Saraceno2008; Ulmanen and Szebehely, Reference Ulmanen and Szebehely2015; Luppi and Nazio, Reference Luppi and Nazio2019; Vergauwen and Mortelmans, Reference Vergauwen and Mortelmans2021). They also spend more time on informal care-giving to their ageing parents than their brothers do (Gerstel and Gallagher, Reference Gerstel and Gallagher2001; Grigoryeva, Reference Grigoryeva2017).

A number of extensive studies on the effect of the gender composition of children on parent care by Matthews and colleagues documented that sibling groups that include only sisters are characterised by frequent contact and by a fairer sharing of filial responsibilities. Sisters support each other during the care-giving process (Matthews and Rosner, Reference Matthews and Rosner1988). On the other hand, examining sibling groups with only one sister revealed that daughters have more filial responsibilities related to parent care than sons do. It is also noted that brothers are more likely to ask for formal help compared with daughters (Matthews, Reference Matthews1995). Finally, Matthews and Heidorn (Reference Matthews and Heidorn1998) examined brother-only sibling groups and found that they expected their parents to contact them when they needed assistance, rather than offering help voluntarily. In these sibling groups, daughters-in-law provided hands-on care more often than sons did. In addition, brothers did not expect to meet all of their parents’ needs and combined informal care with formal care (Matthews and Heidorn, Reference Matthews and Heidorn1998). Similarly to Matthews and colleagues, Coward and Dwyer (Reference Coward and Dwyer1990) investigated three gender compositions of siblings – only children, one-gender-only siblings and mixed-gender siblings – and found that daughters tended to care more intensively in sibling groups, including in a mix of sisters and brothers. The intensity of care-giving was similar among only children compared to one-gender-only sibling groups.

More recent studies have continued to document the prominent care-giving role of daughters among children (Hequembourg and Brallier, Reference Hequembourg and Brallier2005; Connidis and Kemp, Reference Connidis and Kemp2008; Brandt, Reference Brandt2013; Grigoryeva, Reference Grigoryeva2017; Vergauwen and Mortelmans, Reference Vergauwen and Mortelmans2021). Attitudes and perceptions towards care-giving also differ between daughters and sons. Daughters not only provide more care than sons do but also their care-giving is more elastic than sons’ care-giving with regards to individual sources, limitations and parents’ characteristics (Grigoryeva, Reference Grigoryeva2017). Sons are more likely to view themselves as supervising parental care with the goal of maintaining their parents’ independence, and thus, they more often delegate the actual provision of care to someone else. Sons also tend to wait for their parents to request assistance, whereas daughters are more likely to monitor their parents consistently and to give them advice (Matthews, Reference Matthews2002; Hequembourg and Brallier, Reference Hequembourg and Brallier2005).

Social scientists have offered several explanations for the gender differences in adult children's care provisions. Among the most important explanations is women's historical caretaking role, gender identity formation and socialisation theory. The perceptions of and motivations for care-giving differ between men and women because women are taught to take on more care responsibilities, whereas men are expected to give less direct informal care (Kahn et al., Reference Kahn, McGill and Bianchi2011). As young children, women are often socialised to specialise in and to perform traditional ‘feminine’ tasks, which indicates socialisation theory. It is important to note that gender differences in care-giving do not necessarily occur due to a lack of filial responsibility among sons. Rather, they mostly arise from the cultural definition of gender-appropriate behaviour (Brody, Reference Brody1981; Allen, Reference Allen1994; Brewer, Reference Brewer2001). Kruijswijk et al. (Reference Kruijswijk, Da Roit and Hoogenboom2015) touched upon this topic from a different perspective and documented that care-giving has a multifaceted nature and that men contribute to the elasticity and stability of care arrangements by supporting female care-givers.

