Is the Availability of Informal Care Associated with a Lower Uptake in Formal Home Care? An Application to Personal Care in the Netherlands

Abstract

Context: Long-term care (LTC) costs within member countries of the Organisation for Economic Co-operation and Development (OECD) are rising steeply, thereby presenting a challenge to the financial sustainability of most LTC systems. A seemingly attractive policy measure is to decrease the use of (expensive) publicly financed LTC and to increase the provision of informal care. Objectives: This paper assesses how 1) the use of publicly financed LTC and 2) the uptake of entitled LTC care are related to the availability of informal care. Our study only considers personal care as it might be more easily replaced by informal care than other more complex types of care. Personal care includes tasks like bathing, toileting, dressing, and helping with eating. Methods: We have access to unique Dutch nationwide data from 2013, which contain information on care entitlement, care use, potential informal caregivers, and clients’ characteristics. Craggit regression analyses were used to analyse the data. Findings: Only 58% of the maximal amount of entitled hours for formal personal care was used. A lower uptake is observed when children moved out. Also, individuals with a healthy partner use about 19% less formal personal care than the average of 11.5 hours per month. Moreover, individuals with an unhealthy partner use about 7% more formal care. Limitations: We had access to data on availability of informal care and not on the actual informal care provided. Implications: Older individuals use less publicly financed personal care than expected based on their needs and the relatively low uptake of entitled care can partially be explained through informal care.