Analysing the importance of older people's resources for the use of home care in a cash-for-care scheme: evidence from Vienna

Abstract

Older people of lower socioeconomic status (SES) are disproportionately affected by chronic conditions, yet less able to compensate health limitations through use of formal long-term care (LTC) at home, a preferred type of care for most. Some, like older women and single people, are particularly vulnerable. Under the Austrian public cash-for-care scheme, which aims to incentivise care at home and empowerment of LTC users, this study analyses: (i) interdependencies between SES, gender and 'informal' or family care, and (ii) how these factors associate with the use of old age formal home care in Vienna. An adaptation of Arber and Ginn's theory is used to identify material resources (income), health resources (care needs) and informal caring resources (co-residence and/or availability of family care). Gender aspects are also considered as a persistent source of inequalities. Administrative and survey data, collected by public authorities between 2010 and 2012 in Vienna, serve to compare home care use in old age (60+) to other support forms (residential and informal care) using logistic regression analysis. Results show a pro-rich bias in home care use among single-living people, with high-income single people being less likely to move to a care home, while there are no significant income differences present for non-singles. Second, traditional gender roles are salient: female care recipients co-residing with a partner are more likely to use formal care than men, reflecting that men's traditional gender roles involve less unpaid care work than women's. In conclusion, in an urban setting, the Austrian cash-for-care scheme is likely to reinforce stratifications along gender and class, thus implementing the general policy objective of care at home, but more likely for those with higher income. A support mechanism promoting empowerment among all older people might contribute to unequal degrees of choice, especially for those with fewer resources to manage their way through a fragmented system of LTC delivery.

Older Persons’ Views on Using Cash‐for‐Care Allowances at the Crossroads of Gender, Socio‐economic Status and Care Needs in Vienna

“…In addition, the four different analytical dimensions used in the article reflect socio‐economic and gender differences among frail older people regarding barriers in asking for care (system literacy), engagement both in accessing and using care, and ambivalence in choosing between formal and informal care. First, being familiar with existing support structures and care benefits was found to be strongly associated with higher SES, confirming previous studies which show that availability of economic, social and cultural resources correlates with inequalities in the use of formal and informal care (Albertini and Pavolini ; Schmidt ). At the same time, financial barriers were explicitly mentioned only by one case in the sample.…”

“…While a number of authors have focused on analyzing cash‐for‐care schemes from the perspective of informal caregivers (Arksey and Glendinning ; Schmid et al ; Ungerson , ), little is known about the reasoning underlying the ways in which different types of care are accessed and combined in a cash‐for‐care scheme from the perspective of older care recipients themselves (Klie and Blinkert ; Lundsgaard ; Theobald and Kern ). Also, with some exceptions, gender differences in the experience of growing old have been hardly explored in previous works (Calasanti ), and being female (or male) is used as an individual attribute when analyzing determinants of LTC use rather than as a category to analyze inequalities (Einiö et al ; Schmidt ; Dorin et al ). Addressing this gap, we focus on the oldest old (80+), an age group where LTC needs are particularly widespread (BMASK ), and these are going to increase in the future with the rise in chronic diseases and multimorbidity (European Commission ).…”

“…Also, women tend to have less access to (co‐residential) care from a spouse in old‐age, which makes it more difficult for them to preserve their self‐identity towards persons outside the household (Arber and Ginn ; Arber et al ). In addition, single older people in lower income groups, the large majority of which are women, have been shown to be less likely to use formal home care services under a cash‐for‐care scheme (Schmidt ).…”

“… Notes: Table adapted from Schmidt (). Assisted living facilities are not considered in the table as they were undergoing some reforms at the time the data were collected (2011).…”

Informal, Formal, or Both? Assessing the Drivers of Home Care Utilization in Austria Using a Simultaneous Decision Framework

“…The system is characterized by both central and non-central decision making and capacity planning (see Riedel et al, 2016, among others, for details). While Pflegegeld is based on a national law and funded by the national government, LTC services-including decision making, capacity planning and funding-are are organized by the in-1 Multivariate analyses on Austria are limited to the role of the socioeconomic status on LTC utilization in the capital Vienna (Schmidt, 2017). This metropolitan area, however, is characterized by sociodemographic and socioeconomic conditions that are very different from the rest of the country.…”