EAPs/MAP2030 Workshop on the Future of Family Support for Older People
London 15 May 2009
Policy and care – Summary
National and local policies share the care for elderly and disabled people between welfare and
family differently, according to customs, political programmes and budget restraints. The session
was focused to highlight those differences, as well to discuss the outcome of some case-study.
The first group of four paper can be encompassed among the
Comparative researches on the ‘care regimes’ in Europe
The Survey of Health Ageing and Retirement in Europe (SHARE), now at its second wave, allows
interesting comparisons between several European countries that are almost different in the way in
which the problems of caring for old people are solved. The four papers deal with different aspects
of this issue, but their common purpose is to prove whether different ‘care regimes’ do exist in
Europe.
Martina Brandt and Christian Deindl, in their paper “Intergenerational support and welfare state
and Eastern and Western Societies” try to answer this question by testing the ‘specialisation thesis’
about the cares provided by the family, the market and the state in front of the more vs. less
intensive help to old people. Their basic assumption is that helping them in sporadic but vital
activities like housekeeping and paperwork (help) is as much important as assuring them intensive
support in case of need (care). Also financial transfers from children to parents are considered part
of the less intensive aid.
By comparing 13 countries through the dataset of SHARE 2nd wave and using multilevel models,
they conclude saying that social policy is an important factor to explain intergenerational support.
“The more intensive and regular support activities can be transferred to public providers, the more
voluntary and less intensive help elderly parents in need receive from their children.”. So that, in a
geopolitical comparison, “In countries with little public support the family takes over the more
intensive obligatory tasks and vital monetary transfers – but this takes its toll on sporadic and
voluntary forms of help and financial gifts.”. Though there is neither crowding-in nor crowding-out,
private transfers modify according to public transfers, and vice versa. Nevertheless, a specialisation
by actors in supporting old people sets up.
In the discussion, the welfare state indicators and the perception of old people’s health have been
pointed out as important issues to be further analysed. Also the impact of legal and social
obligations and local culture, as well as the different conditions in the settling and housing of old
people in relation to where their children live should be taken into account. Anyway, help is more
sporadic in Northern Countries compared to the Southern ones.
Klaus Haberkern and Mark Szydlik, from the University of Zurich, in their paper “Care of
parents and care Regimes” also compared 11 European countries by logistic models run with the
SHARE 2nd wave dataset.
1
Care is normally divided between formal (institutions) and in informal (family and friends). Do the
family structure and the context influence the type of care provision? The contrast between the
family-based care regimes in Southern and Central Europe and the service-based care regimes in
Northern welfare states appears again in quantifying the intergenerational aid. Social norms or even
the law oblige children to support their parents in the former ones, while the professional home-care
services enable adult children to pursue their personal plans beyond care obligations in the latter
ones. Also the family structure and the individual characteristics explain differences in caring. The
authors found a trade-off between professional care service and informal care provided by children.
In the discussion, some technical and substantial problems have been raised. In particular the
endogeneity of some variables and the consideration of the differences between countries in the
level and kind of institutional aid. If possible, the combination of different types of care should be
analysed as well, stressing that throughout Europe institutional residence is quite low.
Adriaan Kalwij, Giacomo Pasini, and Mingqin Wu, in their paper “Homecare for Older People:
Family, Friends and State” introduced another important actor in the elderly care: ‘friends’, i.e.
relatives different from the old person’s children, his/her personal friends, and the neighbours.
This kind of network has proved fundamental, especially in small communities and when children
are not present or live far away from their old parents. The maintenance of this network is one of
the main reasons to maintain old people in their habitat, where it has been formed and personal
contacts are easier.
The authors tested a theoretical model on the total demand for homecare by the elderly and its
allocation to all the potential care-givers by using the 1st wave of SHARE. They found that friends
and relatives are potential important suppliers of informal care as they provide as much homecare as
children. They also found a sort of balancing between formal and informal care, but the second one
is shared between children and friends. This too balances following the old parents’ needs and the
children’s availability.
In the discussion: accounting for the dimension and type of the community could help in
understanding whether there are differences in the number and role of friends. Sociability
(participation in social events/clubs) could also be disentangled in order to account for social
participation as well (maybe affects networks and therefore willingness to help from friends?).
Unfortunately, in SHARE it is not possible to distinguish between hours spent by friends/family
doing different tasks; it would be desirable to better understand what kind of help friends provide
(personal care, practical, paper work).
Małgorzata Kalbarczyk and Anna Nicińska, from the University of Warsaw, ask “Who gives
whom?”, trying to go in depth into the altruistic relations within the family.
They recall the different theories that have been proposed to explain altruism, with special accent to
the altruism between children and parents. In particular, they wanted to test the socio-biological
theory that treats the kinship altruism as an evolution mechanism of genetic fit improvement, i.e. a
rational behaviour not needing to be connected with any emotional affects. Each individual chooses
such behaviour that would maximize probability of own genes transmission: kinship altruism is part
of such a behaviour and parents-to-children financial and non-financial transfers substantiate
kinship altruism.
The authors used the 2nd SHARE dataset in statistical and econometric models to prove whether the
amount of financial and non-financial transfers from the 50+ year-old parents to their children
depend from the fact that their children are either biological or non-biological (adopted).
The basic descriptive statistics do not provide confirmation for the different relations within the
families with all children being biological and the families with adopted children. The results from
the econometric models show that the presence of an adopted child is not statistically significant for
2
the probability of giving financial and non-financial transfers to children. The variable was also
insignificant as far as the amount of given and received financial transfers.
