long-term care use and supply in europe: projections for germany ...

3. Determinants of use of formal and informal personal care by older
persons living at home: Evidence from Germany, the Netherlands
and Spain
Joanna Geerts, Federal Planning Bureau
Introduction
Population ageing is expected to substantially increase the number of care dependent older persons and,
consequently, the number of long-term care (LTC) users in future years. The impact of population
ageing on formal and informal care use is, however, likely to differ considerably across European
countries. Populations are, in fact, ageing to a different extent and at a different pace. Furthermore, LTC
is currently being organised and financed in very different ways and the extent to which older persons
rely on formal or informal carers varies widely between countries.
In making projections of future use of formal and informal care by older persons living at home, it is
important to discern the main factors affecting care utilisation. Whether older persons are relying on
formal or informal caregivers depends on individual level characteristics such as the level of care
dependency and the potential availability of informal care, but is also determined by societal and care
system level factors such as available supply and organisational characteristics of formal care services.
Given the huge variation across Europe in availability and allocation of care services, one can
reasonably expect there to be differences between countries not only in levels of formal and informal
care use, but also in how care use is related to older persons’ characteristics. For instance, in countries
with strong needs-based entitlements to LTC services one would expect use of formal care not only to be
higher, but also to be more strongly associated with disability and less related to potential availability of
informal care than in countries where access is means-tested and services are targeted at persons without
informal support.
This chapter analyses similarities and differences in determinants of informal and formal personal care
use in Germany, the Netherlands and Spain, each representative of a cluster of countries with a different
LTC system, as identified by Kraus et al. (2010) in work package (WP) 1 of the ANCIEN project. 7 The
main purpose of this study is to estimate probabilities of informal and formal care use by relevant
characteristics of older persons, which will be used in projections of future LTC care use by older people
(see Chapter 4). Using multivariate models, the probabilities of different categories of care use (no care,
informal care only, formal care only, formal and informal care) are linked to factors such as age, gender,
health problems and household composition of older persons. The analysis is based on data of the
Survey of Health, Ageing and Retirement in Europe (SHARE) and builds on WP 3 analyses of factors
determining care use in European countries (Jiménez-Martín, Vegas Sánchez, & Vilaplana Prieto, 2011;
Marcinkowska & Sowa, 2011), but adds to the previous findings in its focus on older persons (aged 65
and over) and on help with personal care tasks only. Help with household tasks has not been included in
the present analysis as comparability of household help data turned out to be limited (see section 3.2.2
below) and the LTC projections include help with personal care only.
The next section briefly reviews studies of the determinants of home care utilisation by older persons.
The aim of the analysis and the data, variables and method used, are discussed in section 3.2. Empirical
results for Germany, the Netherlands and Spain are described in section 3.3, which discusses
country-specific findings as well as similarities and differences between the three countries. The chapter
ends with a summary of the main findings.
3.1 Determinants of home care utilisation
Determinants of formal home care utilisation have been examined in numerous studies, predominantly
in the United States, but also in Europe (see Kadushin, 2004a for a review). The behavioural model of
health service use proposed by Andersen and colleagues (Andersen, 1995, 2008; Andersen & Newman,
7 An analysis of Poland, the representative country for the fourth cluster, was not possible due to data limitations.
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