Some studies (Gerstel, Reference Gerstel2000; Rubinstein, Reference Rubinstein2001; Sarkisian and Gerstel, Reference Sarkisian and Gerstel2004), on the other hand, focused on Giddens’ (Reference Giddens1984) ‘structuration theory’, where he focused on the duality of the structures. Briefly, structuration theory acknowledges ‘the interaction of meaning, standards and values, and power and posits a dynamic relationship between these different facets of society’ (Gibbs, Reference Gibbs2017). Looking from the care-giving perspective, it is described that structural explanations for the gender gaps in family care often highlight the limitations and opportunities that the various employment experiences of women and men generate. Due to better job and career prospects, men often have more lucrative and time-consuming or satisfying jobs than women do. Hence, employment pulls or pushes men away from care responsibilities (Gerson, Reference Gerson1993; Sarkisian and Gerstel, Reference Sarkisian and Gerstel2004).

In addition to these theories, several researchers (Matthews, Reference Matthews, Kramer and Thompson2001; Pillemer and Suitor, Reference Pillemer and Suitor2006; Haberkern and Szydlik, Reference Haberkern and Szydlik2010; Pillemer and Suitor, Reference Pillemer and Suitor2013; Grigoryeva, Reference Grigoryeva2017) have focused on the attitudes and demands of parents and adult children. Matthews (Reference Matthews, Kramer and Thompson2001) demonstrated that parents are more likely to expect care from their daughters than from their sons. Research by Grigoryeva (Reference Grigoryeva2017: 136) documented that ‘caregiving to older parents varies not only by an adult child's own gender, but also by the gender of the siblings with whom caregiving is shared and by the gender of the parent to whom care is provided’. More specifically, she showed that daughters provide more care hours to mothers than to fathers, but they also provide more care hours than sons do regardless of the parent's gender. The number of care services is at its largest in daughter-to-mother dyads, followed by daughter-to-father dyads.

Taken together, the findings on siblings’ gender composition indicate that daughters are more involved in parental care compared with sons, although families and the labour division in families have evolved in a more egalitarian direction (Lachance-Grzela and Bouchard, Reference Lachance-Grzela and Bouchard2010). In the next section, we address the literature on the determinants of receiving informal and formal care, as well as alternative informal care networks that ageing parents can have.

Effects of children's characteristics on informal care provision

Siblings’ characteristics affect the amount of informal care that children give to their parents. The number of children is one of these characteristics. A higher number of siblings tends to increase the total amount of help provided to older parents (Wolf et al., Reference Wolf, Freedman and Soldo1997; Szinovacz and Davey, Reference Szinovacz and Davey2007). Consequently, these children each spend fewer hours caring for their parents than children with fewer or no siblings do (Igel et al., Reference Igel, Brandt, Haberkern and Szydlik2009; Szinovacz and Davey, Reference Szinovacz and Davey2013). Adult children adapt their care provision to the care that their siblings provide. Hence, the larger the sibling group, the greater the potential for informal care arrangements (Szinovacz and Davey, Reference Szinovacz and Davey2007).

The partner status of children is another important determinant of informal care-giving (Tolkacheva et al., Reference Tolkacheva, Broese van Groenou and van Tilburg2010; Leopold et al., Reference Leopold, Raab and Engelhardt2014). Although some studies have found no effect between having a partner and providing care (Wolf et al., Reference Wolf, Freedman and Soldo1997), many studies have demonstrated that children with partners devote less of their time as care-givers, whereas non-partnered children are more often involved in care-giving (Dautzenberg et al., Reference Dautzenberg, Diederiks, Philipsen, Stevens, Tan and Vernooij-Dassen2000; Pezzin et al., Reference Pezzin, Pollak and Schone2008; Haberkern and Szydlik, Reference Haberkern and Szydlik2010; Tolkacheva et al., Reference Tolkacheva, Broese van Groenou and van Tilburg2010; Leopold et al., Reference Leopold, Raab and Engelhardt2014). Looking from the gender perspective, Wiemers and Bianchi (Reference Wiemers and Bianchi2015) reported that because married daughters have more family to take care of due to the inclusion of in-laws, unmarried daughters are the ones who most likely take care of their parents.