However, the definition and behaviour of non-biological children has been discussed regarding the
possible presence of their natural parents. Also the mixing of biological and non-biological children
in the same family could affect the resulting indifference in parents’ financial transfers.
A second group of papers dealt with
Case studies and good practices
Four researchers from the Institute of gerontology and intergenerational relations in Ljubljana, here
represented by Ivana Vusilović, presented the situation of elderly care in Slovenia by reporting four
good practices adopted to provide short courses to train family members in better understanding and
communicating with the old family members (“Family Care for the Elderly in Slovenia”).
The surprising result of their informal inquiry was that three in four old people would want to go to
the hospice when feeling incapable of caring for themselves. In fact, only 5% of the 65+ yrs old
stay there. The reason of the high preference for going to the hospice is that they are of good
quality, while alternatives lack to old people to stay at home. On the other side, low resources
prevent the Slovenian state to meet such a demand. Programmes to enhance perception of older
people, solidarity and intergenerational solidarity have been recently launched.
Marjolein Broese van Groenou and Theo van Tilburg, from the VU University of Amsterdam,
presented the paper “Care potential of the Personal Networks”. Networks are an important way to
stay embedded in the society. Networks are composed of family members, neighbours and friends.
Older people are nowadays experiencing important changes: families are smaller and more
verticalised; older people are more educated and have access to better healthcare; moreover, they
have a greater number of available older people to spend time with (ageing is a mass phenomenon).
Looking at longitudinal data from the Netherlands, it appears that over time older people tend to
have more and more frequent relationships, in particular with people other than family members.
The increasing number of relationships is accompanied by an increasing care potential as well, i.e.
an increasing number of networks members with whom older people have at least monthly contact
and some instrumental or emotional support exchanged.
In the discussion, it was pointed out that, despite the theoretical strength of the network, it would be
valuable to assess whether the potential care turns into real care. Moreover, cohort effect, age,
health and number of children should be all controlled for.
Four researchers from the Research Institute for Economic of Ageing in Vienna, here represented
by Birgit Trukeschitz and Richard Mühlmann, investigated on the workplace characteristics and
workplace behaviour of informal caregivers in their paper “Effect of Informal Elder Care on
Workplace Behaviour”. The aim was to prove their work commitment according to the type of care
given. The analysis is based on a recent survey on informal care-givers vs. a control group.
Analysis’ results show that caring decreases the probability of changing or quitting job. Moreover,
although demanding, caring does not seem to be source of stress in the workplace.
Some questions have been asked in the discussion. Could people not be stressed because those who
are more likely to engage in care-giving activities are generally the ones who are more relaxed?
Could care-giving make the work less stressful (in comparison)? Are there any self-selection
biases? From the analysis, it appears that money and income are not significant variables. A better
overview on care allowances and social protection in Austria was then envisaged.
The paper “Matching Expectations: Care Supply to Older Persons by Immigrants in Madrid, Spain”
by Vicente Rodriguez, Silvia Marcu, Eva Martin Coppola, Santiago Ramos, Fermina Rojo,
Gloria Fernández-Mayoralas, and Raúl Lardies could not been presented but in summary.
3
It stresses the importance of the care giving for the elderly by immigrants. Family transitions and
the good economic conditions have led families living in the Madrid area to entrust elderly care to
immigrants as the common solution to allow women to work. Immigrants are ready to undertake
these jobs.
Near one hundred in-depth interviews have been conducted among immigrants according to their
gender and nationality, family, the type of care given, the situation of the person looking for a caregiver, the family ties, the workload, or the economic conditions and the relationships with NGOs
and local government officers.
Some final remarks
Important differences in facing elderly care throughout Europe are undeniable. The dissimilar ways
in which the family ties are realized along the entire life-cycle, together with the different levels and
modes in self- and other- respect (especially towards relatives) justifies the differences in informal
care by children: social norms and social controls then make it more or less diffused in the society.
On the other side, public and private efficiency in solving the emergency and heavy-burden
problems of old people, together with the welfare spending for elderly care, trims the amount of
formal care. It seems quite acceptable that informal help is more for the daily, trivial problems,
while formal care is more for the emergency and intensive, professional and long-lasting support.
Therefore, help and care should be more complementary than competitive, and no trade-off between
them should happen until the elderly health worsens. However, the thresholds dividing them is so
different in different contexts and welfare systems that the same kind of cares is provided here by
the family, there by services. Comparisons are hindered consequently, even at regional level, if
context and latent variables are not considered.
The operative consequence of those differences is that where the elderly care largely depends on the
old person’s children, relatives and neighbours, in case of important or long-lasting needs elderly
people with few relatives and poor social network risk to become careless. In perspective, we
should wander whether:
a) the present financial and economic crisis is reducing the welfare capabilities in caring for old
people, so that the share of care loaded on families and private resources is enlarging
everywhere, with worrying consequences on the living condition of the increasing old
population;
b) the reducing number of children and siblings in several European countries for the cohorts now
going to attain old age could reduce their nearest network, so enlarging their demand for
services and, in case of a lacking supply, widening the abandonment area;
c) the increasing social network managed through computers (email, Face-book, etc.), while
enlarging the contacts, makes them less effective in case of need, so that old people in the future
may found themselves with a possibly large virtual network but with few people able to actually
intervene to help them. On the other side, however, computers, if adequately equipped and
remote controlled, can be valuable tools in aiding old people in facing their life and health
problems.
Giuseppe Gesano, IRPPS-CNR, Rome (Italy)
Giorgio Di Gessa, CPS, London (UK)
4