Contact frequency and proximity are other crucial determinants that influence the informal care that adult children provide. Having frequent contact and living close to parents increase the opportunity to help them with their daily activities (Haberkern and Szydlik, Reference Haberkern and Szydlik2010). Regarding gender differences and proximity, many studies have demonstrated that when sons and daughters live at equal distance, daughters have more contact with their parents than sons do (Matthews and Heidorn, Reference Matthews and Heidorn1998; Campbell and Martin-Matthews, Reference Campbell and Martin-Matthews2003; Bolin et al., Reference Bolin, Lindgren and Lundborg2008; Szinovacz and Davey, Reference Szinovacz and Davey2007). Spitze and Logan (Reference Spitze and Logan1990) demonstrated that parents with two sons have less contact with their children than parents with one son and one daughter do. They also found that parents with two daughters have more contact compared with parents who have one daughter and one son. One reason for this trend is that daughters develop closer emotional bonds with their parents, especially with mothers, than sons do, leading to greater levels of contact and helping behaviour from daughters (Spitze and Logan, Reference Spitze and Logan1990; Grigoryeva, Reference Grigoryeva2017).

Adult children's employment status also affects the informal care they provide to their parents. Children who have competing demands from their job environments in terms of working hours have less time to enter the care-giving role (Leopold et al., Reference Leopold, Raab and Engelhardt2014). With respect to gender differences in the relationship between work and care-giving, women are more likely than men are to make accommodations in their work schedules (e.g. reducing work hours, taking time off), and they might work part-time to facilitate care-giving for their ageing parents (Starrels et al., Reference Starrels, Ingersoll-Dayton, Neal and Yamada1995; Plantenga, Reference Plantenga2002).

Depending on the need and intensity of formal care, informal care can be complementary or can serve as an alternative to formal care. Although mostly adult children provide the majority of the informal care that their parents receive, other informal care sources also exist. They are briefly covered in the next subsection.

Alternative informal care networks

Besides the care that adult children provide, partner care and the care that in-laws provide are the other most important sources of care for the ageing parents. Partners are often the first to take on care-giving responsibilities, especially in couple-only households (Pinquart and Sörensen, Reference Pinquart and Sörensen2011; Sundström et al., Reference Sundström, Jegermalm, Abellán, Ayala, Pérez, Pujol and Souto2018). Although a few studies indicate that the hours dedicated to partner care differ between women and men only when the level of partner care need increases (Glauber, Reference Glauber2017; Langner and Furstenberg, Reference Langner and Furstenberg2018), most studies that cover partner care suggest that male partners receive help from alternative care sources (Allen, Reference Allen1994) as well as formal care sources (Bertogg and Strauss, Reference Bertogg and Strauss2020) when giving aid to their partners. Meanwhile, female partners provide most of the care that partners require. Some other researchers highlighted that the demography, household structure and availability of different social services in countries are important determinants when explaining the care-giving behaviour of men and women (Abellan et al., Reference Abellan, Perez, Pujol, Sundstrom, Jegermalm and Malmberg2017; Sundström et al., Reference Sundström, Jegermalm, Abellán, Ayala, Pérez, Pujol and Souto2018).

Children-in-law, in co-operation with children, might play an important role in informal care-giving if a parent does not have a healthy partner who can look after him or her. Qualitative research by Matthews and Rosner (Reference Matthews and Rosner1988) divided in-law care into three postures: antagonism, indifference and active support. Antagonism results in no help from in-laws and even limits or stops help from adult children. In the indifference posture, in-laws show no intention to provide any informal care to their parents-in-law. However, they also do not influence the help that their partners give. Finally, active support can be seen as a form of direct support in which the daughter-in-law or son-in-law provides informal care and functions as a source of indirect support by facilitating the partner's involvement in providing parent care.

During times of active support, sons-in-law are willing to substitute for their wives, although this is rare. In contrast, daughters-in-law participate in care-giving activities more often compared with sons-in-law (Johnson and Wiener, Reference Johnson and Wiener2006; Henz, Reference Henz2009; Grundy and Read, Reference Grundy and Read2012). For example, daughters-in-law provide more hands-on care, such as meal preparation and shopping (Matthews and Heidorn, Reference Matthews and Heidorn1998), and they even perceive themselves as good assistants for daughters and as one of their parents-in-law's primary care-givers, although daughters take on more responsibility (Merrill, Reference Merrill1993).

Although family is presumed to be the most appropriate source of care, some old people might receive care from a variety of other informal care sources, such as relatives, friends, neighbours and other non-kin people (LaPierre and Keating, Reference LaPierre and Keating2013; Kalwij et al., Reference Kalwij, Pasini and Wu2014). These (non-)relatives can play a key preventative role in reducing the need for formal care (Nocon and Pearson, Reference Nocon and Pearson2000), and care-giving from these sources may occur in various ways (Croog et al., Reference Croog, Lipson and Levine1972; Himes and Reidy, Reference Himes and Reidy2000; Nocon and Pearson, Reference Nocon and Pearson2000; Barker, Reference Barker2002), such as sharing a meal and picking up groceries (Barker, Reference Barker2002). Additionally, other (non-)relatives are usually similar-age peers, not married, and unemployed or retired (Himes and Reidy, Reference Himes and Reidy2000). LaPierre and Keating (Reference LaPierre and Keating2013) differentiated friends and neighbours as alternative care sources. According to their study, friends have a higher tendency than neighbours to assist in various care tasks, such as personal care, bills and banking, and transportation. Meanwhile, neighbours were more likely to assist in tasks such as home maintenance, and their assistance encompassed only a limited number of tasks compared with friends.

Together, these studies support the notion that spousal care and care from adult children, followed by care from in-laws and other (non-)relatives, constitute the most important sources of informal care for ageing people. The most obvious pattern in the literature is that gender plays an important role in informal care and in the need for formal care.

Determinants of receiving formal care

Demographic transitions not only resulted in longer lifespans of individuals but also increased the need for long-term care for the older population. Previous research on why and the extent to which an ageing parent receives formal care services demonstrated that various reasons exist for why a parent receives more formal care than informal care. The first one is a country's cultural norms and welfare state provisions. Studies have mostly demonstrated that a family member often takes on necessary care tasks in Mediterranean and Eastern European countries, whereas outsourcing care for the older parents mostly takes place in Western Europe and Scandinavia (Damiani et al., Reference Damiani, Farelli, Anselmi, Sicuro, Solipaca, Burgio, Iezzi and Ricciardi2011; Bertogg and Strauss, Reference Bertogg and Strauss2020). The provisions of the welfare state also have an effect on the care composition given to the old people. Motel-Klingebiel et al. (Reference Motel-Klingebiel, Tesch-Roemer and Von Kondratowitz2005) showed that the ageing populations in countries where welfare state provisions are more comprehensive and accessible often receive a combination of informal and formal care. The second determinant is the level of care need of older parents. Parents who have serious functional limitations or experience degenerative conditions tend to receive more professional help (Broese van Groenou et al., Reference Broese van Groenou, Glaser, Tomassini and Jacobs2006; Kjær and Siren, Reference Kjær and Siren2020). The third explanation highlights well-documented individual predictors of the intergenerational solidarity of both parents and children. Parents who do not receive informal care tend to substitute informal care with formal care, or they use a combination of the two. For example, research demonstrates that parents with a high socio-economic status have less contact with their children and are better able to purchase private help. They therefore receive formal care more often than they do informal care (Broese van Groenou et al., Reference Broese van Groenou, Glaser, Tomassini and Jacobs2006; Kalmijn, Reference Kalmijn, Treas, Scott and Richards2014; Ulmanen and Szebehely, Reference Ulmanen and Szebehely2015; Kjær and Siren, Reference Kjær and Siren2020). In addition, the aforementioned predictors, such as employment, proximity, gender and family sizes, are indicated as formal care determinants of ageing parents.

Hypotheses

The gendered nature of the care-giving that adult children provide to their parents has been studied extensively. We take this a step further and examine whether gender composition influences parental care, as well as the various care networks utilised. To answer our research questions, we established the following hypotheses:

1. H1 Parents who have more sons tend to receive more formal care.

2. H2 Parents who have daughters are more likely to receive informal care from children than parents with sons do.

3. H3 Parents who have more sons are more likely to use their children-in-law as an informal care source.

4. H4 Parents who have sons have a higher tendency to use more other (non-)relatives as care sources.

Dependent variable

We established four hypotheses to answer our research questions. To test these hypotheses, we constructed two outcome variables: care type and care network. We used the care type variable for examining H1; it indicates whether respondents received only informal care, a combination of formal and informal care, only formal care or no care at all. Respondents received informal care if they indicated getting personal care or help with household chores at least once per month during the 12 months preceding the Wave 6 interviews. Respondents received formal care if they indicated getting professional or paid services from a professional care provider at least once per month in the same period.

To construct our second outcome variable, care network, addressing H2, H3 and H4, we first identified the particular sources of informal care (e.g. partners, children, other family members, friends, colleagues, etc.) that parents received (for personal care or help with household chores) from inside or outside the household. In addition, we considered parents’ use of formal care (professional personal care, paid help with household chores and stays at a nursing home). Subsequently, we sorted the informal care sources based on the frequency of care-giving to distinguish primary and secondary care-givers. Using a latent class analysis (LCA), we found five prominent care sources that parents use: ‘partner care’, ‘children’, ‘children-in-law’, ‘other (non-)relatives’ and ‘only formal care’. The LCA yielded a best-fitting model of five of the presented classes for those receiving informal or formal care. Although the LCA suggests a separate class comprising formal care only, combinations between informal care sources and formal care render a great deal of infrequent categories (about 25% of each informal care source is combined with formal care). For the simplicity and feasibility of the multivariate analysis, this level of detail is not reflected in the dependent variable. In addition, from the analysis, it is clear that the categories of secondary care-givers are mostly the same as those for the primary care-givers, leading to no substantial patterns of a different primary and secondary care source. To cover all respondents, we added a separate category consisting of those receiving ‘no care at all’ in addition to the five care sources identified using LCA, leading to a dependent variable of six categories.

Independent variables

We present the independent variables in three groups: variable of interest, children characteristics and parental characteristics.

Since the main focus of this study is to understand how the gender composition of siblings influences the care type and care network of parents, this article's variable of interest is gender composition of children. This variable has seven categories: (1) daughter as only child, (2) son as only child, (3) as many daughters as sons, (4) more than half of the siblings are daughters, (5) more than half of the siblings are sons, (6) only daughters, and (7) only sons. With the help of this categorical variable, we could observe whether having more or less daughters or sons has an influence on the care type and care network of parents.

Before introducing children characteristics, it is crucial to highlight that all individual characteristics are averaged over the total number of children. Numeric characteristics yield an average score (e.g. contact frequency and proximity), whereas dichotomous information (e.g. employed or not) translates into proportions. The children characteristics Footnote ¹ covered in this article are education (proportion highly educated), partnership status (proportion having a partner), employment status (proportion employed) and parental status (proportion having a child).Footnote ² Further, we averaged contact frequency per year between children and parents, starting from the following categorisation: (1) 365 days, (2) 156 days, (3) 52 days, (4) 24 days, (5) 12 days, (6) 6 days, and (7) 0 days. The averaged geographic parent–child proximity was calculated from the individual categorisation encompassing (1) 0 kilometres (km) (which corresponds to child(ren) living in the same building or less than 1 km away from their parents), (2) 3 km, (3) 15 km, (4) 63 km, (5) 300 km, and (6) 750 km. Financial helpFootnote ³ is introduced by dichotomies expressing whether children received gifts from or gave gifts to parents of at least €250 in the 12 months before the interview.

We included several parental characteristics in the analyses. Age, gender, education, partnership status, number of children and employment status provided the basic background information about the respondents. The number of limitations with activities of daily living (ADL), such as getting out of bed, buying groceries, bathing, and so on, is used as a measure of parental health. The ADL scale ranges from 0 (no limitations) to 6 (limited with respect to all activities). In addition, a binary variable reflects whether the parents were hospitalised in the 12 months preceding the interview or not: 1 indicates that the respondent stayed overnight in a hospital in the last 12 months and 0 indicates no hospitalisation. Another binary variable reflecting whether the parents were born in the country where the interview was held or not is also added. The proportion of biological children indicates what share of children are biological or not.